Structured Interviews Regarding Immunization Communication and Text Message Reminders
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Abstract
Background
Adherence to childhood immunization schedules is likely a function of various factors, including parents’ health literacy skills, immunization knowledge, perceived quality of patient-provider communication, and preferences for communication methods. Given the increased use of technology as a strategy to increase coverage, it is important to investigate how parents perceive communication forms, such as text-message reminders, as compared to more traditional means. Our objective is to examine the forms of communication about immunization information, patients’ satisfaction levels with these communication modes, and perceived barriers and benefits to using text-messaging.
Methods
Structured parent interviews were developed and approved by two local Institutional Review Boards. Parents were recruited from two local pediatric clinics. The interview included demographic information, a health literacy assessment, and questions regarding technology. The interviewer elicited information on text-messaging, communication with their child’s physician, and sources of immunization information. Participants were asked whether they would be willing to receive text-message immunization reminders from their child’s provider, and to identify benefits and barriers of text communication. Content analysis was performed on questions regarding text-message immunization reminders; responses to “barriers†and “benefits†of text-message-based reminders were classified using emergent coding methods (kappas>0.70).
Results
The majority of respondents were female (45; 90%), White non-Hispanic (31; 62%), with one or two children (range 1 - 9). Participant age ranged from 20 to 41 years old (M=29, SD=5). Nearly all participants (48; 96%) had an S-TOFHLA score in the Adequate range (>22 out of 36). Regarding current communication with their child’s physician, all (100%) parents engage in face-to-face contact at the appointments, 74% (37) reported communication via telephone, and no (0; 0%) parents reported e-mail or text communication. Most parents were satisfied with the face-to-face (96%) and telephone (75%) communication. Parents reported getting the majority of information about immunizations for their child at doctor’s appointments (39; 78%). Ninety-eight percent (49) of participants were interested in receiving immunization reminders by text-message, and 100% were willing to receive general appointment reminders by text-message. Parents made 127 comments suggesting benefits of text message reminders. The largest category of comments was “Technologyâ€. Many comments in this category addressed a dislike for talking on the phone or checking voicemail. “Technology†was also the largest category regarding barriers to text message reminders with 43 of the 73 comments (59%). Many comments addressed barriers such as if a phone was turned off or lost or cost if parents utilized pay-per-text programs. Thirteen participants (26%) could not identify any barriers.
Conclusions
Most parents were satisfied with this form of 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. In addition, most of the barriers identified were not text specific. Most of the comments that could be applied exclusively to text-messaging were centered on cost if parents did not have unlimited texting.
Adherence to childhood immunization schedules is likely a function of various factors, including parents’ health literacy skills, immunization knowledge, perceived quality of patient-provider communication, and preferences for communication methods. Given the increased use of technology as a strategy to increase coverage, it is important to investigate how parents perceive communication forms, such as text-message reminders, as compared to more traditional means. Our objective is to examine the forms of communication about immunization information, patients’ satisfaction levels with these communication modes, and perceived barriers and benefits to using text-messaging.
Methods
Structured parent interviews were developed and approved by two local Institutional Review Boards. Parents were recruited from two local pediatric clinics. The interview included demographic information, a health literacy assessment, and questions regarding technology. The interviewer elicited information on text-messaging, communication with their child’s physician, and sources of immunization information. Participants were asked whether they would be willing to receive text-message immunization reminders from their child’s provider, and to identify benefits and barriers of text communication. Content analysis was performed on questions regarding text-message immunization reminders; responses to “barriers†and “benefits†of text-message-based reminders were classified using emergent coding methods (kappas>0.70).
Results
The majority of respondents were female (45; 90%), White non-Hispanic (31; 62%), with one or two children (range 1 - 9). Participant age ranged from 20 to 41 years old (M=29, SD=5). Nearly all participants (48; 96%) had an S-TOFHLA score in the Adequate range (>22 out of 36). Regarding current communication with their child’s physician, all (100%) parents engage in face-to-face contact at the appointments, 74% (37) reported communication via telephone, and no (0; 0%) parents reported e-mail or text communication. Most parents were satisfied with the face-to-face (96%) and telephone (75%) communication. Parents reported getting the majority of information about immunizations for their child at doctor’s appointments (39; 78%). Ninety-eight percent (49) of participants were interested in receiving immunization reminders by text-message, and 100% were willing to receive general appointment reminders by text-message. Parents made 127 comments suggesting benefits of text message reminders. The largest category of comments was “Technologyâ€. Many comments in this category addressed a dislike for talking on the phone or checking voicemail. “Technology†was also the largest category regarding barriers to text message reminders with 43 of the 73 comments (59%). Many comments addressed barriers such as if a phone was turned off or lost or cost if parents utilized pay-per-text programs. Thirteen participants (26%) could not identify any barriers.
Conclusions
Most parents were satisfied with this form of 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. In addition, most of the barriers identified were not text specific. Most of the comments that could be applied exclusively to text-messaging were centered on cost if parents did not have unlimited texting.
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