The Role of Text Messages in Patient-Physician Communication about the Influenza Vaccine

"Text messaging is a feasible tool to engage patients in their health and improve annual influenza vaccination rates among low-income, racial and ethnic minority patients."

In the United States (US) 2017 early-influenza season, only 38% of adults received the influenza vaccine, which is recommended for all US adults. This study explores whether the push-pull capacity model could be adapted to improve influenza vaccination communication between patients and physicians. In this context, an intervention "pushing" the patient to ask their physician about the influenza vaccination may then "pull" the physician into talking about or recommending the vaccine. As racial and ethnic minorities have been found to be more likely to have poorer communication with their physicians, adapting the push-pull model using text messages may help improve this communication especially among these groups.

This study was conducted June 2014 - February 2015 in a primary care clinic that serves low-income, mostly uninsured racial and ethnic minority patients. Overall, 98 (36%) of the 274 study participants had never received an influenza vaccination recommendation from their physician, 230 (84%) would be comfortable asking their physician for the vaccination, and 176 of 234 (75%) cell-phone-owning participants would be comfortable receiving a vaccination text message reminder. Furthermore, 51 of 98 (52%) participants who had never received an influenza vaccination recommendation would be comfortable asking their physician for the vaccination and could be prompted by a text message to do so (being cell phone owners).

According to the researchers, text messages may be particularly suitable for delivering vaccine information in healthcare settings. Texts can be tailored and delivered at a highly pertinent time, such as immediately before a patient enters the examination room. An example of a personalised text message could be: "Jane, even healthy adults can get the flu and spread it to loved ones. Remind Dr. Jones at your appointment today to talk to you about your yearly flu shot." Such a campaign may be more influential at prompting patients to ask for the influenza vaccination than static and non-personalised campaigns, epitomised by posters in a clinic that may simply go unnoticed among a sea of signs and that may not be relatable to the specific patient.

Another benefit of a text message campaign, the researchers assert, is that it can be integrated into the existing electronic medical record (EMR). Many EMR systems have the capability to send text messages. EMRs are able to extract patient name, physician name, appointment date and time, patient phone number, and lack of receipt of influenza vaccination - all of which can be used to personalise the text message. For healthcare systems that already use the EMR for appointment reminders, an influenza vaccination campaign could complement the existing reminder.

In conclusion, these findings suggest that a text message could "push" patients to "pull" their physicians into an influenza vaccination discussion. Future research could examine the optimal text message content to cue patients to engage in an influenza vaccination conversation with their physicians. Physician ordering of the vaccination after a patient prompt would also need to be assessed to provide empirical evidence supporting the push-pull model for influenza vaccination.