Editors' ChoiceCommunity Medicine

Texting Can Be Healthy

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Science Translational Medicine  02 May 2012:
Vol. 4, Issue 132, pp. 132ec76
DOI: 10.1126/scitranslmed.3004204

Texting has moved beyond “what’s up?” “nmu?” In the realm of health care delivery, electronic messaging has demonstrated a positive impact on health care interventions, such as for smoking cessation and the management of diabetes. Less well-established is the role of text messages in preventative health. Now, Stockwell and colleagues reveal results from their randomized controlled trial to assess the effects of text messaging on influenza vaccination among low-income urban populations at four clinics in New York City that cater to a majority of patients who receive publicly funded health care.

Influenza vaccination is a safe effective intervention. The benefits extend beyond prevention of disease and death and include reductions in sick leave time for parents and children and blocking of viral transmission to susceptible individuals, including the immune-compromised. Influenza vaccination guidelines were extended in 2008 to include children and adolescents of age 6 months to 18 years. Despite the clear benefits and savings in terms of health, loss of productive time, and money, uptake of the influenza vaccination has been low (~50%) in the United States.

Cell phones are ubiquitous, and messages are easily received. Integration with electronic health records allows computer access to phone numbers and vaccination records, allowing text messages to be automated. In the new work, parents of children ranging in age from 6 months to 18 years were randomized to receive either (i) up to five text messages that contained reminders for vaccination and information on the availability of Saturday clinics, or (ii) the typical standard reminder, one automated phone message.

Stockwell and colleagues observed a modest but statistically significant increase in the uptake of vaccination among text-message recipients compared with those families who did not receive a text message. At the end of the vaccination season, the clinical trial noted a modest increase in vaccination rates. Among the 7574 children and adolescents, 43.6% of the text-message intervention group and 39.9% of the typical phone-message group were vaccinated. Although the increase in vaccination was just 4%, at the national level this increase could represent 2.5 million children and adolescents. Further, the cost of the intervention was minimal compared with the gains.

Other text-message studies are ongoing to identify relevant messages that may increase intervention uptake, such as for adherence to daily medication and attendance of outpatient appointments. Two-way text messages—which allow clients to respond and receive follow-up when they have questions or need help—have been shown to increase the uptake of health interventions (such as taking daily medication) more than do messages that don’t permit a response, and this can be explored in future work. Results from these more extensive interventions studies can be adapted to promote disease-preventing health habits beyond vaccination. Perhaps one day, the answer to “what’s up” will be “gtng vacc’d.”

M. S. Stockwell et al., Effect of a text messaging intervention on influenza vaccination in an urban, low-income pediatric and adolescent population: A randomized controlled trial. JAMA 307, 1702–1708 (2012). [Abstract]

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