Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia.
Vaccine Uptake Group, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia.
JAMA Pediatr. 2023 Apr 1;177(4):337-344. doi: 10.1001/jamapediatrics.2022.6145.
Children with chronic medical conditions are at increased risk of severe influenza. Uptake of influenza vaccination in children and adolescents with these identified special risk medical conditions (SRMCs) is suboptimal.
To assess the effectiveness of Flutext-4U, a parent short message service (SMS) reminder nudge intervention, in increasing influenza immunization in children and adolescents with SRMCs.
DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted at a tertiary pediatric hospital in Adelaide, South Australia, from April 15 to September 30, 2021. Children and adolescents aged 6 months to younger than 18 years with SRMCs and a subspecialist outpatient appointment over a 5-month period during the Australian seasonal influenza vaccination season (April-August 2021) were eligible to participate. Follow-up was until September 30, 2021.
Participants were randomly assigned (1:1 ratio) to control: clinician nudges (hospital vaccine availability, ease of access, and recommendation from hospital subspecialists) or SMS intervention (control conditions plus an additional SMS reminder nudge to parents), with randomization stratified by age group (<5 years, 5-14 years, or >14 to <18 years).
The primary outcome was influenza vaccination, as confirmed by the Australian Immunisation Register.
A total of 600 participants (intervention group: 298 [49.7%]; mean [SD] age, 11.5 [4.6] years; 162 female participants [54.4%]; control group: 302 [50.3%]; mean [SD] age, 11.4 [4.7] years; 155 female participants [51.3%]) were included. Influenza vaccination was 38.6% (113 of 293) in the SMS intervention group compared with 26.2% (79 of 302) in the control group (adjusted odds ratio [aOR], 1.79; 95% CI, 1.27-2.55; P = .001). Time to vaccine receipt was significantly lower among SMS participants (adjusted hazard ratio, 1.67; 95% CI, 1.25-2.22; P < .001). For participants randomly assigned by June 15, a significantly greater proportion receiving the SMS intervention were vaccinated during the optimal delivery period April to June 30 (SMS group: 40.0% [76 of 190] vs 25.4% [50 of 197]; aOR, 1.97; 95% CI, 1.28-3.06; P = .002).
Results of this randomized clinical trial suggest that an additional SMS reminder nudge for parents delivered in the tertiary care hospital setting to children and adolescents with SMRCs resulted in higher influenza vaccine uptake compared with clinician nudges alone.
ANZCTR Identifier: ACTRN12621000463875.
患有慢性疾病的儿童患严重流感的风险增加。患有这些确定的特殊风险医疗条件（SRMC）的儿童和青少年接种流感疫苗的比例并不理想。
评估 Flutext-4U（一种家长短信服务（SMS）提醒推干预措施）在增加患有 SRMC 的儿童和青少年流感免疫接种方面的有效性。
设计、设置和参与者：这是一项在南澳大利亚阿德莱德的一家三级儿科医院进行的随机临床试验，时间为 2021 年 4 月 15 日至 9 月 30 日。在澳大利亚季节性流感疫苗接种季节（2021 年 4 月至 8 月）期间，有 6 个月至 18 岁以下患有 SRMC 和专科门诊预约的儿童和青少年有资格参加。随访时间截至 2021 年 9 月 30 日。
参与者被随机分配（1:1 比例）至对照组：临床医生提示（医院疫苗的可及性、便利性和医院专家的推荐）或 SMS 干预（对照条件外加额外的 SMS 提醒推给父母），随机分组按年龄组（<5 岁、5-14 岁或>14-<18 岁）分层。
主要结局是通过澳大利亚免疫登记处确认的流感疫苗接种。
共有 600 名参与者（干预组：298[49.7%]；平均[SD]年龄，11.5[4.6]岁；162 名女性参与者[54.4%]；对照组：302[50.3%]；平均[SD]年龄，11.4[4.7]岁；155 名女性参与者[51.3%]）被纳入研究。在 SMS 干预组中，流感疫苗接种率为 38.6%（293 人中的 113 人），而在对照组中为 26.2%（302 人中的 79 人）（调整后的优势比[aOR]，1.79；95%CI，1.27-2.55；P = 0.001）。与对照组相比，接受 SMS 干预的参与者的疫苗接种时间明显缩短（调整后的危险比，1.67；95%CI，1.25-2.22；P < 0.001）。对于在 6 月 15 日前随机分配的参与者，在最佳交付期 4 月至 6 月 30 日期间，接受 SMS 干预的参与者中，有更大比例接种了疫苗（SMS 组：40.0%[190 人中的 76 人]与 25.4%[197 人中的 50 人]；aOR，1.97；95%CI，1.28-3.06；P = 0.002）。
这项随机临床试验的结果表明，与仅由临床医生提供提示相比，在三级护理医院环境中为患有 SRMC 的儿童和青少年提供额外的家长 SMS 提醒推可提高流感疫苗接种率。
澳大利亚新西兰临床试验注册中心标识符：ACTRN12621000463875。
