Reminder text messages can increase influenza vaccination rates

Rosanne Barrett

5/05/2021 3:10:00 PM

A new US study that found alerts prompt people to keep their flu-shot bookings could be a ‘template’ for COVID vaccinations.

Woman in mask reading phone
The research found the notifications were more effective when framed as reminders and consistent with the tone of healthcare considerations.

A major study to ‘nudge’ people into keeping their influenza vaccination appointments found twin text messages can increase inoculation rates more than 10%, in a result doctors believe could also work well in Australia.
The University of Pennsylvania study of more than 47,000 people reveals direct text messaging is a cost-effective way of increasing flu vaccination rates, suggesting it could be a ‘template’ for future vaccination drives, including COVID-19.
The research found the notifications were more effective when framed as reminders and consistent with the tone of healthcare considerations.
RACGP Expert Committee – Practice, Technology and Management (REC–PTM) Chair, Dr Rob Hosking, says many Australian practices have existing reminder and recall systems in place already.
‘The dramatic increase in uptake of SMS reminders would suggest that they work,’ he told newsGP.
‘Anecdotally, it has reduced no-shows for all appointments and it would certainly be the case for vaccinations as well.’
Dr Hosking says with mass vaccination programs, such as the COVID-19 rollout, there would be complications with a widespread messaging scheme, with no formal system to link individuals to specific practices in Australia, consent issues, and costs affecting the clinics.
He anticipates most clinics performing COVID-19 vaccinations use reminders.
‘I would expect most practices would be doing something like this to try and maximise the patients attending their appointments,’ he said. ‘They don’t want to be having wasted appointments or vaccines.
‘It comes down to, if you’re going to mandate something like this, who is going to pay for it? The current vaccination program for COVID has been only just marginally funded, anyway. You’ve got to be pretty efficient to make break-even with the current funding.’
Dr Hosking wants a national campaign to inform and educate Australians on how to book a COVID-19 vaccination, suggesting there was confusion in the community about when and where people were eligible and whether they would be specifically told when to have a shot.
The US study acknowledged the social and logistical challenges of mass vaccination. It noted separate surveys that found just 60% of Americans were planning to get the COVID-19 vaccination, and other research that revealed the gap between intending to vaccinate and actually doing it.
The new research, published in the Proceedings of the National Academy of Sciences of the United States of America, drew parallels between the flu vaccinations and shots for COVID-19.
‘Many Americans fail to get life-saving vaccines each year, and the availability of a vaccine for COVID-19 makes the challenge of encouraging vaccination more urgent than ever,’ the study noted.
‘Although COVID-19 differs from the flu in many ways, both are deadly respiratory diseases with an available vaccine that many Americans choose not to get.
‘This successful script could be used as a template for campaigns to encourage the adoption of life-saving vaccines, including against COVID-19.’
Just under half of eligible Americans had a flu vaccine in 2019–20 and 35,000 died from the condition. In Australia, a 2014 survey found 39% of people had a flu shot that season, including 63% in an at-risk group.
The ‘nudge’ study found notifications were effective at raising the vaccination rates across the board, with a 5% increase in presentations regardless of what the message said.
It tested 19 different forms of messaging.
The top-performing messages resulted in a 4.6% boost in vaccination, an 11% increase on overall rates.
The first nudge was sent 72 hours before the appointment. The vaccine reminder read: ‘It’s flu season’ and ‘A flu vaccine is available for you’.
The second round, sent 24 hours before the booking, read: ‘This is a reminder that a flu vaccine has been reserved for your appointment’.
Researchers said the most effective were those that were consistent with healthcare messaging. They said some of the ‘most artful interventions’ such as a picture of a dog telling a cat a joke about flu, were the least effective.
REC–PTM member Dr David Adam,  believes the tone and message in the US study may not translate to an Australian context, although he supports the use of reminders.
‘If there are practices or doctors who are struggling to get people to turn up to appointments they’ve booked, this study might be useful,’ he told newsGP.
‘We’ve always got to ask ourselves if what works in the American context is going to work in an Australian context.
‘Particularly their findings around the structure of the message and the tone of the message, I think it’s fair to say Australians have a slightly different relationship with their doctor on the whole than Americans do.’
Dr Adam echoed the call for increased awareness for COVID-19 vaccinations, especially as the scheme ramps up.
‘As we move down the phases, public messaging to address the hesitancy is really important,’ he said.
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Dr Oliver Ralph Frank   6/05/2021 4:46:43 PM

In the Discipline of General Practice at the University of Adelaide we are conducting studies aimed at increasing influenza and pneumococcal vaccination of patients at higher risk of pneumococcal infection or influenza. When any of these patients who is not fully vaccinated makes an appointment for any reason, a new function of the Doctors Control Panel software ( generates an SMS message recommending that they discuss these vaccinations in their consultation. Currently the study includes 24 general practices (mainly in South Australia) and 107,126 patients aged 18 years or older attending these clinics, of whom 29% have at least one high-risk condition for which these immunisations are recommended. Our early feedback is that vaccination uptake improves with SMS reminders. However, uptake differs between vaccines due to specific factors including changing national recommendations, narrow government funding and cost of private prescriptions.