Text Message Reminders Boost Teen Vaccination : They generally reach the intended person, whereas a phone call might be answered by someone else.

Major Finding: Adolescents whose parents were sent personalized text messages reminding them that their children needed vaccines were 2.5 times more likely to receive the MCV4 vaccine, the Tdap vaccine, or both.

Data Source: A randomized trial among 361 low-income urban adolescents and their parents.

Disclosures: Dr. Stockwell reported that she had no conflicts, but that one of the study's investigators is on an advisory board for, and has received research funding from, Merck.

VANCOUVER, B.C. — Text messages reminding parents that their adolescents need vaccines are an effective and efficient means of improving immunization rates in this population, according to findings of a randomized trial conducted in New York City.

Adolescents whose parents were sent automated, personalized text message reminders that included walk-in times for vaccination were 2.5 times more likely to receive the meningococcal conjugate (MCV4) vaccine, the tetanus-diphtheria-pertussis (Tdap) vaccine, or both.

They were also more likely to receive other vaccines for which they were not up to date.

The observed gains in immunization rates are greater than are those seen previously with reminder and recall strategies, lead investigator Dr. Melissa S. Stockwell said.

In fact, this strategy works so well that busy clinics with many competing priorities will need to be prepared to meet the increased demand for vaccines.

“The actual texting is instantaneous and fast, but you have the repercussions of bringing all those kids in,” she explained. One option is to stagger the messages to control the numbers of adolescents who might show up at one time.

The trial was conducted in six networked primary care practices in New York City among parents who had a child aged 11–18 years needing the MCV4 vaccine, the Tdap vaccine, or both, and had a cell phone number in the system. The practices were randomized to a control (usual-care) group or an intervention (Text4Health) group.

In intervention practices, parents were sent text message reminders that were automatically generated using data from a linked immunization registry. The reminders were sent up to five times over a 7-week period until the adolescent had received the two target vaccines.

“Based on our focus group [of parents], they really wanted the messages to be personal,” commented Dr. Stockwell, a pediatrician at Columbia University in New York. So the messages included their child's name, their clinic's name, and walk-in times for vaccination, plus offered the option of switching between English and Spanish.

Study results reported in a poster were based on 195 adolescents in the intervention group and 166 in the control group. The adolescents were 16 years old on average, 55% were Hispanic, and 80% had public health insurance.

In the intervention group, 821 text messages were sent, only 7 of which bounced. Merely 6% of parents in this group were found to have wrong numbers, and just 3% opted out of receiving the messages.

At 24 weeks, adolescents in the intervention group had a higher rate of receipt of the MCV4 vaccine, Tdap vaccine, or both, compared with their peers in the control group (35% vs. 17%)—for a difference between groups of 18% (P less than .001). After adjustment for potential confounders, the intervention was associated with a 2.5-fold higher odds of receiving these vaccines.

Adolescents in the intervention group also had a higher rate of receipt of any other needed vaccines, such as the human papillomavirus vaccine and the hepatitis A vaccine (42% vs. 29.5%), with a difference between groups of 12.5% (P less than .05).

The estimated cost of the intervention, assuming that it were sustained for 2 years in a hypothetical cohort of 100,000 adolescents, was $1.71 per adolescent immunized and $0.42 per additional vaccine delivered.

There are several possible reasons why a text message might work when a reminder phone call does not, according to Dr. Stockwell.

“One, it always reaches the right recipient, the intended person,” she said, whereas a phone call might be answered by someone else or go to voicemail that is picked up by someone else. “Also, it stays on the phone, so it might sort of be a constant reminder, or the information—especially the walk-in times—is right there so they can send their child at that time.”

Finally, focus groups suggest that parents in their study population perceive information sent by text messages to be more important than that conveyed by more commonplace phone calls, although she said that might change as the novelty of texting wears off.

Major Finding: Adolescents whose parents were sent personalized text messages reminding them that their children needed vaccines were 2.5 times more likely to receive the MCV4 vaccine, the Tdap vaccine, or both.

Data Source: A randomized trial among 361 low-income urban adolescents and their parents.

Disclosures: Dr. Stockwell reported that she had no conflicts, but that one of the study's investigators is on an advisory board for, and has received research funding from, Merck.

VANCOUVER, B.C. — Text messages reminding parents that their adolescents need vaccines are an effective and efficient means of improving immunization rates in this population, according to findings of a randomized trial conducted in New York City.

Adolescents whose parents were sent automated, personalized text message reminders that included walk-in times for vaccination were 2.5 times more likely to receive the meningococcal conjugate (MCV4) vaccine, the tetanus-diphtheria-pertussis (Tdap) vaccine, or both.

They were also more likely to receive other vaccines for which they were not up to date.

The observed gains in immunization rates are greater than are those seen previously with reminder and recall strategies, lead investigator Dr. Melissa S. Stockwell said.

In fact, this strategy works so well that busy clinics with many competing priorities will need to be prepared to meet the increased demand for vaccines.

“The actual texting is instantaneous and fast, but you have the repercussions of bringing all those kids in,” she explained. One option is to stagger the messages to control the numbers of adolescents who might show up at one time.

The trial was conducted in six networked primary care practices in New York City among parents who had a child aged 11–18 years needing the MCV4 vaccine, the Tdap vaccine, or both, and had a cell phone number in the system. The practices were randomized to a control (usual-care) group or an intervention (Text4Health) group.

In intervention practices, parents were sent text message reminders that were automatically generated using data from a linked immunization registry. The reminders were sent up to five times over a 7-week period until the adolescent had received the two target vaccines.

