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Lee WN, Stück D, Konty K, Rivers C, Brown CR, Zbikowski SM, Foschini L. Large-scale influenza vaccination promotion on a mobile app platform: A randomized controlled trial. Vaccine 2020; 38:3508-3514. [PMID: 31787410 DOI: 10.1016/j.vaccine.2019.11.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 11/01/2019] [Accepted: 11/19/2019] [Indexed: 11/25/2022]
Abstract
While health-care providers have used incentives in an attempt to motivate patients to obtain vaccinations, their effect on vaccination rates has not been systematically evaluated on a large scale. In this study, we examined whether mobile applications may improve population vaccination rates through enhanced communication and incentives education. Our study is the first randomized controlled trial assessing the effect of large-scale messaging combined with individualized incentives on influenza-vaccination rates. In this trial, we delivered messages regarding influenza vaccinations to 50,286 adults, aged 18 through 65, then compared the subsequent vaccination rate, the effectiveness of the message content and the timing. Multiple rounds of messaging occurred over a seven-week period during the 2016 flu season, after which vaccination rates were observed for one week. Participants were randomly assigned to one of three messaging approaches: conspicuous (highlighting the amount of rewards to be received for obtaining a flu shot); generic (promoting vaccinations with no mention of rewards); or no-message. Evidence of vaccination obtainment was indicated by medical and pharmacy claims, augmented by patients self-reporting through the mobile wellness app during the study period. Of the people assigned to receive messaging, 23.2% obtained influenza vaccination, compared to 22.0% of people who obtained vaccination in the no-messaging control arm. This difference was statistically significant (p < 0.01). The research revealed that messaging effectiveness decreased after each successive batch sent, suggesting that most participants responsive to messaging would become activated immediately after receiving one alert. Interestingly, in this large-scale study, there were no significant differences between conspicuous incentives and generic messaging, suggesting an important area for future research. Trial Registration: clinicaltrials.gov identifier: NCT02908893.
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Affiliation(s)
- Wei-Nchih Lee
- Evidation Health, 167 2nd Avenue, San Mateo, CA 94401, United States.
| | - David Stück
- Evidation Health, 167 2nd Avenue, San Mateo, CA 94401, United States.
| | - Kevin Konty
- Evidation Health, 15 Figueroa St., Santa Barbara, CA 93101, United States.
| | - Caitlin Rivers
- Johns Hopkins University Bloomberg School of Public Health, 621 E. Pratt Street, Suite 210, Baltimore, MD 21230, United States.
| | - Courtney R Brown
- Humana, 500 W. Main Street, Louisville, KY 40202, United States.
| | | | - Luca Foschini
- Evidation Health, 15 Figueroa St., Santa Barbara, CA 93101, United States.
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Powell GA, Bonnett LJ, Tudur-Smith C, Hughes DA, Williamson PR, Marson AG. Using routinely recorded data in the UK to assess outcomes in a randomised controlled trial: The Trials of Access. Trials 2017; 18:389. [PMID: 28835254 PMCID: PMC5569524 DOI: 10.1186/s13063-017-2135-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 08/03/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In the UK, routinely recorded data may benefit prospective studies including randomised controlled trials (RCTs). In an on-going study, we aim to assess the feasibility of access and agreement of routinely recorded clinical and non-clinical data compared to data collected during a RCT using standard prospective methods. This paper will summarise available UK routinely recorded data sources and discuss our experience with the feasibility of accessing routinely recorded data for participants of a RCT before finally proposing recommendations for improving the access and implementation of routinely recorded data in RCTs. METHODS Setting: the case study RCT is the Standard and New Antiepileptic Drugs II (SANAD II) trial, a pragmatic, UK, multicentre, phase IV RCT assessing the clinical and cost-effectiveness of antiepileptic drug treatments for newly diagnosed epilepsy. PARTICIPANTS 98 participants have provided written consent to permit the request of routinely recorded data. Study procedures: routinely recorded clinical and non-clinical data were identified and data requested through formal applications from available data holders for the duration that participants have been recruited into SANAD II. The feasibility of accessing routinely recorded data during a RCT is assessed and recommendations for improving access proposed. RESULTS Secondary-care clinical and socioeconomic data is recorded on a national basis and can be accessed, although there are limitations in the application process. Primary-care data are recorded by a number of organisations on a de-identified basis but access for specific individuals has not been feasible. Access to data recorded by non-clinical sources, including The Department for Work and Pensions and The Driving and Vehicle Licensing Agency, was not successful. CONCLUSIONS Recommendations discussed include further research to assess the attributes of routinely recorded data, an assessment of public perceptions and the development of strategies to collaboratively improve access to routinely recorded data for research. TRIAL REGISTRATION International Standard Randomised Controlled Trials, ISRCTN30294119 . Registered on 3 July 2012. EudraCT No: 2012-001884-64. Registered on 9 May 2012.
