"Necesita una vacuna": what Spanish-speakers want in text-message immunization reminders.

Appointment reminders help parents deal with complex immunization schedules. Preferred content of text-message reminders has been identified for English-speakers. Spanish-speaking parents of children under three years old were recruited to develop Spanish text-message immunization reminders. Structured interviews included questions about demographic characteristics, use of technology, and willingness to receive text reminders. Each participant was assigned to one user-centered design (UCD) test: card sort, needs analysis or comprehension testing. Respondents (N=54) were female (70%) and averaged 27 years of age (SD=7). A card sort of 20 immunization-related statements resulted in identification of seven pieces of critical information, which were compiled into eight example texts. These texts were ranked in the needs assessment and the top two were assessed for comprehension. All participants were able to understand the content and describe intention to act. Utilizing UCD testing, Spanish-speakers identified short, specific text content that differed from preferred content of English-speaking parents.

Feasibility of a randomized controlled trial to evaluate Text Reminders for Immunization Compliance in Kids (TRICKs).

OBJECTIVE: To pilot test the Text Reminders for Immunization Compliance in Kids (TRICKs) program to evaluate its feasibility and potential to increase immunization coverage. DESIGN: Randomized controlled trial (RCT). SETTING: Pediatric clinic. PARTICIPANTS: Parents of newborns being discharged from a local hospital who intended to seek child health care at the University-sponsored pediatric resident and faculty clinic. INTERVENTION: Text message immunization reminders prior to immunization due dates. MAIN OUTCOME MEASURES: Receipt and timeliness of immunizations at 2, 4 and 6 months of age. RESULTS: Participants (N=90) were English (83%) or Spanish (17%) speaking. The majority were female (83%), on public insurance (59%), and had adequate health literacy (96%). Parents were married or a member of an unmarried couple (62%). Over 66% had a high school diploma or less. Greater numbers of intervention children received immunizations and were "on time" using per protocol analysis; though not statistically significance. Limitations include sample size, problematic text messaging software, and loss of phone service at 7 months for 40% of intervention parents. However, post-intervention interviews (N=18) indicated strong support for TRICKs; 83% found the text message reminders very helpful and 17% somewhat helpful. DISCUSSION: Pilot testing allowed us to assess processes, including recruitment, retention, and software, which will increase the success of an RCT. Software with built-in backup systems is needed for follow-up when mobile service is interrupted. However, in spite of limitations, immunization rates were higher in the text message reminder group, though not statistically significant. Parent support and interest was high. A fully powered RCT is needed with follow-up over the full 4-3-1-3-3-1 series. Based on our results, for 80% power where we expected 90% compliance in the intervention group and 80% in the control group we need 219 per group, plus increases to address drop out and loss of follow-up.

Parent opinions about use of text messaging for immunization reminders.

BACKGROUND: Adherence to childhood immunization schedules is a function of various factors. Given the increased use of technology as a strategy to increase immunization coverage, it is important to investigate how parents perceive different forms of communication, including traditional means and text-message reminders. OBJECTIVE: To examine current forms of communication about immunization information, parents' satisfaction levels with these communication modes, perceived barriers and benefits to using text messaging, and the ideal content of text messages for immunization reminders. METHODS: Structured interviews were developed and approved by two Institutional Review Boards. A convenience sample of 50 parents was recruited from two local pediatric clinics. The study included a demographics questionnaire, the shortened form of the Test of Functional Health Literacy for Adults (S-TOFHLA), questions regarding benefits and barriers of text communication from immunization providers, and preferred content for immunization reminders. Content analyses were performed on responses to barriers, benefits, and preferred content (all Cohen's kappas > 0.70). RESULTS: Respondents were mostly female (45/50, 90%), white non-Hispanic (31/50, 62%), between 20-41 years (mean = 29, SD 5), with one or two children (range 1-9). Nearly all (48/50, 96%) had an S-TOFHLA score in the "adequate" range. All parents (50/50, 100%) engaged in face-to-face contact with their child's physician at appointments, 74% (37/50) had contact via telephone, and none of the parents (0/50, 0%) used email or text messages. Most parents were satisfied with the face-to-face (48/50, 96%) and telephone (28/50, 75%) communication. Forty-nine of the 50 participants (98%) were interested in receiving immunization reminders by text message, and all parents (50/50, 100%) were willing to receive general appointment reminders by text message. Parents made 200 comments regarding text-message reminders. Benefits accounted for 63.5% of comments (127/200). The remaining 37.5% (73/200) regarded barriers; however, no barriers could be identified by 26% of participants (13/50). Parents made 172 comments regarding preferred content of text-message immunization reminders. The most frequently discussed topics were date due (50/172, 29%), general reminder (26/172, 26%), and child's name (21/172, 12%). CONCLUSIONS: Most parents were satisfied with traditional communication; however, few had experienced any alternative forms of communication regarding immunizations. Benefits of receiving text messages for immunization reminders far outweighed the barriers identified by parents. Few barriers identified were text specific. Those that were, centered on cost if parents did not have unlimited texting plans.

