Effect of Text Messaging and Behavioral Interventions on COVID-19 Vaccination Uptake: A Randomized Clinical Trial.
Effect of Text Messaging and Behavioral Interventions on COVID-19 Vaccination Uptake: A Randomized Clinical Trial.
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DOI：
10.1001/jamanetworkopen.2022.16649
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发表时间：
2022-06-01
影响因子：
13.8
通讯作者：
Asch, David A.
中科院分区：
文献类型：
--
作者：
Mehta, Shivan J.;Mallozzi, Colleen;Shaw, Pamela A.;Reitz, Catherine;McDonald, Caitlin;Vandertuyn, Matthew;Balachandran, Mohan;Kopinsky, Michael;Sevinc, Christianne;Johnson, Aaron;Ward, Robin;Park, Sae-Hwan;Snider, Christopher K.;Rosin, Roy;Asch, David A.
带有行为见解的短信能提高COVID-19疫苗外展活动的参与度吗？在这项包括16045名参与者的随机临床试验中，短信的回复率并不比出站电话高。行为信息传递并没有导致比通常内容更高的反应。短信提供了一种比出站电话更低成本的替代方法，但需要进一步努力提高疫苗的吸收率。城市人口的COVID-19疫苗接种率仍然很低。评估带有出境或入境安排和行为知情内容的短信是否会增加COVID-19疫苗的吸收率。该随机临床试验采用因子设计，于2021年4月29日至7月6日在城市学术卫生系统中进行。该试验包括16045名来自宾夕法尼亚州费城的18岁以上患者，这些患者在过去5年中至少进行过一次初级保健就诊，或在未来3个月内计划进行一次初级保健就诊，并且对先前的外展治疗无反应。该研究在试验方案中预先指定，数据来自意向治疗人群。符合条件的患者以1:20:20的比例被随机分配到(1)只通过呼叫中心进行外呼，(2)通过呼叫中心向应答者发送短信和外呼，或(3)发送短信，并指示患者拨打热线电话。第2组和第3组的患者以1:1:1:1的比例同时随机分配，接收不同的内容：标准信息、临床医生认可（例如，“XXX医生推荐”）、稀缺性（“可用供应有限”）或捐赠框架（“我们为您预留了COVID-19疫苗预约”）。根据电子健康记录，主要结局是在1个月内完成第一剂COVID-19疫苗接种的患者比例。次要结果是在2个月内完成第一剂接种，并在最初外展的2个月内完成疫苗接种系列。其他结果包括无效手机号码（号码错误或不能发短信）的患者百分比、短信无回复、预定接种疫苗的患者百分比、短信回复以及接诊中心拨打的电话数量。分析以意向治疗为基础。在纳入的16045例患者中，平均（SD）年龄为36.9（11.1）岁；9418例（58.7%）为女性；12869人（80.2%）参加商业保险，2283人（14.2%）参加医疗补助；白人8345人（52.0%），黑人4706人（29.3%），西班牙裔或拉丁裔967人（6.0%）。1个月时，仅外呼组390例患者中有14例（3.6% [95% CI, 1.7%-5.4%]）完成了1剂疫苗接种，文本加外呼组7890例患者中有243例（3.1% [95% CI, 2.7%-3.5%]）完成了1剂疫苗接种(绝对差异，- 0.5% [95% CI, - 2.4% - 1.4%]; P =。在文本加呼入组中，7765例患者中有253例（3.3% [95% CI, 2.9%-3.7%]）（绝对差异为- 0.3% [95% CI, - 2.2%至1.6%];P = .72）。在15655名接受短信的患者中，标准短信组3889名患者中有118名（3.0% [95% CI, 2.5%-3.6%]）完成了1剂疫苗接种，临床医生认可组3920名患者中有135名（3.4% [95% CI, 2.9%-4.0%]）完成了1剂疫苗接种(绝对差异为0.4% [95% CI, - 0.4% - 1.2%]; P =。31)，稀缺组3911例患者中有100例（2.6% [95% CI, 2.1%-3.1%]）(绝对差异为- 0.5% [95% CI, - 1.2% - 0.3%]；20)， 3935例患者中有143例（3.6% [95% CI, 3.0%-4.2%]）在捐赠组（绝对差异为0.6% [95% CI, - 0.2%至1.4%];P = .14）。接受短信的患者接种疫苗的数量与只接受电话或行为信息内容的患者相比没有明显的增加。这项随机临床试验评估带有出站或入站调度和行为知情内容的短信是否可能增加COVID-19疫苗的吸收率。
Can text messaging with behavioral insights increase participation in COVID-19 vaccine outreach? In this randomized clinical trial comprising 16 045 participants, text messaging did not result in a higher response rate than outbound telephone calls. Behaviorally informed messaging did not result in a significantly higher response than usual content. Text messaging offers a low-cost alternative to outbound telephone calls, but additional efforts are needed to increase vaccine uptake. COVID-19 vaccine uptake among urban populations remains low. To evaluate whether text messaging with outbound or inbound scheduling and behaviorally informed content might increase COVID-19 vaccine uptake. This randomized clinical trial with a factorial design was conducted from April 29 to July 6, 2021, in an urban academic health system. The trial comprised 16 045 patients at least 18 years of age in Philadelphia, Pennsylvania, with at least 1 primary care visit in the past 5 years, or