Educational messages to parents help kids complete flu vaccinations
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* Kim Krisberg

Text message reminders that include educational tips are more effective at bringing families back in for a child’s second dose of flu vaccine than texts that only remind families about the date that the second dose is due, finds a new study.

Given that less than half of young children who need two doses of flu shot complete the immunization regimen, researchers from the Columbia University Mailman School of Public Health and Columbia University Medical Center set out to determine what types of text message reminders increase the likelihood that children will receive the second flu shot on time. To conduct the study, researchers recruited 660 families during the 2012-2013 flu season whose children had already received their first dose of flu shot at one of three community clinics in New York City. According to the Centers for Disease Control and Prevention, some children between ages 6 months and 8 years require two doses of flu vaccine, with one dose providing reduced or no protection against the flu.

Study participants, most of whom were Hispanic and had public insurance coverage, were assigned to one of three groups: those that received only written reminders about the second flu dose due date; those that received a “conventional” text message that included the due date and clinic hours; and those that received an “educational” text message, which also included information about the importance of their children receiving the second dose in a timely fashion. According to the study, which was published in the January issue of *Pediatrics*, nearly 72 percent of study participants initially thought their children were somewhat protected against the flu after just one dose of vaccine.

Melissa Stockwell, MD, MPH, the study’s principal investigator and an assistant professor of pediatrics as well as population and family health at Columbia University Medical Center, said there are two main reasons why families do not return for their child’s second dose of flu shot. The first is that many simply forget, for which conventional text message reminders are typically an effective intervention. The second reason is low health literacy levels and confusion about the need for a second dose. For those families, a text reminder embedded with educational information may be particularly effective, Stockwell said.

“These are families that have already committed to getting one dose,” she told *The Nation’s Health*. “So if we know there are some families who have educational needs, offering them more information may help facilitate their decision to come back.”

Indeed, the study found that educational text messages were an effective intervention. Stockwell and her colleagues found that nearly 73 percent of families who received an educational text message reminder returned to receive a second flu shot, compared to about 67 percent who received the conventional text messages and about 57 percent who received only written reminders. Children in the educational text message group were also more likely to receive the second flu shot dose within two weeks of its due date.

In addition, about two-thirds of study participants said the texting reminders were either the main reason or a factor in their decision to return for the second dose, while more than 70 percent said the reminders encouraged them to return to the clinic sooner than they would have otherwise.

Stockwell noted that reaching a large audience is one of the greatest benefits that text messaging offers health care providers. Linking text reminders with emerging electronic systems, such as electronic medical records, could greatly optimize the technology’s effect on health.

“It’s on a population scale where these types of messages can have the greatest impact,” she said.

For more information, visit [http://pediatrics.aappublications.org/content/135/1/e83.abstract?sid=9ef0e0ee-799a-4149-a30e-c42d30721b52](http://pediatrics.aappublications.org/content/135/1/e83.abstract?sid=9ef0e0ee-799a-4149-a30e-c42d30721b52).

*   Copyright The Nation’s Health, American Public Health Association