Using human factors techniques to design text message reminders for childhood immunization.

This study engaged parents to develop concise, informative, and comprehensible text messages for an immunization reminder system using Human Factors techniques. Fifty parents completed a structured interview including demographics, technology questions, willingness to receive texts from their child's doctor, and health literacy. Each participant was assigned to one user-centered design test: card sort, needs analysis, or comprehension. The majority of respondents were female (90%), White non-Hispanic (62%), and averaged 29 years (SD = 5). Nearly all (96%) had "adequate" health literacy. The card sort, an activity in which end users organize information into categories, identified six pieces of critical information. These were compiled into eight example texts, which were ranked in the needs assessment. The top two were assessed for comprehension, with 100% of participants able to understand the content and describe intention to act. Using user-centered design methods, the authors developed concise, informative text messages that parents indicated would prompt them to schedule their child's immunization appointment.

Physician impressions of using text message technology to increase vaccination compliance.

INTRODUCTION: Immunization schedules are complicated and difficult for parents to remember. Parents are willing to receive text message reminders. However, it is unknown whether physicians are willing to implement such a system. The purpose of this study was to evaluate the feasibility of a text messaging reminder system from the physician's perspective. MATERIALS AND METHODS: Surveys were distributed in the winter of 2009-2010 by e-mail, facsimile, and telephone interview to 149 family physicians and pediatricians who provide immunizations in Sedgwick County, Kansas. RESULTS: A 69% response rate was achieved. Nearly all (92%) respondents reported that they currently communicate information about immunization schedules to parents using traditional methods such as verbal reminders or appointment cards; however, none (0%) currently use text or email to generate reminders to parents. Even when asked to assume they had all of the necessary resources, almost one-third (31%) reported that they were "very unwilling" or "unwilling" to use a general text-messaging program, 43% were "neutral" or "undecided," and only 27% were "willing" or "very willing." Physician willingness to use a text-messaging program was not related to their reported gender (χ²(2)=0.224, p=0.894), specialization (χ² (2)=4.363, p=0.113), years in practice (F(2, 91)=0.435, p=0.149), or comfort level with technology (χ²(4)=1.861, p=0.761). CONCLUSIONS: There is a hesitancy to implement a text message reminder system for childhood vaccine schedules. This may be due to the lack of empirical evidence supporting the use of this technology for health reminders or the lack of willingness to implement another system. Further investigation is needed to determine why few physicians are willing to implement text messaging for immunization reminders.

Content of text messaging immunization reminders: what low-income parents want to know.

OBJECTIVE: The purpose of this project was to gather preliminary data on preferred content for text reminders sent to low-income parents. METHODS: A brief, IRB-approved survey was administered to 200 consecutive English-speaking parents of children under 6 years old at a Pediatric Residency clinic. Because text messages can hold only limited content, parents were given three example texts ranging from very basic to very specific information and asked to select the information they would wish to receive. RESULTS: Of the 190 parents (95%) who responded, 22.1% (42) were Hispanic and 76.3% (145) were non-Hispanic. Over 80% (153) received Medicaid. Of the 79.5% (151) of respondents interested in receiving text messages who responded to the question regarding content, nearly 50% (74) preferred Option 2, with the remaining respondents divided between Option 1 (43) and Option 3 (35). Results differed significantly between Hispanic and non-Hispanic respondents (χ(2)(2)=6.36, p=0.042). CONCLUSION: The majority of parents preferred a message containing the child's name, specific immunization information and physician information. However, Hispanic respondents were significantly more likely to endorse an option that included additional information. PRACTICE IMPLICATIONS: Text messaging may be an optimal vehicle for provider-patient communication, however cultural differences should be considered when developing messages.

