In the JournalsPerspective

Text messages increase flu shot rates

Text messages were a low-cost and modestly effective way of increasing seasonal influenza vaccine rates, according to findings recently published in Annals of Family Medicine.

“Historically, we know vaccination rates are low in some groups of patients who are at high-risk for severe influenza infection, including pregnant women and young children,”Annette K. Regan, PhD, MPH, of the School of Public Health at Curtin University in Perth, Australia, told Healio Family Medicine. “We wanted to see whether a relatively low-resource intervention could be used by primary care physicians to improve uptake of influenza vaccines among patients who stand to benefit the most through annual influenza vaccination.”

Researchers identified 12,354 participants in several high-risk population groups in Australia who had not received the influenza vaccine. Six weeks after influenza vaccination season began, half of those participants were randomly assigned to receive one text message reminding them to get the vaccine. RRs for vaccination about 3 months after the text reminder was sent were determined using log-binomial regression models.

Regan and colleagues found that 12% of those who received the reminder were vaccinated within the approximate 3-month window vs. 9% of those who did not get the text (RR = 1.39; 95% CI, 1.26-1.54). It took 29 text messages costing 12 cents each to ensure one additional high-risk person was immunized.

In addition, children whose parents received the reminder were 2.4 times more likely to receive at least one dose of seasonal influenza vaccine vs. children whose parents did not get the text. These reminders also led to increased uptake among patients with a history of influenza vaccination, and among patients at high risk because of age: younger than 5 years and older than 65 years without a pre-existing medical condition.

The text message’s content, its timing, and the reliability of its originator may also play a role in how well the reminder encourages influenza vaccine rates, according to researchers.

“These results are important, since we know influenza can be a very serious disease in certain patient groups, and unfortunately vaccination rates are poor in some of these groups,” Regan said, adding that the study is the most comprehensive randomized controlled trial of text message reminders regarding influenza vaccination to date. – by Janel Miller

Disclosures: The authors report no relevant financial disclosures.

Text messages were a low-cost and modestly effective way of increasing seasonal influenza vaccine rates, according to findings recently published in Annals of Family Medicine.

“Historically, we know vaccination rates are low in some groups of patients who are at high-risk for severe influenza infection, including pregnant women and young children,”Annette K. Regan, PhD, MPH, of the School of Public Health at Curtin University in Perth, Australia, told Healio Family Medicine. “We wanted to see whether a relatively low-resource intervention could be used by primary care physicians to improve uptake of influenza vaccines among patients who stand to benefit the most through annual influenza vaccination.”

Researchers identified 12,354 participants in several high-risk population groups in Australia who had not received the influenza vaccine. Six weeks after influenza vaccination season began, half of those participants were randomly assigned to receive one text message reminding them to get the vaccine. RRs for vaccination about 3 months after the text reminder was sent were determined using log-binomial regression models.

Regan and colleagues found that 12% of those who received the reminder were vaccinated within the approximate 3-month window vs. 9% of those who did not get the text (RR = 1.39; 95% CI, 1.26-1.54). It took 29 text messages costing 12 cents each to ensure one additional high-risk person was immunized.

In addition, children whose parents received the reminder were 2.4 times more likely to receive at least one dose of seasonal influenza vaccine vs. children whose parents did not get the text. These reminders also led to increased uptake among patients with a history of influenza vaccination, and among patients at high risk because of age: younger than 5 years and older than 65 years without a pre-existing medical condition.

The text message’s content, its timing, and the reliability of its originator may also play a role in how well the reminder encourages influenza vaccine rates, according to researchers.

“These results are important, since we know influenza can be a very serious disease in certain patient groups, and unfortunately vaccination rates are poor in some of these groups,” Regan said, adding that the study is the most comprehensive randomized controlled trial of text message reminders regarding influenza vaccination to date. – by Janel Miller

Disclosures: The authors report no relevant financial disclosures.

    Perspective
    Jeffrey Duchin

    Jeffrey Duchin

    Standards for adult and child immunization practices and professional organizations recommend reminder and recall processes, such as text messages, sending letters, phone call reminders, and emails as an important method to increase immunization rates. 

    Use of text messaging for patient reminder or recall to increase influenza vaccination rates has been effective in certain patient populations and practice settings, although previous research has yielded mixed results. In this well-designed randomized controlled study by Regan et al, intervention group patients received just one brief text message stating that they or their child were due for a dose of seasonal influenza vaccine and instructed them to schedule an appointment for vaccination. The researchers found a modest increase in vaccination rates among the intervention group (12% vaccinated) compared with the control a group that received no recall intervention of any type (9% vaccinated); the effect was greatest in children younger than 5 years.

    Several things could have been done differently that might have improved the results, such as sending more than one message, providing low-barrier access to vaccine that did not require making an appointment, and providing health literacy information about the importance of immunization in the text message.

    Text messages are emerging as an important option in the recommended multi-faceted strategy to increase adult and child vaccination coverage, but are not magic bullets. There is still a lot we need to learn about how to use text messaging most effectively, such as better understanding how to identify receptive target audiences, and the optimal frequency and content of messages. Additional research on the use of text messaging to increase influenza vaccination rates, especially among high-risk patients, is needed.

    • Jeffrey Duchin, MD
    • Health Officer and Chief, Communicable Disease Epidemiology and Immunization Public Health, Seattle and King County
      Professor of medicine, Division of Infectious Diseases, School of Public Health
      University of Washington
      Spokesman for the Infectious Diseases Society of America

    Disclosures: Duchin reports no relevant financial disclosures.