Effect of a Text Messaging Intervention on Influenza Vaccination in an Urban, Low-Income Pediatric and Adolescent Population A Randomized Controlled Trial

Department of Pediatrics, Mailman School of Public Health, Columbia University, New York, New York 10032, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 04/2012; 307(16):1702-8. DOI: 10.1001/jama.2012.502
Source: PubMed


Influenza infection results in substantial costs, morbidity, and mortality. Vaccination against influenza is particularly important in children and adolescents who are a significant source of transmission to other high-risk populations, yet pediatric and adolescent vaccine coverage remains low. Traditional vaccine reminders have had a limited effect on low-income populations; however, text messaging is a novel, scalable approach to promote influenza vaccination.
To evaluate targeted text message reminders for low-income, urban parents to promote receipt of influenza vaccination among children and adolescents.
Randomized controlled trial of 9213 children and adolescents aged 6 months to 18 years receiving care at 4 community-based clinics in the United States during the 2010-2011 influenza season. Of the 9213 children and adolescents, 7574 had not received influenza vaccine prior to the intervention start date and were included in the primary analysis.
Parents of children assigned to the intervention received up to 5 weekly immunization registry-linked text messages providing educational information and instructions regarding Saturday clinics. Both the intervention and usual care groups received the usual care, an automated telephone reminder, and access to informational flyers posted at the study sites.
Receipt of an influenza vaccine dose recorded in the immunization registry via an electronic health record by March 31, 2011. Receipt was secondarily assessed at an earlier fall review date prior to typical widespread influenza activity.
Study children and adolescents were primarily minority, 88% were publicly insured, and 58% were from Spanish-speaking families. As of March 31, 2011, a higher proportion of children and adolescents in the intervention group (43.6%; n = 1653) compared with the usual care group (39.9%; n = 1509) had received influenza vaccine (difference, 3.7% [95% CI, 1.5%-5.9%]; relative rate ratio [RRR], 1.09 [95% CI, 1.04-1.15]; P = .001). At the fall review date, 27.1% (n = 1026) of the intervention group compared with 22.8% (n = 864) of the usual care group had received influenza vaccine (difference, 4.3% [95% CI, 2.3%-6.3%]; RRR, 1.19 [95% CI, 1.10-1.28]; P < .001).
Among children and adolescents in a low-income, urban population, a text messaging intervention compared with usual care was associated with an increased rate of influenza vaccination. However, the overall influenza vaccination rate remained low. Identifier: NCT01146912.

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Available from: Elyse Olshen Kharbanda, Apr 28, 2014
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    • "IT-based health interventions also provide necessary information and advice and counseling related to certain diseases and conditions, such as mental disorders113114115116117118119120, asthma[57,76,96,121122123, obesity[30,32,124125126127128129130131132, smoking[40,68,69,88,133134135136, diabetes[11,137138139140141142143144145146147148149150151, sleep disorder[152], hypertension[127,153,154], cancer[34,58,60,74,75,82,92,97,98,155156157, thereby encouraging healthy living[30,31,72,124,158,159]. Moreover, these interventions enable patients to be engaged in self-monitoring, thereby directing patients toward healthy eating, enhancing attendance rate[136,160161162163164165166, improving medication adherence[162,167168169170171172173, increasing knowledge about disease and treatment[33,42,47,75,85,90,94,96,115,119,168,174,175], and enhancing exercise use[32,56,808182122,125,126,128129130131132153,156,176177178179180181182183. Online coaching by specialists enables patients to recover quickly, ensuring that the pain they experience is reduced[89,184], and doctor-patient communications are made readily available[73,157,185186187188189190191. "
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    ABSTRACT: Background: Advancements in information technology (IT) and its increasingly ubiquitous nature expand the ability to engage patients in the health care process and motivate health behavior change. Objective: Our aim was to systematically review the (1) impact of IT platforms used to promote patients' engagement and to effect change in health behaviors and health outcomes, (2) behavior theories or models applied as bases for developing these interventions and their impact on health outcomes, (3) different ways of measuring health outcomes, (4) usability, feasibility, and acceptability of these technologies among patients, and (5) challenges and research directions for implementing IT platforms to meaningfully impact patient engagement and health outcomes. Methods: PubMed, Web of Science, PsycINFO, and Google Scholar were searched for studies published from 2000 to December 2014. Two reviewers assessed the quality of the included papers, and potentially relevant studies were retrieved and assessed for eligibility based on predetermined inclusion criteria. Results: A total of 170 articles met the inclusion criteria and were reviewed in detail. Overall, 88.8% (151/170) of studies showed positive impact on patient behavior and 82.9% (141/170) reported high levels of improvement in patient engagement. Only 47.1% (80/170) referenced specific behavior theories and only 33.5% (57/170) assessed the usability of IT platforms. The majority of studies used indirect ways to measure health outcomes (65.9%, 112/170). Conclusions: In general, the review has shown that IT platforms can enhance patient engagement and improve health outcomes. Few studies addressed usability of these interventions, and the reason for not using specific behavior theories remains unclear. Further research is needed to clarify these important questions. In addition, an assessment of these types of interventions should be conducted based on a common framework using a large variety of measurements; these measurements should include those related to motivation for health behavior change, long-standing adherence, expenditure, satisfaction, and health outcomes.
    Full-text · Article · Jan 2016
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    • "Furthermore, many of these types of interventions only developed content appropriate for very specific time frames. For example, a texting service used to encourage parents to vaccinate their children developed content for the few weeks leading up to when children should be vaccinated (Stockwell et al., 2012) and another service provided new parents texts during the first year of children's lives (Evans et al., 2012; Gazmararian et al., 2013). "

