PRISM: Personalized Reminders for Immunization using Short Messaging systems

说明(申请人提供)：问题：疫苗接种覆盖率远低于健康人2010年和2020年的目标，低收入和其他弱势群体的差距很大。卫生信息技术干预将短信等通信技术与电子健康记录数据联系起来，为促进疫苗接种和其他预防保健行为提供了低成本、可扩展的机会。研究表明，在与其他形式的提醒/召回相一致的水平上，这类干预措施在疫苗接种覆盖率方面是有效的，特别是在其他形式的提醒/召回不成功的低收入人口中。然而，它们的效果并不像需要的那样强劲。需要更有效的消息传递干预措施。青少年，特别是少数族裔青少年，没有充分预防人类乳头瘤病毒(HPV)及其可能的后遗症，包括癌症和生殖器疣。尽管向所有青少年推荐了高效疫苗，但启动3剂系列疫苗的人的完成率很低，特别是在少数群体中。使用非随机设计，我们展示了传统短信疫苗提醒的效果，通知父母他们的孩子将接种下一针，在主要是城市拉丁裔青少年中增加HPV疫苗接种。尽管与对照组相比有了很大改善，但只有50%的人按时接种了下一剂，只有45%的人完成了这一系列。虽然这些结果有力地支持了这种干预在传统形式的疫苗接种提醒不起作用的少数群体中的潜在有效性，但仍然不到一半的人完成了疫苗系列。文本消息点击干预的一个潜在优势是提供个性化消息的能力，但尚未得到很好的调查。我们建议在一项务实的随机试验中，在少数族裔青少年中比较使用个性化HPV疫苗短信提醒和传统短信提醒的情况。行为改变的跨理论模型将指导我们对短信的剪裁。具体目的：比较个性化短信提醒与传统短信提醒在提高少数族裔青少年HPV疫苗系列完成率方面的有效性。方法：将956名接种了第一针HPV疫苗的青春期女孩和男孩的父母随机分为两组：1)个性化短信或(2)常规短信。个性化提醒包括针对父母决策阶段量身定做的疫苗健康素养促进信息。传统的短信提醒只通知父母他们的孩子将接种下一剂疫苗，就像以前的HPV疫苗短信研究中使用的那样。结果：主要结果是在12个月内完成3剂HPV疫苗系列。如果成功，该项目将以一种低成本、可扩展、易于传播的方式支持一种新的互动式卫生交流模式。

DESCRIPTION (provided by applicant): Problem: Vaccination coverage is well below Healthy People 2010 and 2020 goals, with substantial disparities for low-income and other disadvantaged populations. Health information technology interventions that link communication technologies, like text messaging, with electronic health record data offer low-cost, scalable opportunities to foster vaccination as well as other preventive care behaviors. Studies have demonstrated the effectiveness of such interventions on vaccination coverage at levels in line with other forms of reminder/recall particularly in low-income populations for whom other forms of reminder-recall have not been successful. However, their effect has not been as robust as needed. More effective messaging interventions are needed. Adolescents, in particular minority adolescents, are not adequately protected against human papillomavirus (HPV) and its potential sequelae, which include cancer and genital warts. Despite the highly efficacious vaccine being recommended for all adolescents, completion rates among those who initiate the 3- dose series are low, particularly among minorities. Using a non-randomized design, we demonstrated the effect of conventional text message vaccine reminders, notifying a parent their child was due for the next dose, in increasing HPV vaccination in primarily, urban Latina adolescents. Although much improved over controls, only 50% received their next dose on time and only 45% completed the series. While these results strongly support the potential effectiveness of this intervention in minority populations for whom traditional forms of vaccination reminders have not worked, still fewer than half completed the vaccine series. A potential advantage of text message HIT interventions that has not been well investigated is the ability to provide personalized messages. We propose to compare the use of personalized HPV vaccine text message reminders to conventional text message reminders among minority adolescents in a pragmatic randomized trial. The trans-theoretical model of behavior change will guide the tailoring of our text messages. Specific Aim: To compare the effectiveness in improving HPV vaccine series completion for minority adolescents of personalized text message reminders with tailored vaccine-health-literacy-promoting information vs. conventional text message vaccination reminders. Methods: 956 parents of adolescent girls and boys who have received the 1st HPV vaccine dose will be randomized to receive either: 1) personalized or (2) conventional text messages. Personalized reminders include vaccine health literacy-promoting information tailored to parental stage of decision-making. Conventional text message reminders solely notify a parent their child is due for the next dose such as used in previous HPV vaccine text message studies. Outcomes: The primary outcome is completion of 3-dose HPV vaccine series within 12 months. If successful this project could support a new paradigm in interactive health communication in a low cost, scalable manner that may be readily disseminated.