Text Messaging fails to increase COVID-19 Vaccination Uptake significantly: JAMA

COVID-19 vaccine uptake among urban populations remains low. A study was conducted 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.

Results:

• 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 in the outbound telephone call–only group completed 1 vaccine dose, as did 243 of 7890 patients in the text plus outbound call group and 253 of 7765 patients in the text plus inbound call group
• Among the 15 655 patients receiving text messaging, 118 of 3889 patients in the standard messaging group completed 1 vaccine dose, as did 135 of 3920 patients in the clinician endorsement group, 100 of 3911 patients in the scarcity group and 143 of 3935 patients in the endowment group

There was no detectable increase in vaccination uptake among patients receiving text messaging compared with telephone calls only or behaviorally informed message content.

Reference:

Effect of Text Messaging and Behavioral Interventions on COVID-19 Vaccination Uptake: A Randomized Clinical Trial by Shivan J. Mehta, et al. published in the JAMA Network Open.

doi:10.1001/jamanetworkopen.2022.16649

Keywords:

Text, Messaging, fails, increase, COVID-19, Vaccination, Uptake, significantly, Shivan J. Mehta, Colleen Mallozzi, Pamela A. Shaw, Catherine Reitz, Caitlin McDonald, Matthew Vandertuyn, Mohan Balachandran, Michael Kopinsky, Christianne Sevinc, Aaron Johnson, jama network open