A UCLA Health study aimed to determine whether receiving text reminders to receive routine influenza vaccination was more effective than patient portal reminders. However, researchers found neither text nor portal-based messages significantly increased influenza vaccination rates.
The study, led by Peter G. Szilagyi, MD, MPH, a pediatrician at the UCLA Mattel Children’s Hospital, was conducted throughout the entire UCLA Health System. It tested the hypothesis on 262,085 patients, including 237,404 adults and 24,681 children, all receiving primary care at UCLA primary care practices.
The study's primary objective was to compare the effectiveness of portal versus text message reminders in improving influenza vaccination rates across the UCLA Health system and to compare each intervention to usual care. This critical question was addressed through a large, randomized trial. However, upon completion, researchers discovered no statistically significant differences between text and portal messages. Moreover, with one exception, neither portal nor text messages could improve influenza vaccination rates at the level of the entire health system, whether sent monthly or before existing visits.
The data show that influenza vaccination rates for the different study groups were as follows: patients receiving usual care (47.1%), patients receiving portal reminders (47.3%), and patients receiving text message reminders (47.2%).
The hypothesis that text message reminders might be more effective than patient portal updates was based on the concept of nudging behaviors, which suggests that eliminating even minor obstacles to a desired action can boost compliance. In this context, confirming an appointment via text was presumed to be simpler than dealing with the additional steps required with portal reminders. Typically, patients must first receive an email notifying them of a portal message, log in to the portal, and finally navigate within it to read the initial message. However, for this UCLA population, neither intervention worked if assessed at the level of the entire population.
The one exception was that text messages sent to patients who had scheduled primary care visits during the flu vaccination season successfully raised influenza vaccination rates. For this population, text messages increased the likelihood of influenza vaccination by 7 percentage points. Portal messages sent to this group were not effective.
“Increasing vaccination rates is pivotal to public health, so our objective was to assess whether a text message reminder system could contribute to this goal,” Szilagyi said. “However, given its limited effectiveness, alternative strategies to consider include enhancing access to vaccinations or providing communication training for clinicians to address vaccine hesitancy.”
Researchers suggest that more intensive interventions than portal or text messages are necessary to increase influenza vaccination rates and meet national goals. Text message reminders sent just before already scheduled primary care visits did raise vaccination rates for the subgroup of patients who already have a scheduled primary care visit during flu vaccination season and can be considered by a health system to efforts to boost influenza vaccination for those patients.
