JMIR Publications

ABSTRACT

Background:

Completion rates among adolescents who initiate the human papillomavirus (HPV) vaccine 3-dose series are low. Text message vaccine reminders are effective, but less is known about best types for HPV series completion, or ability to assess/target vaccine decision-making stage.

Objective:

We compared effectiveness in HPV vaccine series completion for minority adolescents who received precision and educational versus conventional text message reminders.

Methods:

Enrolled parents of adolescents ages 9-17 who received the first HPV vaccine dose at one of four academic-affiliated community health clinics in New York City were randomized 1:1 to one of two parallel, unblinded arms: precision text messages (which included stage-targeted educational information, next dose due date, and site-specific walk-in hours) or conventional text messages without educational information. Randomization was stratified by gender, age, and language. The primary outcome was series completion within 12 months. In post-hoc analysis, enrollees were compared to concurrent non-enrollees and historical controls.

Results:

Overall, 956 parents were enrolled. The precision (475 families) and conventional (481 families) text message arms had similarly high series completion rates (72.4% vs. 75.7%). Forty-two days after the first dose, two-thirds of families not initially in preparation stage moved to preparation or vaccinated. Those in either text message arm had significantly higher completion rates than non-enrollees (n=1503) (74.1% vs 45.2%; P<0.0001). Even after removing those needing only 2 HPV doses, adolescents receiving any text messages had higher completion rates than historical controls (n= 2823) (71.1% vs. 34.8%; p<0.0001). A population-wide effect was seen from 2014-16, above historical trends.

Conclusions:

Text message reminders led to timely HPV vaccine series completion in a low-income, urban, minority study population, and also led to population-wide effects. Educational information did not provide added benefit in this population. Clinical Trial: PRISM is registered with ClinicalTrials.gov with identifier NCT02236273.