Innovative Text Message Intervention Improves Flu Vaccine Uptake in Pediatric Population

Jane Tuckerman, PhD

According to data published today, SMS “nudges” for parents reminding them the importance of influenza vaccination for their children with special risk medical conditions (SRMCs) was an effective approach for optimizing vaccine receipt. While many clinicians offer reminders when in a clinical setting, the uptake of flu vaccination has been suboptimal in this population.¹

The results of the trial showed that the parent SMS reminder nudge intervention increased vaccination uptake, with influenza vaccination rates of 38.6% in the SMS intervention group compared with 26.2% in the control group. The adjusted odds ratio for vaccination in the SMS group was 1.79, indicating a significant increase in vaccination uptake.

Additionally, time to vaccination was significantly lower among SMS participants, with an adjusted hazard ratio of 1.67. For participants randomly assigned by June 15, a significantly greater proportion receiving the SMS intervention were vaccinated during the optimal delivery period  of April-June.

SMS Reminders Effectively Increase Uptake in Flu Vaccination

The findings of the trial conducted by Jane Tuckerman, PhD, Adelaide Medical School, The University of Adelaide, and a team of investigations, provided key implications for efficiently increasing the amount of children and adolescents who receive the influenza vaccine, which is crucial for those with chronic medical conditions that put them at greater risk.

Not only is this an optimal approach, but the parent SMS reminder nudge intervention is a simple and low-cost strategy that could be easily implemented in healthcare settings to improve vaccination rates in this population. Investigators stated that a possible explanation for the effectiveness of the intervention is that it increases the salience of the vaccination recommendation and makes it more prominent in the minds of parents.

The SMS reminder may also provide a convenient and timely prompt for parents to schedule and attend the vaccination appointment. The study did not assess the acceptability or satisfaction of the intervention, which could be an area for future research.

Protecting Pediatric Patients from Adverse Flu Outcomes

The trial enrolled 600 patients under the age of 18 years with the youngest patients being at least 6 months. All participating patients had been diagnosed with a special risk medical condition and had a subspecialist outpatient appointment over a 5-month period during the Australian seasonal influenza vaccination season (April-August 2021).

Patients were randomly assigned to either the control group or the SMS intervention group, which consisted of clinician nudges and an additional SMS reminder nudge to parents. Investigators stated the primary outcome was influenza vaccination, as confirmed by the Australian Immunisation Register.

There were several limitations, including the single-site design and the use of administrative data to confirm vaccination status, investigators stated. The trial was also conducted during the COVID-19 pandemic, which may have influenced vaccination behavior and access to healthcare.

The team concluded that results highlighted the potential benefits of parent-clinician nudges for improving vaccination rates among children and adolescents with special risk medical conditions, as well as the importance of implementing low-cost and scalable strategies to optimize vaccine uptake. Future research could explore the generalizability of the findings to other healthcare settings and populations and identify the mechanisms underlying the effectiveness of the intervention.

References:

1. Tuckerman J, Harper K, Sullivan TR, et al. Short Message Service Reminder Nudge for Parents and Influenza Vaccination Uptake in Children and Adolescents With Special Risk Medical Conditions: The Flutext-4U Randomized Clinical Trial. JAMA Pediatr. Published online February 20, 2023. doi:10.1001/jamapediatrics.2022.6145