Preliminary benefits of information therapy.

UNLABELLED: Information therapy (ie, information prescriptions) is a potential new tool for primary care physicians that could improve patient knowledge, decision making, and communication between physicians and patients. Although patients have access to numerous health-related articles online, the availability of this health information does not ensure improved knowledge or better health decisions by patients. Communication between patients and physicians is often limited and messages are commonly misunderstood. Information therapy offers a potential solution for the primary care environment. METHOD: Two employers, in different geographical locations of the Midwest, offered the MedEncentive program to employees and their dependents as a part of their health plans. This program also offers primary care physicians the opportunity to prescribe information to patients during office visits. Patients were then eligible to participate in this information therapy (Ix) through a Web-based platform. Both primary care physicians and patients were financially incentivized for participation. Physicians received a monetary stipend for prescribing evidence-based information therapy and patients were refunded part or all of their copayment for reading their condition-specific Ix and answering questions about knowledge, compliance, health status, and satisfaction with the care they received compared to the evidence from the Ix. RESULTS: Patients received information therapy from their primary care physicians and reported a high level of satisfaction with care, improved health status, and compliance with pharmaceutical prescriptions. DISCUSSION: This case study had a number of limitations and as such the results should be interpreted with caution. However, there is a need for an immediate solution as patient satisfaction with their care and compliance with pharmaceutical prescriptions continue to decrease, despite the amounts of widely available health information. These preliminary findings suggest that information therapy through a Web-based platform, augmented by doctor-patient mutual accountability, could be part of the solution for the current ambulatory health care environment.

Effects of therapeutic massage on the quality of life among patients with breast cancer during treatment.

OBJECTIVE: Therapeutic massage has demonstrated positive physical and emotional benefits to offset the effects of treatments associated with breast cancer. The goal of this study was to assess the impact of therapeutic massage on the quality of life of patients undergoing treatment for breast cancer. DESIGN: Using a pre/post intervention assessment design, this prospective, convenience sample pilot study measured anxiety, pain, nausea, sleep quality, and quality of life. Treatment consisted of one 30-minute treatment per week for 3 consecutive weeks. OUTCOME MEASURES: Instruments selected for this study were used in previous massage therapy studies to measure quality of life/health status and have documented validity and reliability. RESULTS: Participants experienced a reduction in several quality of life symptom concerns after only 3 weeks of massage therapy. Respondents' cumulative pre- and post-massage mean for state anxiety, sleep quality, and quality of life/functioning showed significant improvement. Among study participants, there was variability in reported episodes of nausea, vomiting, and retching; although participants reported decreased pain and distress, changes were non-significant. CONCLUSIONS: Therapeutic massage shows potential benefits for ameliorating the effects of breast cancer treatment by reducing side affects of chemotherapy and radiation and improving perceived quality of life and overall functioning.

An assessment of a pilot asthma education program for childcare workers in a high-prevalence county.

OBJECTIVE: To assess changes in knowledge, attitudes, and intentions among childcare workers before and after an asthma-management-education session. METHODS: Between May and August 2004 five asthma-education sessions were provided for childcare workers from Sonoma County, California. A total of 71 childcare workers came to the sessions. Before and after each session we assessed the participants' knowledge, attitudes, and intentions about asthma. RESULTS: Participant knowledge of asthma causes (eg, air quality, common cold) and interventions (eg, bronchodilators), asthma trigger control plans, ability to identify a child who needs medical attention for asthma, and comfort level with caring for a child with asthma increased significantly. Their knowledge about asthma triggers, early warning signs, and asthma control plans was high before and after the asthma education intervention. Their stated intentions to utilize their asthma knowledge were high before and after the training, which may indicate willingness to implement knowledge and attitude change. CONCLUSIONS: Asthma education can improve childcare workers' knowledge about asthma-control strategies and attitudes toward asthma interventions.