Text4Vax: Understanding the Effectiveness and Implementation of Text Message Reminders for Pediatric COVID-19 and Influenza Vaccines

Problem: COVID-19 is the #8 and influenza and pneumonia the #9 leading causes of death among children. Both COVID-19 and influenza vaccines are on the CDC recommended vaccine schedule for children and adolescents and both are effective against severe disease. However, coverage rates for both vaccines remain low or are dropping. Vaccine reminders are widely recommended with text messaging, as a single-method reminder, having the largest benefit. However, behaviorally-informed COVID-19 vaccine text messages have not been tested in a pediatric population. Additionally, while COVID-19 and influenza vaccination are going to be due at the same time it is not known how COVID-19 and influenza vaccination reminders will interact. We propose a pragmatic Hybrid Type 2 effectiveness/implementation trial with national scope vital to understanding the effectiveness and implementation of COVID-19 and influenza text message reminders across parents with varied backgrounds and whose children are cared for in diverse pediatric primary care practice settings. AIM 1. To compare the effectiveness of behaviorally informed text message reminders versus usual care on timely receipt of a needed COVID-19 or influenza vaccine dose in a diverse pediatric primary care population. AIM 2. To compare the effectiveness of two implementation strategies on timely receipt of each vaccination: combined COVID-19 and influenza vaccine reminders versus COVID-19 or influenza reminders alone. AIM 3. To assess parental and child characteristics that modify text message effectiveness. AIM 4. To identify contextual factors, facilitators and barriers to implementation and sustainability of text messages for influenza and COVID-19 vaccination in a diverse pediatric population. Methods: This multi-site trial will include 40,000 parents of 6 month-17-year-old children who are due for both a COVID-19 and influenza vaccine. Practices will be recruited through the American Academy of Pediatrics national Pediatric Research in Office Settings (PROS) network. In season 1, children will be randomized into 4 arms: combined COVID-19 and influenza vaccine text message reminders, COVID-19 reminders alone, influenza reminders alone, and no reminders. Messages will be managed by the research team. The primary outcome for Aim 1 will be timeliness of vaccine receipt (COVID-19 and/or influenza separately) from trial start. Aim 2 will compare the implementation strategy of single vs combined reminders assessing whether combining reminders for both vaccines leads to additive (or synergistic) or negative effects. Season 2 will be a replication study. In season 3, practices will implement messages on their own. Using a mixed-methods approach, we will use the RE-AIM framework in combination with the Consolidated Framework for Implementation Research (CFIR) to understand factors shaping implementation success. On a national scale, understanding the effectiveness and implementation of influenza and COVID-19 vaccine text message reminders among a diverse pediatric population will provide key information to multiple stakeholders to bolster vaccine receipt.