According to a study in the April 25 issue of JAMA, the coverage for children to get vaccinated against influenza increased amongst low-income, hard-to-reach, minority children and adolescents if their patients received education-related text message reminders, as compared with the standard care, even though the overall coverage remained low.

The researchers explained:

"Timely vaccination is the cornerstone of influenza prevention through vaccination of susceptible populations before illness becomes epidemic in communities. The effectiveness of the influenza vaccine in children and adolescents ranges from 66 percent to 95 percent, depending on age, vaccine type, and season."

Influenza is one of the most prevalent causes of hospitalization in children and adolescents. Between the ages 6 months to 18 years, children and adolescents are at increased risk for influenza illness and death. According to parental report, during the 2010-2011 influenza season, only 51% of those aged 6 months to 17 years received the influenza vaccination.

The researchers said:

"Coverage is lower in low-Income populations who are at higher risk of influenza spread due to crowded living conditions. Traditional vaccine reminders have had a limited effect on low-Income populations; however, text messaging is a novel, scalable approach to promote influenza vaccination."

In order to assess whether vaccination reminders via text messages for low-income, urban parents increased influenza vaccination among children and adolescents, Melissa S. Stockwell, M.D., M.P.H., of Columbia University, New York, and her team conducted a randomized controlled trial involving 9,213 children and adolescents aged 6 months to 18 years.

All study participants were receiving care at 4 community-based clinics in the U.S., during the 2010-2011 influenza season. The researchers included 7,574 of the 9,213 participants who had not received the influenza vaccine in the primary analysis.

The researchers randomly assigned parents of children to receive either usual care or education-related text messages. Those assigned to the intervention group received up to five weekly text messages regarding influenza vaccine and Saturday clinics. Both groups received the usual care and access to informational flyers posted at the study sites, as well as an automated telephone reminder.

88% of the children and adolescents participating in the study were publicly insured and 58% were from Spanish-speaking families.

As of March 31, 2011, the researchers found that more children and adolescents in the intervention group received the influenza vaccine (43.6%) than those in the usual care group (39.9%).

97.2% of children and adolescents in the usual care group were vaccinated outside of the Saturday clinic vs. 93.9% of those in the intervention group.

The researchers found that 27.1% of the intervention group had received the influenza vaccine before the fall review date, compared with 22.8% of those in the usual care group.

The researchers observed that the impact of the intervention was greater in a subgroup analysis that considered sending text messages. This supports the view that text messaging was effective in encouraging a change in behavior that lead to higher rates of vaccination.

The researchers said:

"Using text messaging (especially when linked with electronic health records [EHRs] or registries) to identify and notify large patient populations in need of vaccination could be an efficient means for improving influenza vaccination rates in adults as well as children and adolescents."

According to the researchers text messaging to increase vaccination coverage has several strengths:

"It can reach large populations, and for vaccines like influenza recommended for the majority of the population, even small increases in vaccination rates can lead to large numbers of protected individuals. It may also be cost-effective. Once the system is set up, the only variable cost is the sending of the text messages, which, even using commercial platforms, usually cost pennies per message. Therefore, depending on the size of the population, even amortizing upfront and monitoring costs, text messaging is inexpensive on a per individual basis."

The conclude:

"Underlying vaccination coverage overall remained low, as they do nationally, and further studies are recommended to identify ways to maximize the potential of text messaging."

In an associated report, Peter G. Szilagyi, M.D., M.P.H., of the University of Rochester School of Medicine and Dentistry, Rochester, New York, and William G. Adams, M.D., of the Boston University School of Medicine, Boston, said:


"Study by Stockwell et al is a modest step forward in an important area of public health.

Modest steps are the norm when complex behaviors and systems are targeted such as receipt of preventive services. Nonetheless, these systems have substantial potential, particularly when the technologies are tailored to individual patients and families, delivered in an actionable way, and driven toward important health behaviors.

There can be little doubt that in the next decade there will be an increasing use of such systems and their application to additional services. As recently as 10 years ago, e-mailing patients was considered novel and text messaging did not exist.

Within the next few years, the novel findings presented in this study will also become a routine component of the complex system of health care delivery.

There can be little doubt that in the next decade there will be an increasing use of such systems and their application to additional services. As recently as 10 years ago, e-mailing patients was considered novel and text messaging did not exist. Within the next few years, the novel findings presented in this study will also become a routine component of the complex system of health care delivery."

Written By Grace Rattue