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Affiliation(s)
- G. A. Powell
- Department of Molecular and Clinical Pharmacology, Clinical Sciences Centre, Lower Lane, Fazakerley, Liverpool, L9 7LJ UK
| | - L. J. Bonnett
- Department of Biostatistics, University of Liverpool, Waterhouse Building, Block F, 1-5 Brownlow Street, Liverpool, L69 3GL UK
| | - C. Tudur-Smith
- Department of Biostatistics, University of Liverpool, Waterhouse Building, Block F, 1-5 Brownlow Street, Liverpool, L69 3GL UK
| | - D. A. Hughes
- Centre for Health Economics and Medicines Evaluation, Institute of Medical and Social Care Research, College of Health and Behavioural Sciences, Bangor University, Ardudwy, Normal Site, Gwynedd, North Wales LL57 2PZ UK
| | - P. R. Williamson
- Department of Biostatistics, University of Liverpool, Waterhouse Building, Block F, 1-5 Brownlow Street, Liverpool, L69 3GL UK
| | - A. G. Marson
- Department of Molecular and Clinical Pharmacology, Clinical Sciences Centre, Lower Lane, Fazakerley, Liverpool, L9 7LJ UK
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Text Message Reminders Increase Appointment Adherence in a Pediatric Clinic: A Randomized Controlled Trial. Int J Pediatr 2016; 2016:8487378. [PMID: 28127311 PMCID: PMC5227159 DOI: 10.1155/2016/8487378] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 11/26/2016] [Accepted: 12/06/2016] [Indexed: 11/17/2022] Open
Abstract
Background. High no-show rates can burden clinic productivity and affect patient care. Although multiple studies have shown that text messages improve appointment adherence, very little research has focused on low-income and predominantly African American populations in resident clinic settings. Objectives. To determine whether incorporating a text message reminder reduces the no-show rate at an urban, pediatric resident clinic. Methods. A randomized controlled trial was conducted at a tertiary level ambulatory pediatric practice between August 2014 and February 2015. Following a demographic survey, 170 patients were enrolled. Patients were randomized into control or intervention groups. All patients received the standard voice message appointment reminder, but the intervention group additionally received a text message reminder. The primary outcome was no-show rate. Results. 95.3% of the participants were African American, and the overall no-show rate was 30.8%. No-show rate was significantly lower in the intervention group (23.5%) than the control group (38.1%) representing a difference of 14.6% (p = 0.04). No demographic factors were found to alter the association between no-show rate and text message intervention. Conclusions. Text message reminders effectively improve show rates at a resident pediatric practice with high no-show rates, representing a promising approach to improving appointment adherence.
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Vaccination adherence: Review and proposed model. J Infect Public Health 2016; 9:781-789. [PMID: 27659114 DOI: 10.1016/j.jiph.2016.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/10/2016] [Accepted: 09/06/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The prevalence of childhood vaccine-preventable diseases can be significantly reduced through adherence to confirmed vaccination schedules. However, many barriers to vaccination compliance exist, including a lack of awareness regarding the importance of vaccines, missing due dates, and fear of complications from vaccinations. The aim of this study is to review the existing tools and publications regarding vaccination adherence, and to propose a design for a vaccination adherence application (app) for smartphones. METHODS Android and iOS apps designed for vaccination reminders have been reviewed to examine six elements: educational factor; customizing features; reminder tools; peer education facilitations; feedback, and the language of apps' interface and content. The literature from PubMed has been reviewed for studies addressing reminder systems or tools including apps. RESULTS The study has revealed insufficient (n=6) technology-based interventions for increasing childhood vaccination rates by reminding parents in comparison to the fast growth in technology, out of which are two publications discussed mobile apps. Ten apps have been found in apps stores; only one out of them was designed for the Saudi vaccination schedule in Arabic language with some weaknesses. The study proposed a design for a vaccination reminder app that includes a number of features in order to overcome the limitations discussed in the studied reminders, apps, and systems. The design supports the Arabic language and the Saudi vaccination schedule; parental education including peer education; a variety of reminder methods, and the capability to track vaccinations and refer to the app as a personal health record. CONCLUSION The study discussed a design for a vaccination reminder app that satisfies the specific requirements for better compliance to children's immunization schedules based on reviewing the existing apps and publications. The proposed design includes element to educate parents and answer their concerns about vaccines. It involves their peers and can encourage the exchange of experiences and overcome vaccine fears. In addition, it could form a convenient child personal health record.
