A text messaging-based intervention increasesinfluenza vaccination compared with usual care in a low-income, urban population, although overall rates of vaccination remain low, study data indicate. In a low-income, urban population, weekly text message reminders resulted in a vaccination rate of 43.6% compared with 39.9% in families who received usual care with just the single phone call reminder, Melissa S. Stockwell, MD, MPH, of Columbia University School of Public Health in New York City, and colleagues reported in the April 25 issue of the Journal of the American Medical Association.
Although the difference was statistically significant, by the end of influenza season it was small at a relative 9% and an absolute 3.7%, according to the researchers. They conducted a randomized-controlled trial involving 9,213 children and adolescents aged 6 months to 18 years during the 2010 to 2011 influenza season. The primary analysis included 7,574 participants who had not received influenza vaccine prior to study initiation. Parents of children assigned to the intervention received up to five weekly text messages providing educational information and vaccination clinic information in addition to usual-care automated telephone reminders. Study participants were mainly minorities, with 58% from Spanish-speaking families, and 88% were publicly insured.
At the end of the study period, significantly more participants in the intervention versus usual-care group had received an influenza vaccine (43.6% vs. 39.9%; relative rate ratio [RRR], 1.09; P= 0.001). At an earlier review date, prior to influenza activity, significantly more participants in the intervention group compared with the usual-care group had received the influenza vaccine (27.1% vs. 22.8%; RRR, 1.19; P< 0.001). The researchers acknowledged that the low-income, urban study population likely faced competing priorities and barriers to vaccination that were not addressed by the texting intervention that contributed to keeping rates low.
In an accompanying editorial, Peter G. Szilagyi, MD, MPH, of the University of Rochester, in Rochester, N.Y., and William G. Adams, MD, of Boston University, said that although the findings were modest, the study still represents an important step forward in delivering preventive health-care services. “At a population level, an increase of even four percentage points is important,” they wrote. “If applied across the U.S., it could represent an additional 2.5 million children and adolescents who receive influenza vaccination.” Szilagyi and Adams pointed out a number of advantages to text message reminders, such as providing a more stable platform for reaching individuals compared with home addresses and telephone numbers, which might change, as well as providing the ability to reach the recipient directly.
They called for additional studies to determine the optimal text message strategies to achieve public health goals, as well as efforts to make information more actionable. “Future studies might examine the incremental benefit of including a telephone number that could be called immediately to schedule an appointment or perhaps one that could scan an online calendar to propose a few available times for vaccination,” Szilagyi and Adams suggested.