American researchers increase flu vaccination rates by combining educational messages with vaccine reminders in text messages.

Influenza Vaccination Rates on the Rise in the U.S., but the Numbers Don’t Tell the Whole Story

Within the U.S., influenza vaccination coverage was up across all age groups for the 2012-2013 flu season according to the Centers for Disease Control. For children aged 6 months to 17 years, flu vaccine coverage increased 5.1 percentage points compared to the 2011-2012 flu season. Among these children, coverage with one or more doses of the flu vaccine was 56.6%. However, according to the American Academy of Pediatrics, any child under the age of 9 who has not already had two flu vaccines within the same flu season requires two half-doses. So, although the 5.1 percentage point increase is positive, it is hard to determine how many of those children were fully protected.

Study Indicates that Parents Appreciate Text Reminders of Vaccination Schedules

A study published in the most recent issue of Pediatrics, the journal of the American Academy of Pediatrics, indicates that text messages can serve as effective vaccination reminders for parents.

Researchers from Columbia University Medical Center and New York-Presbyterian Hospital, both within the city of New York, conducted a trial involving 660 Latino children between the ages of 6 months and 8 years who required two doses of the flu vaccine. At enrollment in the study, all parents received a written reminder about the required second dose.

The children were divided into three groups:

  1. Those who received the usual information sheet describing the timing of the second dose
  2. Those who received text messages indicating the date the second vaccine was due along with locations and hours of vaccination clinics
  3. Those who recieved an expanded text message, with the due date, times and locations, and educational information about why a second dose was needed

While the conventional text messages were more effective than the written reminders, the text messages that contained additional educational information were even more successful. Over 72% of parents who received the educational texts came back for the second dose, compared to 66.7% of those who received conventional texts, and 57% of those who received only a written reminder at the time of vaccination.

When the flu season was over in April, the research team surveyed participants about their experience. The majority of parents reported appreciating the reminders, and liked that they were short. Somewhat ironically, respondents both liked that the SMS did not require talking with anyone yet also felt the messages demonstrated that someone cared.

Over 60% of parents reported that the reminder was at least part of the reason they brought their child back for the second vaccine dose, and 70% indicated that they brought their child back sooner because of the message.

Digital Tools for Health Literacy

The Pediatrics study is not the first study to show that SMS reminders effectively increase vaccination rates for children. In 2012, the American Journal of Public Health published a review of two studies, both indicating that text reminders improved immunization coverage for pediatric patients in low-income, urban populations.

With more than 700 million mobile phones that support SMS services in India, the Indian Academy of Pediatrics, a non-profit organization, and Vodafone, a national telecom partner, have joined forces to send immunization reminders via SMS to parents. Organizers of the project, called Immunize India, hopes that the reminders will increase vaccination coverage and reduce child mortality rates throughout the country.

The Columbia study was based on the transtheoretical model of behavior change, which maintains that behavior change is a process with a variety of steps. People move through the stages of behavior change only when they have the knowledge and motivation to do so. By embedding educational information within the SMS reminders, parents moved through the decision-making process.

Health literacy is a complex issue. Healthcare consumers need to know how to access care, they should be able to evaluate the risks and benefits of proposed treatments, and determine the credibility of health information. According to the Affordable Care Act of 2010, Title V, health literacy is “the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services in order to make appropriate health decisions.” Only 12% of American adults are said to have proficient levels of health literacy.   

“Teaching parents about what to expect is one of the most important aspects of a pediatrician’s job,” according to Dr. Deb Lonzer, chair of the department of Community Pediatrics at Cleveland Clinic. “Babies aren’t driving themselves to the doctor or giving consent for vaccines. Parent education is both critical and life saving.”

Conventional text message reminders work for families that might otherwise forget to return for the second vaccine dose, but this presupposes that the families have the health literacy (i.e., knowledge, attitudes, and motivation) to act on them. Delivering educational messages through a preferred means of communication is a scalable way to increase both vaccination coverage and health literacy.

Jenn Lonzer has a B.A. in English from Cleveland State University and an M.A. in Health Communication from Johns Hopkins University. Passionate about access to care and social justice issues, Jenn writes on global digital health developments, research, and trends. Follow Jenn on Twitter @jnnprater3.