“Based on our focus group [of parents], they really wanted the messages to be personal,” commented Dr. Stockwell, a pediatrician at Columbia University in New York. So the messages included their child's name, their clinic's name, and walk-in times for vaccination, plus offered the option of switching between English and Spanish.

Study results reported in a poster were based on 195 adolescents in the intervention group and 166 in the control group. The adolescents were 16 years old on average, 55% were Hispanic, and 80% had public health insurance.

In the intervention group, 821 text messages were sent, only 7 of which bounced. Merely 6% of parents in this group were found to have wrong numbers, and just 3% opted out of receiving the messages.

At 24 weeks, adolescents in the intervention group had a higher rate of receipt of the MCV4 vaccine, Tdap vaccine, or both, compared with their peers in the control group (35% vs. 17%)—for a difference between groups of 18% (P less than .001). After adjustment for potential confounders, the intervention was associated with a 2.5-fold higher odds of receiving these vaccines.

Adolescents in the intervention group also had a higher rate of receipt of any other needed vaccines, such as the human papillomavirus vaccine and the hepatitis A vaccine (42% vs. 29.5%), with a difference between groups of 12.5% (P less than .05).

The estimated cost of the intervention, assuming that it were sustained for 2 years in a hypothetical cohort of 100,000 adolescents, was $1.71 per adolescent immunized and $0.42 per additional vaccine delivered.

There are several possible reasons why a text message might work when a reminder phone call does not, according to Dr. Stockwell.

“One, it always reaches the right recipient, the intended person,” she said, whereas a phone call might be answered by someone else or go to voicemail that is picked up by someone else. “Also, it stays on the phone, so it might sort of be a constant reminder, or the information—especially the walk-in times—is right there so they can send their child at that time.”

Finally, focus groups suggest that parents in their study population perceive information sent by text messages to be more important than that conveyed by more commonplace phone calls, although she said that might change as the novelty of texting wears off.

Major Finding: Adolescents whose parents were sent personalized text messages reminding them that their children needed vaccines were 2.5 times more likely to receive the MCV4 vaccine, the Tdap vaccine, or both.

Data Source: A randomized trial among 361 low-income urban adolescents and their parents.

Disclosures: Dr. Stockwell reported that she had no conflicts, but that one of the study's investigators is on an advisory board for, and has received research funding from, Merck.

VANCOUVER, B.C. — Text messages reminding parents that their adolescents need vaccines are an effective and efficient means of improving immunization rates in this population, according to findings of a randomized trial conducted in New York City.

Adolescents whose parents were sent automated, personalized text message reminders that included walk-in times for vaccination were 2.5 times more likely to receive the meningococcal conjugate (MCV4) vaccine, the tetanus-diphtheria-pertussis (Tdap) vaccine, or both.

They were also more likely to receive other vaccines for which they were not up to date.

The observed gains in immunization rates are greater than are those seen previously with reminder and recall strategies, lead investigator Dr. Melissa S. Stockwell said.

In fact, this strategy works so well that busy clinics with many competing priorities will need to be prepared to meet the increased demand for vaccines.

“The actual texting is instantaneous and fast, but you have the repercussions of bringing all those kids in,” she explained. One option is to stagger the messages to control the numbers of adolescents who might show up at one time.

The trial was conducted in six networked primary care practices in New York City among parents who had a child aged 11–18 years needing the MCV4 vaccine, the Tdap vaccine, or both, and had a cell phone number in the system. The practices were randomized to a control (usual-care) group or an intervention (Text4Health) group.

In intervention practices, parents were sent text message reminders that were automatically generated using data from a linked immunization registry. The reminders were sent up to five times over a 7-week period until the adolescent had received the two target vaccines.

“Based on our focus group [of parents], they really wanted the messages to be personal,” commented Dr. Stockwell, a pediatrician at Columbia University in New York. So the messages included their child's name, their clinic's name, and walk-in times for vaccination, plus offered the option of switching between English and Spanish.

Study results reported in a poster were based on 195 adolescents in the intervention group and 166 in the control group. The adolescents were 16 years old on average, 55% were Hispanic, and 80% had public health insurance.

In the intervention group, 821 text messages were sent, only 7 of which bounced. Merely 6% of parents in this group were found to have wrong numbers, and just 3% opted out of receiving the messages.

At 24 weeks, adolescents in the intervention group had a higher rate of receipt of the MCV4 vaccine, Tdap vaccine, or both, compared with their peers in the control group (35% vs. 17%)—for a difference between groups of 18% (P less than .001). After adjustment for potential confounders, the intervention was associated with a 2.5-fold higher odds of receiving these vaccines.

Adolescents in the intervention group also had a higher rate of receipt of any other needed vaccines, such as the human papillomavirus vaccine and the hepatitis A vaccine (42% vs. 29.5%), with a difference between groups of 12.5% (P less than .05).

The estimated cost of the intervention, assuming that it were sustained for 2 years in a hypothetical cohort of 100,000 adolescents, was $1.71 per adolescent immunized and $0.42 per additional vaccine delivered.

There are several possible reasons why a text message might work when a reminder phone call does not, according to Dr. Stockwell.

“One, it always reaches the right recipient, the intended person,” she said, whereas a phone call might be answered by someone else or go to voicemail that is picked up by someone else. “Also, it stays on the phone, so it might sort of be a constant reminder, or the information—especially the walk-in times—is right there so they can send their child at that time.”

Finally, focus groups suggest that parents in their study population perceive information sent by text messages to be more important than that conveyed by more commonplace phone calls, although she said that might change as the novelty of texting wears off.