Short Message Service Reminder Nudge for Parents and Influenza Vaccination Uptake in Children and Adolescents With Special Risk Medical Conditions

Author:

Tuckerman Jane123,Harper Kelly45,Sullivan Thomas R.67,Cuthbert Alana R.6,Fereday Jennifer4,Couper Jennifer145,Smith Nicholas14,Tai Andrew145,Kelly Andrew14,Couper Richard4,Friswell Mark4,Flood Louise8,Blyth Christopher C.9101112,Danchin Margie2313,Marshall Helen S.145

Affiliation:

1. Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia

2. Vaccine Uptake Group, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Victoria, Australia

3. Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia

4. Women's and Children’s Health Network, North Adelaide, South Australia, Australia

5. Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia

6. SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia

7. School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia

8. Communicable Disease Control Branch, South Australian Department of Health and Wellbeing, Adelaide, South Australia, Australia

9. Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University Western Australia, Perth, Western Australia, Australia

10. Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia

11. School of Medicine, University of Western Australia, Perth, Western Australia, Australia

12. Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia

13. Department of General Medicine, The Royal Children’s Hospital, Melbourne, Victoria, Australia

Abstract

ImportanceChildren with chronic medical conditions are at increased risk of severe influenza. Uptake of influenza vaccination in children and adolescents with these identified special risk medical conditions (SRMCs) is suboptimal.ObjectiveTo assess the effectiveness of Flutext-4U, a parent short message service (SMS) reminder nudge intervention, in increasing influenza immunization in children and adolescents with SRMCs.Design, Setting, and ParticipantsThis randomized clinical trial was conducted at a tertiary pediatric hospital in Adelaide, South Australia, from April 15 to September 30, 2021. Children and adolescents aged 6 months to younger than 18 years with SRMCs and a subspecialist outpatient appointment over a 5-month period during the Australian seasonal influenza vaccination season (April-August 2021) were eligible to participate. Follow-up was until September 30, 2021.InterventionsParticipants were randomly assigned (1:1 ratio) to control: clinician nudges (hospital vaccine availability, ease of access, and recommendation from hospital subspecialists) or SMS intervention (control conditions plus an additional SMS reminder nudge to parents), with randomization stratified by age group (<5 years, 5-14 years, or >14 to <18 years).Main Outcomes and MeasuresThe primary outcome was influenza vaccination, as confirmed by the Australian Immunisation Register.ResultsA total of 600 participants (intervention group: 298 [49.7%]; mean [SD] age, 11.5 [4.6] years; 162 female participants [54.4%]; control group: 302 [50.3%]; mean [SD] age, 11.4 [4.7] years; 155 female participants [51.3%]) were included. Influenza vaccination was 38.6% (113 of 293) in the SMS intervention group compared with 26.2% (79 of 302) in the control group (adjusted odds ratio [aOR], 1.79; 95% CI, 1.27-2.55; P = .001). Time to vaccine receipt was significantly lower among SMS participants (adjusted hazard ratio, 1.67; 95% CI, 1.25-2.22; P < .001). For participants randomly assigned by June 15, a significantly greater proportion receiving the SMS intervention were vaccinated during the optimal delivery period April to June 30 (SMS group: 40.0% [76 of 190] vs 25.4% [50 of 197]; aOR, 1.97; 95% CI, 1.28-3.06; P = .002).Conclusions and RelevanceResults of this randomized clinical trial suggest that an additional SMS reminder nudge for parents delivered in the tertiary care hospital setting to children and adolescents with SMRCs resulted in higher influenza vaccine uptake compared with clinician nudges alone.Trial RegistrationANZCTR Identifier: ACTRN12621000463875

Publisher

American Medical Association (AMA)

Subject

Pediatrics, Perinatology and Child Health

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