A Study to Determine the Preliminary Effects of a Theory Based Text Messaging Intervention (SayNo2Flu) on Parent"s Beliefs and Behaviors in a Primary Care Setting

Introduction: The Advisory Committee on Immunization Practice (ACIP) recommends that all children 6 months to 18 years old be vaccinated annually against Influenza. The influenza immunization rate for school-age children is less than 56%. Primary care Influenza vaccination interventions may increase vaccination rates among hard-to-reach populations, particularly children with low-income, urban parents. Given the increased use of technology as a strategy to increase immunization coverage, theory-based text messages may result in greater increases in vaccination rates than traditional vaccine reminders. The purpose of this study is to examine the preliminary effectiveness of a health belief and text messaging intervention to determine whether health beliefs and influenza vaccine receipt differ when compared to a text messaging control group.

 Methods: This study is a randomized controlled trial using a two-group pre- and posttest experimental design. It targeted parents of five-to eight-year-old children from a low-income, publically insured, primarily Latino, inner city primary care clinic. Parents were included in the study if their child had not received a prior Influenza vaccination. The intervention consisted of a series of six weekly text messages personalized in English or Spanish and based on the constructs of the Health Belief Model.(HBM). The study instrument was a two-part pretest and posttest Health Beliefs questionnaire.

Results: The sample included 136 parents (M age=35 years). 95% female, 98% Spanish speaking, and 77.5% had a high school education or less. Also, 51% of the parents had a total family annual income less than $10,000 and 82% of parents had a total family annual income less than $25,000. This study found that a theory-based intervention (SayNo2Flu) guided by the HBM and combined with the use of mobile technology (SMS text messaging) did change parents’ influenza vaccination perceptions. It had an overall increase of 38.1% in Influenza vaccination rates in the intervention group (OR: 4.46, 95% CI, 1.705-11.706, p < .001).

 Conclusions: This study is significant because no published studies evaluating the use of HBM-guided interventions using text messaging to promote influenza vaccine receipt among parents of school-age children have been identified. This intervention may be used to bridge gaps and reduce child health disparities, as it was designed to be easily carried out by healthcare providers in a primary care setting incorporating mobile technology. These results offer some insight into the use of theory-based preventative interventions for parents of young school-age children.