Text Messages Saying Influenza Vaccine ‘Reserved for You’ May Boost Uptake

Sending text messages informing patients about influenza vaccines ahead of scheduled appointments increased vaccine uptake, according to a new study, which suggested that wording messages to say a vaccine was “reserved for you” and including an option to reply yes or no may be the best strategy.

The study, published in JAMA Network Open, included 10,158 participants randomized into three groups, with 3375 receiving text messages saying an influenza vaccine was “reserved for you,” 3351 receiving text messages saying an influenza vaccine was “available,” and 3432 who didn’t receive a text message.

During the subsequent appointments held at two large health systems—Penn Medicine and Geisinger Health—1168 (34.61%) of those who received a “reserved for you” text message got an influenza vaccine compared with 1113 (33.21%) of those who received an “available” message and 1075 (31.32%) of those who didn’t receive a text message.

“These findings suggest that text messaging encourages vaccination,” the authors, led by Alison Buttenheim, PhD, MBA, Department of Family and Community Health, School of Nursing, University of Pennsylvania, wrote. “More research is needed to evaluate the potential benefits of messages conveying ownership sent before a primary care visit.”

While receiving a text message was associated with higher vaccine uptake, the difference between uptake among those who received messages indicating a vaccine was “reserved” and those who received messages saying a vaccine was “available” was not statistically significant.

The text messages were sent the evening before scheduled primary care appointments and included the option to reply with yes (Y) or no (N) to indicate whether a participant wanted to receive the vaccine during their appointment. The primary care appointments were held between Sept. 20, 2020 and March 31, 2021.

Vaccination rates were 3.3 percentage points higher among patients who received “reserved” messages than those who didn’t receive messages. Patients in that group also were more likely to text back Y (31.5%) compared with those who received “available” messages (26.47%). Replying Y also was associated with a higher likelihood of getting vaccinated (78.56%) compared with those who did not (15.68%).

The study was part of a larger study that tested 19 messages overall. Limitations of the study include that it didn’t include influenza vaccines received outside of the two participating health systems and investigators didn’t observe clinical encounters, including whether clinicians offered an influenza vaccine. The study also included only patients who scheduled appointments who consented to receiving text messages. It also may have been affected by the COVID-19 pandemic, which may have affected decisions about seeking care.

“Our results contribute to the rapidly accumulating evidence on ownership messages to promote vaccination, which have now been tested for COVID-19 vaccination as well as other outcomes,” the authors wrote.

Even before the COVID-19 pandemic, vaccine hesitancy was named as one of the Top 10 global health threats of 2019, according to the World Health Organization, and only 48% of US adults received an influenza vaccine in 2019-2020.

A recent study published in Nature by investigators at Carnegie Mellon University and the University of California, Los Angeles found that text message reminders boosted appointment and vaccination rates for COVID-19 shots by 84%.

Other studies have shown that text messaging may be used to improve adherence to HIV pre-exposure prophylaxis and to improve hand hygiene among healthcare workers in hospitals.