Two-way text reminders boost adolescent vaccine use

From Pediatric News:

Sending parents text messages that request a response increased the likelihood that their adolescent children would receive all their needed vaccinations and other well-child services, according to a recent study.

Receipt of all services was highest among children whose parents texted back requesting that the pediatric office call them to set up an appointment.

“Providers in diverse settings should consider text messaging as a viable method of reminder/recall in their adolescent patient populations, and the use of bidirectionality as a prompt for an intended action deserves further study,” Dr. Sean T. O’Leary, of the University of Colorado at Denver, Aurora, and his associates wrote. “Text messaging, because of its potential for automation and scalability, may represent the future of reminder/ recall.”

The randomized controlled trial ran from September 2012 to August 2013 and included 4,587 adolescents, aged 11 to 17, whose parents had a cell phone number and who were patients at one of five private or two safety-net pediatric practices in the greater Denver area.

All participating patients were due for either a well-child care visit and/or one of the recommended adolescent vaccines (tetanus-diphtheria-acellular pertussis, meningococcal conjugate 4, or human papillomavirus).

The parents of the 2,228 adolescents randomized to the intervention received up to three personalized text messages asking for a response. Parents had three response options: clinic will call to schedule; parents will call clinic; or STOP, which would opt them out of the text service.

Parents who responded to the original message did not receive further texts. The other 2,359 adolescents formed the control group and received usual care with no reminders during the study (Pediatrics. 2015 Oct 5, doi: 10.1542/peds.2015-1089.).

According to mobile phone carrier data, 84% of the parents received the text reminder that was sent to them. Among all parents who were sent a message, 30% responded by text. Nearly two-thirds of responses occurred after the first text attempt.

More than 40% of parents requested a call from the clinic, 28% said they would call the clinic later, and 22% texted STOP to opt out of the text service. Another 9% responded in some other way, such as asking a question, according to the researchers.

Adolescents whose parents received the text messages were 31% more likely than those in the control group to receive all their needed services, including well-child care and all recommended vaccinations (risk ratio: 1.31). Patients in the intervention group were 29% more likely to receive all needed vaccinations (RR: 1.29) and 36% more likely to receive any vaccination (RR: 1.36).

Adolescents were 89% more likely to receive all needed services if their parents responded with option 1, indicating that the clinic should call them to schedule a visit (RR: 1.89).

For individual vaccines, no difference existed between groups for the MCV booster. However, intervention group patients were significantly more likely than controls to get any of the needed HPV doses (16% vs. 12%, P less than .0001). The effect of the text intervention on first HPV dose was significant, but modest (11% intervention vs. 9% control, P = .04).

Rates of well-child care visits did not significantly differ between the two groups, but 69% of adolescents in the text intervention group missed an opportunity for vaccination, compared with 75% of the control group adolescents (P = .002).

The cost of the text reminder program ranged from $855 to $3,394 per practice.

“It is not clear if the bidirectional nature of our intervention offered much advantage over a unidirectional text message. Parents who responded with an intention, though, were more likely to have their child vaccinated compared with those who did not respond,” the authors wrote. “Psychology research has shown that simply prompting people to develop a plan for a desired action can increase the likelihood of success.”

The research was funded by the National Center for Immunization and Respiratory Diseases and the Centers for Disease Control and Prevention. The authors reported having no financial disclosures.

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