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Simpson CR, Lone N, McMenamin J, Gunson R, Robertson C, Ritchie LD, Sheikh A. Early estimation of pandemic influenza Antiviral and Vaccine Effectiveness (EAVE): use of a unique community and laboratory national data-linked cohort study. Health Technol Assess 2016; 19:1-32. [PMID: 26450686 DOI: 10.3310/hta19790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND After the introduction of any new pandemic influenza, population-level surveillance and rapid assessment of the effectiveness of a new vaccination will be required to ensure that it is targeted to those at increased risk of serious illness or death from influenza. OBJECTIVE We aimed to build a pandemic influenza reporting platform that will determine, once a new pandemic is under way: the uptake and effectiveness of any new pandemic vaccine or any protective effect conferred by antiviral drugs once available; the clinical attack rate of pandemic influenza; and the existence of protection provided by previous exposure to, and vaccination from, A/H1N1 pandemic or seasonal influenza/identification of susceptible groups. DESIGN An observational cohort and test-negative study design will be used (post pandemic). SETTING A national linkage of patient-level general practice data from 41 Practice Team Information general practices, hospitalisation and death certification, virological swab and serology-linked data. PARTICIPANTS We will study a nationally representative sample of the Scottish population comprising 300,000 patients. Confirmation of influenza using reverse transcription polymerase chain reaction and, in a subset of the population, serology. INTERVENTIONS Future available pandemic influenza vaccination and antivirals will be evaluated. MAIN OUTCOME MEASURES To build a reporting platform tailored towards the evaluation of pandemic influenza vaccination. This system will rapidly measure vaccine effectiveness (VE), adjusting for confounders, estimated by determining laboratory-confirmed influenza; influenza-related morbidity and mortality, including general practice influenza-like illnesses (ILIs); and hospitalisation and death from influenza and pneumonia. Once a validated haemagglutination inhibition assay has been developed (and prior to the introduction of any vaccination), cross-reactivity with previous exposure to A/H1N1 or A/H1N1 vaccination, other pandemic influenza or other seasonal influenza vaccination or exposure will be measured. CONCLUSIONS A new sentinel system, capable of rapidly determining the estimated incidence of pandemic influenza, and pandemic influenza vaccine and antiviral uptake and effectiveness in preventing influenza and influenza-related clinical outcomes, has been created. We have all of the required regulatory approvals to allow rapid activation of the sentinel systems in the event of a pandemic. Of the 41 practices expressing an interest in participating, 40 have completed all of the necessary paperwork to take part in the reporting platform. The data extraction tool has been installed in these practices. Data extraction and deterministic linkage systems have been tested. Four biochemistry laboratories have been recruited, and systems for serology collection and linkage of samples to general practice data have been put in place. FUTURE WORK The reporting platform has been set up and is ready to be activated in the event of any pandemic of influenza. Building on this infrastructure, there is now the opportunity to extend the network of general practices to allow important subgroup analyses of VE (e.g. for patients with comorbidities, at risk of serious ILI) and to link to other data sources, in particular to test for maternal outcomes in pregnant patients. STUDY REGISTRATION This study is registered as ISRCTN55398410. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Colin R Simpson
- Centre for Medical Informatics, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Nazir Lone
- Centre for Medical Informatics, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | | | - Rory Gunson
- West of Scotland Specialist Virology Centre, Glasgow, UK
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Lewis D Ritchie
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - Aziz Sheikh
- Centre for Medical Informatics, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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Herrett E, Williamson E, van Staa T, Ranopa M, Free C, Chadborn T, Goldacre B, Smeeth L. Text messaging reminders for influenza vaccine in primary care: a cluster randomised controlled trial (TXT4FLUJAB). BMJ Open 2016; 6:e010069. [PMID: 26895984 PMCID: PMC4762100 DOI: 10.1136/bmjopen-2015-010069] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES (1) To develop methods for conducting cluster randomised trials of text messaging interventions utilising routine electronic health records at low cost; (2) to assess the effectiveness of text messaging influenza vaccine reminders in increasing vaccine uptake in patients with chronic conditions. DESIGN Cluster randomised trial with general practices as clusters. SETTING English primary care. PARTICIPANTS 156 general practices, who used text messaging software, who had not previously used text message influenza vaccination reminders. Eligible patients were aged 18-64 in 'at-risk' groups. INTERVENTIONS Practices were randomly allocated to either an intervention or standard care arm in the 2013 influenza season (September to December). Practices in the intervention arm were asked to send a text message influenza vaccination reminder to their at-risk patients under 65. Practices in the standard care arm were asked to continue their influenza campaign as planned. BLINDING Practices were not blinded. Analysis was performed blinded to practice allocation. MAIN OUTCOME MEASURES Practice-level influenza vaccine uptake among at-risk patients aged 18-64 years. RESULTS 77 practices were randomised to the intervention group (76 analysed, n at-risk patients=51,121), 79 to the standard care group (79 analysed, n at-risk patients=51,136). The text message increased absolute vaccine uptake by 2.62% (95% CI -0.09% to 5.33%), p=0.058, though this could have been due to chance. Within intervention clusters, a median 21.0% (IQR 10.2% to 47.0%) of eligible patients were sent a text message. The number needed to treat was 7.0 (95% CI -0.29 to 14.3). CONCLUSIONS Patient follow-up using routine electronic health records is a low cost method of conducting cluster randomised trials. Text messaging reminders are likely to result in modest improvements in influenza vaccine uptake, but levels of patients being texted need to markedly increase if text messaging reminders are to have much effect. TRIAL REGISTRATION NUMBER ISRCTN48840025.