    Full-text · Dataset · Aug 2015
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    • "ment, health education, emergency medical response, and data collection in disease surveillance [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15]. Evidence in favor of its usefulness is accumulating. "
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    ABSTRACT: Introduction: Evidence in favor of mHealth for healthcare delivery in settings where trained health workforce is limited or unavailable is accumulating. With rapid growth in access to mobile phones and an acute shortage of health workforce in Bangladesh, mHealth initiatives are increasing with more than 20 current initiatives in place. "Readiness" is a crucial prerequisite to the successful implementation of telehealth programs. However, systematic assessment of the community readiness for mHealth-based services in the country is lacking. We report on a recent study describing the influence of community readiness for mHealth of a rural Bangladesh community. Methods: A conceptual framework for mHealth readiness was developed, which included three categories: technological, motivational and resource readiness. This guided the questionnaire development for the survey conducted in the Chakaria sub-district of Bangladesh from November 2012 to April 2013. Multivariate logistic regression was used to examine ownership of mobile phones, use of the technology, and knowledge regarding awareness of mHealth services as predictors of the community readiness to adopt mHealth. Results: A total of 4915 randomly selected household members aged 18 years and over completed the survey. The data explained the sub-categories of the readiness dimensions. In terms of access, 45% of respondents owned a mobile phone with ownership higher among males, younger participants and those in the highest socioeconomic quintiles. Results related to technological readiness showed that among mobile phone owners, 50% were aware of SMS but only sending and receiving SMS. Only 37% generally read the received SMS. Only 5% of respondents used the internet capabilities on their phone and 25% used voice messages. The majority (73%) of the participants were interested in joining mHealth programs in the future. Multivariate analysis showed that ownership of a mobile phone (aOR 1.3, 95% CI 1.1-1.5), younger age (aOR 2.6, 95% CI 2.1-3.3), males (aOR 1.8, 95% CI 1.6-2.1), educated respondents (11 years or more education) (aOR 11.1, 95% CI 6.2-19.2) and those belonging to the highest socio-economic group (aOR 3.7, 95% CI 2.9-4.7) were significantly independently associated with knowledge regarding awareness of current mHealth services. Conclusions: We developed a conceptual framework to assess community readiness for mHealth. We described three high level dimensions of readiness and have partially tested the conceptual framework in a rural sub-district in Bangladesh. We found that the community has some technological readiness but inequity was observed for human resource readiness and technological capabilities. The study population is motivated to use mHealth. Our conceptual framework is a promising tool to assist policy-makers in planning and implementing mHealth programs.
    Full-text · Article · Jul 2015 · International Journal of Medical Informatics
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