Text message reminders to promote human papillomavirus vaccination
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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2023, Journal of Adolescent HealthIncreasing HPV Vaccination Rates Using Text Reminders: An Integrative Review of the Literature
2022, Journal of Pediatric Health CareCitation Excerpt :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).
The impact of publicly funded immunization programs on human papillomavirus vaccination in boys and girls: An observational study
2022, The Lancet Regional Health - AmericasSPN white paper: Recommendations for pediatric reminder and recall interventions to improve immunization rates
2022, Journal of Pediatric Nursing
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Now at Health Partners Research Foundation, Minneapolis, MN, USA.