Personalized Texts Can Boost Receipt of Second Influenza Shot for Young Children

Vaccinating young children against influenza is a public health priority in the United States. Young children, particularly those under the age of 2, are at higher risk of experiencing serious complications if not vaccinated and could transmit the infection to other high-risk populations.^1,2  The Advisory Committee on Immunization Practices currently recommends that children get 2 doses of the vaccine 4 weeks apart if they are aged 6 months to 8 years of age and are receiving the influenza vaccine for the first time or only received 1 dose previously.³  Receiving 2 doses of the influenza vaccine may provide nearly 50% greater odds of reducing the likelihood of infection than if only 1 dose is received;⁴  however, many young children do not receive the recommended second dose,^5,6  leaving them and the greater public at increased risk of infection.

Finding ways to effectively communicate these recommendations to caregivers of young children is necessary to improve adherence. Reaching caregivers through in-person patient–provider communication or mass media campaigns has potential, but these communication methods require that caregivers be present, available, and willing to receive the message when it is delivered. Instead, sending personalized educational text messages about second-dose vaccination directly to caregivers’ cell phones may better ensure that the message is received, and then, if the recipient does not delete the message, allows for them to come back to the information later at their time and convenience.

In this issue of Pediatrics, Stockwell et al⁷  present results from the Flu2Text randomized control trial that included a diverse sample of patients from pediatric practices across the United States, with a mix of census regions, urbanicity, and patient demographics (eg, race/ethnicity, insurance provider status) represented. Over 2 influenza seasons (2017 to 2018 and 2018 to 2019), caregivers of young children from 1 of 50 pediatrics primary care practices enrolled in the study were randomly assigned to either receive 5 text messages about second-dose vaccination for their young children (ie, intervention group) or were not sent any text messages (ie, usual care/control group). The authors found that the young children whose caregivers received the text messages were significantly more likely to receive a second dose of the influenza vaccine for both seasons and at both time points measured, after the last text message was sent (day 42 after the first dose) and by the influenza season end.

The successful results from this study should, however, not be misinterpreted to indicate that all it takes are a few simple text message reminders to get caregivers to bring their children back in for a second dose of the influenza vaccine. The text messages sent in this study were personalized to the individual recipient, allowed for interactivity, and included educational information about vaccination. Messages included personal information such as the child’s name, sex, and practice location. They were delivered in either English or Spanish based on the caregiver’s preferred language. One message also allowed recipients to request additional information about influenza vaccination.

Although the authors did not test the effectiveness of sending simple text message reminders versus personalized educational text messages, some research suggests that messages using personalization can improve receipt of health information if the messages are perceived as personalized.^8,9  Pediatricians and health practitioners who wish to implement similar practices with their own patients must, therefore, ensure they have the resources and information to personalize messages and are available to respond to any patients who reach out for additional information.

It is also important to note that caregivers in the current study were motivated caregivers who already brought their young children in to receive the first dose of the influenza vaccine and were not vaccine-hesitant, indicating that significant effects of sending personalized educational text messages may only be observed among patients who already indicate interest and willingness to engage with flu vaccination for their young children. Other potential limitations of this approach may be related to social determinants of health, such as caregivers having access to a cell phone to receive text messages and access to transportation and time off from work to get their children vaccinated. Nevertheless, the results from this nationwide study provide a promising intervention for improving influenza vaccination among young children using a low-cost, accessible tool such as personalized text messages, something many pediatric practices can employ.