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Affiliation(s)
- Emily Herrett
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Tjeerd van Staa
- Health eResearch Centre, Farr Institute, University of Manchester, Manchester, UK
- Faculty of Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Michael Ranopa
- London School of Hygiene and Tropical Medicine, London, UK
| | - Caroline Free
- London School of Hygiene and Tropical Medicine, London, UK
| | - Tim Chadborn
- Health and Wellbeing Directorate, Public health England, Wellington House, London, UK
| | - Ben Goldacre
- London School of Hygiene and Tropical Medicine, London, UK
- Department of Primary Care Health Sciences, Centre for Evidence Based Medicine, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | - Liam Smeeth
- London School of Hygiene and Tropical Medicine, London, UK
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Dempsey AF, Zimet GD. Interventions to Improve Adolescent Vaccination: What May Work and What Still Needs to Be Tested. Am J Prev Med 2015; 49:S445-54. [PMID: 26272849 DOI: 10.1016/j.amepre.2015.04.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 04/02/2015] [Accepted: 04/02/2015] [Indexed: 02/03/2023]
Abstract
Since the development of the "adolescent platform" of vaccination in 1997, hundreds of studies have been conducted, identifying barriers to and facilitators of adolescent vaccination. More recent research has focused on developing and evaluating interventions to increase uptake of adolescent vaccines. This review describes a selection of recent intervention studies for increasing adolescent vaccination, divided into three categories: those with promising results that may warrant more widespread implementation, those with mixed results requiring more research, and those with proven effectiveness in other domains that have not yet been tested with regard to adolescent vaccination.
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Affiliation(s)
- Amanda F Dempsey
- Adult and Child Center for Outcomes Research and Dissemination Science program, University of Colorado Denver, Aurora, Colorado.
| | - Gregory D Zimet
- Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Sato APS. National Immunization Program: Computerized System as a tool for new challenges. Rev Saude Publica 2015; 49:39. [PMID: 26176746 PMCID: PMC4544423 DOI: 10.1590/s0034-8910.2015049005925] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 01/11/2015] [Indexed: 11/22/2022] Open
Abstract
The scope and coverage of the Brazilian Immunization Program can be compared with those in developed countries because it provides a large number of vaccines and has a considerable coverage. The increasing complexity of the program brings challenges regarding its development, high coverage levels, access equality, and safety. The Immunization Information System, with nominal data, is an innovative tool that can more accurately monitor these indicators and allows the evaluation of the impact of new vaccination strategies. The main difficulties for such a system are in its implementation process, training of professionals, mastering its use, its constant maintenance needs and ensuring the information contained remain confidential. Therefore, encouraging the development of this tool should be part of public health policies and should also be involved in the three spheres of government as well as the public and private vaccination services.
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Affiliation(s)
- Ana Paula Sayuri Sato
- Departamento de Epidemiologia. Faculdade de Saúde Pública. Universidade de São Paulo. São Paulo, SP, Brasil
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Abstract
Older adults aged 65 years and over are particularly vulnerable to seasonal influenza as their immune system is weaker than that of younger adults. The influenza vaccination helps to reduce influenza severity and the incidence of complications, but a range of factors can affect uptake among older people. These factors can be categorised as follows: the system of vaccination; influenza vaccination mistrust and fear of side-effects; health beliefs and behaviours; and other factors. Various interventions to maximise influenza vaccination uptake among older people in the community have been identified, including: interventions to increase community demand, enhance access and improve influenza vaccination among community nurses, as well as provider or system-based interventions and societal interventions. Community nurses have been found to have a positive influence on influenza vaccination uptake and should continue to promote the benefits of influenza vaccination to their patients who are 'persistent decliners'.
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Affiliation(s)
- Savita Bakhshi
- Research Associate, Florence Nightingale Faculty of Nursing and Midwifery, King's College London
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