Programs that Work
Healthy and Safe Children
Children experiencing good physical health
Age of Child
Middle Childhood (9-12)
Type of Setting
Health Care Provider
Type of Service
Health Care Services
Type of Outcome Addressed
Evidence Level (What does this mean?)
Text4Health-Adolescents is a text-messaging platform which sent automated vaccination reminders to parents of adolescents in New York City. Utilizing electronic medical records and a hospital immunization registry that receives data from the New York Citywide Immunization Registry, Text4Health delivered a series of automatic messages to parents of adolescents ages 11-18 who had not yet received standard vaccinations reminding them of their child's need for meningococcal (MCV4) and/or tetanus-diphtheria-acellular pertussis (Tdap) immunizations.
Parents of adolescents (ages 11-18) in a network of community-based clinics affiliated within an academic medical center in New York City, primarily serving a low-income, minority population.
Stockwell et al. (2011) assessed the effect of Text4Health-Adolescents on receipt of one or both of two routinely recommended adolescent vaccines: meningococcal (MCV4) and tetanus-diphtheria-acellular pertussis (Tdap). Study authors utilized electronic medical records from a network of community-based pediatric clinics and a hospital immunization registry which receives data from the city of New York's Citywide Immunization Registry to determine each child's immunization status.
All six pediatric clinics associated with an ambulatory care network affiliated with an academic institution in New York City were included in the study; 4 sites were designated as intervention sites and 2 were designated as control sites. Intervention and control sites were selected in order to be able to have comparably sized adolescent populations to choose from at the study baseline. At baseline, the intervention and control sites had comparable MCV4 and Tdap vaccination coverage rates. All sites served primarily minority patients receiving Medicaid and free Vaccines for Children provided vaccines. Authors performed tests in order to determine whether there were differences across the sites that may have led to the differences in observed outcomes, and found no such effect (Stockwell et al. 2011).
Parents were eligible to participate in the Text4Health-Adolescents study if they had an 11- to 18-year-old child with any visit (including sick visits) at a study site within the previous 12 months who was in need of MCV4 and/or Tdap vaccine. Additionally, eligible parents needed to have a cell phone number recorded in the clinic registration system. . Over the course of four months from January 2009 to April 2009, a random sample of parents was drawn weekly from intervention sites who met the above-specified eligibility criteria. Intervention patients were then matched by gender and age to randomly selected eligible patients from control sites. Throughout the study, the group of eligible parents was updated based on current immunization status information.
Over the course of the 4 months of the study, there were 1,656 adolescents who needed Tdap and/or MCV vaccination at the intervention sites and 1,460 at control sites. Of these, only twenty percent of parents (625) had a cell phone number in the clinic registration system, as cell phone numbers were not routinely collected during the registration process until 2008. Authors evaluated the receipt of MCV and/or Tdap vaccination specifically, as well as the receipt of any vaccine at three time points: 4, 12, and 24 weeks (Stockwell et al. 2011).
Key Evaluation Findings
Stockwell et al. (2011) found that receipt of any vaccine was significantly higher for the Text4Health-Adolescents participants than for those in the control group at the three time points assessed (4, 12 and 24 weeks following randomization).
Additionally, specific receipt of MCV4 and/or Tdap vaccine was also significantly higher among Text4Health-Adolescents participants compared with those in the control group at all three time points:
- At 4 weeks after randomization, 15.4 percent of Text4Health-Adolescents participants had received one or both of MCV4 or Tdap, compared with 4.2 percent of controls
- At 12 weeks, 26.7% versus 13.9% received one or both of MCV4 or Tdap
- At 24 weeks, 36.4% versus 18.1% received one or both of MCV4 or Tdap
Regional and local care networks; health care clinics
The Stockwell et al. 2011 study of Text4Health-Adolescents was supported by the Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, Department of Health and Human Services.
Text4Health-Adolescents participants' parents were sent text messages that were personalized to include the adolescent's first name, their regular clinic name, and a schedule of times when immunizations were administered at that clinic. Messages were sent in English or Spanish based upon the preferred language listed in the electronic medical record. Families were also given information on how to opt-out of future messages.
Issues to Consider
Text4Health-Adolescents received a "promising" rating. Although sites were not randomly assigned, authors demonstrated that the sites were similar on baseline demographic characteristics as well as baseline vaccine coverage rates.
An additional evaluation of a Text4Health-Peds intervention was conducted among a pediatric population. Text4Health-Peds attempted to galvanize parents to attend special Haemophilus influenzae type B (HiB) vaccination sessions for children overdue for their HiB vaccination due to a national shortage that occurred following a voluntary recall of HiB vaccine from the market. While this intervention did have a significant impact on parental attendance at the special sessions, it did not impact the rates of vaccination in the total population studied, so it does not qualify for inclusion on PPN.
All six pediatric clinics associated with the New York-Presbyterian Ambulatory Care network (affiliated with a New York City academic medical center) were involved in the 2011 study.
Dr. Melissa Stockwell
mailing: 622 West 168th Street, VC402 NY, NY 10032
Additional information can be found at the study website: http://www.columbia.edu/cu/text4health/
Stockwell, Melissa S., Elyse Olshen Kharbanda, Raquel Andres Martinez, Marcos Lara, David Vawdrey, Karthik Natarajan, and Vaughn I. Rickert, "Text4Health: Impact of Text Message Reminder-Recalls for Pediatric and Adolescent Immunizations,"
American Journal of Public Health,
2012, 102:2, e15-e21.