Elsevier

Vaccine

Volume 29, Issue 14, 21 March 2011, Pages 2537-2541
Vaccine

Text message reminders to promote human papillomavirus vaccination

https://doi.org/10.1016/j.vaccine.2011.01.065Get rights and content

Abstract

Objective

To implement and evaluate text message reminders for the second (HPV2) and third (HPV3) vaccine doses.

Design

Site-based intervention.

Setting

Nine pediatric sites (5 academic and 4 private) located in New York City.

Participants

Parents of adolescents 9–20 years who received HPV1 or HPV2 during the intervention period, January–June 2009.

Intervention

Parents who enrolled received up to three weekly text message reminders that their daughter was due for her next vaccine dose.

Outcome measure

On-time receipt of the next vaccine dose, within one month of its due date.

Results

During the intervention period, of 765 eligible HPV vaccine events, 434 enrollment instructions were distributed to parents (56.7% of doses). Parents of 124 adolescent girls (28.6% of those handed instructions) activated text message reminders. Comparing children of parents who enrolled versus those who did not, on-time receipt of next HPV vaccine dose occurred among 51.6% (95% CI 42.8–60.4%) versus 35.0% (95% CI 29.6–40.2%) of adolescents (p = .001). Similarly, among a historical cohort of adolescents, receiving HPV1 or HPV2 in the six months prior to the intervention period, on-time receipt of next vaccine dose was noted for 38.1% (95% CI 35.2–41.0%) (p = .003). Increases in receipt of next vaccine dose among intervention subjects were sustained at 4 months following the vaccine due date. Using a logistic regression model, after controlling for insurance and site of care, intervention subjects were significantly more likely than either control population to receive their next HPV vaccine dose on-time.

Conclusion

Among those choosing to enroll, text message reminders were an effective intervention to increase on-time receipt of HPV2 or HPV3.

Introduction

The human papillomavirus (HPV) vaccine has the potential to greatly improve the health of women by preventing cervical cancer and precancerous dysplastic lesions [1]. It may also reduce the risk for oropharyngeal and anal cancers in both men and women [2]. In 2006, the Advisory Committee for Immunization Practices recommended the quadrivalent HPV vaccine to be included in the routine immunization schedule for adolescent girls in the United States [3]. More recently, a permissive recommendation to immunize adolescent males was added [4]. The quadrivalent HPV vaccine is administered as a 3-dose series; timing for the second (HPV2) and third (HPV3) doses is two and six months after the initial (HPV1) dose, respectively.

A large body of literature has examined barriers to HPV vaccine initiation, including parental [5], [6], [7], [8] and provider beliefs [9], [10], [11], financial constraints [12], and failure of adolescents to present for medical care [13], [14]. Fewer studies have specifically addressed vaccine adherence. Due to their developmental stage, busy lives with competing priorities [15], and dependence on parents to access immunizations [12], adolescents may find adherence with the three-dose HPV vaccine regimen to be particularly challenging. In an observational study by Neubrand et al., only 58% of adolescent girls who received HPV1 completed the 3-dose series over a 17-month period [16]. In the 2009 National Immunization Survey-Teen, among a cross-sectional sample of 13–17 year old females, 44% of girls had started the vaccine series while only 27% had received all three doses [17].

Immunization reminder-recalls are widely recommended and may effectively increase completion rates for the HPV vaccine series [18]. By notifying families when the next HPV vaccine dose is due, reminder-recalls may provide a cue to action, motivating teens and their parents to seek medical care. Unfortunately, traditional mail or phone reminders have had limited impact in adolescent populations [19]. An increasing number of US adults now own mobile phones and many homes are now exclusively wireless [20]. In previous work by our group, urban parents of adolescents reported they would welcome receiving text messages from their child's medical provider and that they would be likely to act based on the content of the messages [15]. In the current study, we implemented and evaluated a text messaging service to remind parents when their daughters were due for their next HPV vaccine dose.

Section snippets

Setting

Nine pediatric clinical sites located in New York City (NYC) participated in this practice-based intervention to improve adherence with HPV vaccination guidelines. Five sites were hospital-affiliated, academic practices, serving primarily publicly insured youth. The remaining four were private practices, serving primarily privately insured children and adolescents. All sites reported immunization data to the Citywide Immunization Registry (CIR), as mandated for all NYC medical providers. At

Intervention population

During the six-month intervention period, across the nine participating clinical sites, 364 adolescent girls received HPV1 and 401 received HPV2 (256 received both HPV1 and HPV2 during the intervention period). Of the 765 eligible HPV vaccine events, 434 sign-up cards were distributed (56.7% of doses), and 128 (29.5% of those handed cards) signed up for the text message reminders. We observed wide site-based variation in our process measures. Across the nine participating sites, the percent of

Discussion

Despite the potential benefits of the HPV vaccine, to date, vaccine coverage remains sub-optimal. According to the 2009 National Immunization Survey Teen, among a nationally representative sample of 13–17 year old girls, only 27% had completed the three dose series [17]. While educational efforts have targeted vaccine initiation, we are not aware of other studies to demonstrate effective strategies for increasing adherence with the 3-dose HPV vaccine schedule.

In the current study, compared to

Acknowledgements

The authors would like to acknowledge the New York Presbyterian Hospital Ambulatory Care Network and affiliated private practices for supporting this intervention. The authors would also like to acknowledge Dr. Jane Chang for assisting with data collection.

Disclosure statement: Dr. Rickert is on the Adolescent and Adult Vaccine National Advisory Board of Merck and Company, Inc. as well as has received research funding from Merck unrelated to this study. Dr. Rickert also serves on the Adolescent

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    • Increasing HPV Vaccination Rates Using Text Reminders: An Integrative Review of the Literature

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      All seven articles evaluated the efficacy and effectiveness of text message reminders on HPV vaccination, whether it was the initial dose or subsequent dose(s) (Gerend et al., 2021; Keeshin & Feinberg, 2017; Kharbanda et al., 2011; Matheson et al., 2014; Rand et al., 2015; Rand et al., 2017; Tull et al., 2019). All seven studies also had an intervention group that received various frequencies of text messages at different times as a reminder for each dose (Gerend et al., 2021; Keeshin & Feinberg, 2017; Kharbanda et al., 2011; Matheson et al., 2014; Rand et al., 2015; Rand et al., 2017; Tull et al., 2019). One study used a historical control group, which was 6 months before implementation of the text message reminder system, as a comparison tool (Kharbanda et al., 2011).

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    Now at Health Partners Research Foundation, Minneapolis, MN, USA.

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