PRISM: Personalized Reminders for Immunization using Short Messaging systems

DESCRIPTION (provided by applicant): Problem: Vaccination coverage is well below Healthy People 2010 and 2020 goals, with substantial disparities for low-income and other disadvantaged populations. Health information technology (HIT) interventions that link communication technologies, like text messaging, with electronic health record data offer low-cost, scalable opportunities to foster vaccination as well as other preventive care behaviors. High quality data from randomized trials demonstrating the effectiveness of this strategy are lacking. Adolescents, in particular minority adolescents, are not adequately protected against human papillomavirus (HPV) and its potential sequelae, which include cancer and genital warts. Despite the highly efficacious vaccine being recommended for all adolescents, completion rates among those who initiate the 3- dose series are low, particularly among minorities. Using a non-randomized design, we demonstrated the effect of conventional text message vaccine reminders, notifying a parent their child was due for the next dose, in increasing HPV vaccination in primarily, urban Latina adolescents. Although much improved over controls, only 50% received their next dose on time and only 45% completed the series. While these results strongly support the potential effectiveness of this intervention in minority populations for whom traditional forms of vaccination reminders have not worked, still fewer than half completed the vaccine series. Additional research is needed to enhance the effectiveness of text messaging and demonstrate effectiveness in a randomized trial. To be most effective, text messages reminders could include patient-centered health literacy information which is tailored to the specific family needs. Thus we are proposing to compare the use of enhanced (i.e. patient centered AND tailored) HPV vaccination text message reminders to conventional reminders and to usual care among minority adolescents in a pragmatic randomized trial. The trans-theoretical model of behavior change will guide the tailoring of our text messages. Specific Aim: To compare the effectiveness in n improving HPV vaccine series completion for minority adolescents of usual care alone vs. conventional text message vaccination reminders vs. text message reminders enhanced with tailored vaccine-health-literacy-promoting information Methods: 1434 parents of adolescent girls and boys who have received the 1st HPV vaccine dose will be randomized to receive either: 1) usual care, 2) usual care plus conventional text messages that notify when the next dose is due, or 3) usual care plus enhanced text message reminders. Usual care is a written reminder to complete the HPV series in the form of a card with due dates for subsequent doses. Outcomes: The primary outcome is completion of 3-dose HPV vaccine series within 12 months. If successful this project could support a new paradigm in interactive health communication in a low cost, scalable, and sustainable manner that may be readily disseminated.