a future scheduled primary care visit within the next 3 months, who were unresponsive to prior outreach. The study was prespecified in the trial protocol, and data were obtained from the intent-to-treat population. Eligible patients were randomly assigned in a 1:20:20 ratio to (1) outbound telephone call only by call center, (2) text message and outbound telephone call by call center to those who respond, or (3) text message, with patients instructed to make an inbound telephone call to a hotline. Patients in groups 2 and 3 were concurrently randomly assigned in a 1:1:1:1 ratio to receive different content: standard messaging, clinician endorsement (eg, “Dr. XXX recommends”), scarcity (“limited supply available”), or endowment framing (“We have reserved a COVID-19 vaccine appointment for you”). The primary outcome was the proportion of patients who completed the first dose of the COVID-19 vaccine within 1 month, according to the electronic health record. Secondary outcomes were the completion of the first dose within 2 months and completion of the vaccination series within 2 months of initial outreach. Additional outcomes included the percentage of patients with invalid cell phone numbers (wrong number or nontextable), no response to text messaging, the percentage of patients scheduled for the vaccine, text message responses, and the number of telephone calls made by the access center. Analysis was on an intention-to-treat basis. Among the 16 045 patients included, the mean (SD) age was 36.9 (11.1) years; 9418 (58.7%) were women; 12 869 (80.2%) had commercial insurance, and 2283 (14.2%) were insured by Medicaid; 8345 (52.0%) were White, 4706 (29.3%) were Black, and 967 (6.0%) were Hispanic or Latino. At 1 month, 14 of 390 patients (3.6% [95% CI, 1.7%-5.4%]) in the outbound telephone call–only group completed 1 vaccine dose, as did 243 of 7890 patients (3.1% [95% CI, 2.7%-3.5%]) in the text plus outbound call group (absolute difference, −0.5% [95% CI, −2.4% to 1.4%]; P = .57) and 253 of 7765 patients (3.3% [95% CI, 2.9%-3.7%]) in the text plus inbound call group (absolute difference, −0.3% [95% CI, −2.2% to 1.6%]; P = .72). Among the 15 655 patients receiving text messaging, 118 of 3889 patients (3.0% [95% CI, 2.5%-3.6%]) in the standard messaging group completed 1 vaccine dose, as did 135 of 3920 patients (3.4% [95% CI, 2.9%-4.0%]) in the clinician endorsement group (absolute difference, 0.4% [95% CI, −0.4% to 1.2%]; P = .31), 100 of 3911 patients (2.6% [95% CI, 2.1%-3.1%]) in the scarcity group (absolute difference, −0.5% [95% CI, −1.2% to 0.3%]; P = .20), and 143 of 3935 patients (3.6% [95% CI, 3.0%-4.2%]) in the endowment group (absolute difference, 0.6% [95% CI, −0.2% to 1.4%]; P = .14). There was no detectable increase in vaccination uptake among patients receiving text messaging compared with telephone calls only or behaviorally informed message content. ClinicalTrials.gov Identifier: NCT04834726 This randomized clinical trial evaluates whether text messaging with outbound or inbound scheduling and behaviorally informed content might increase COVID-19 vaccine uptake.
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