Improving influenza vaccination rates in nurses through electronic text message reminders : a randomized controlled trial

Abstract

Although the public health care service has reinforced yearly influenza vaccinations for health care providers for more than ten years, the vaccination rate of nurses remains low. Many interventions have been taken to improve influenza vaccination uptake rates but the cost of these approaches was high and they have not resulted in long-lasting increases. Studies have shown educational information focused on health behavioural determinants is an effective intervention in changing the health beliefs of nurses. Text messaging has been tested in a number of studies and found to be an acceptable, effective and cost-effective method of promoting various health behaviour changes. A randomised controlled trial was conducted to examine the effects of educational information developed using the Health Belief Model and delivered by electronic text messages to promote influenza vaccination uptake among nurses in Hong Kong. A total of 537 unvaccinated nurses who owned smart phones with the electronic text messaging function were recruited from a local acute care hospital in Hong Kong. They were randomised to receive the usual hospital promulgation information on influenza vaccination or additional weekly electronic text messages operated by a push app installed in the participants’ mobile phones which provided educational information on influenza and vaccination. Participants were required to complete pre-study questionnaires and were followed up by telephone after four months to ascertain their vaccination status. The primary outcome was the receipt of influenza vaccine. The secondary outcomes were the proportion of participants seeking out influenza vaccination, and the proportion of participants receptive to electronic text messages. A total of 403 (75.05%) participants completed the telephone follow-up. Overall, the influenza vaccination uptake rate was 22.2%. The vaccination rate was higher among participants in the intervention group than the control group (35.2% vs. 9.3%, p<0.001). The findings in this study are consistent with those from some previous studies in different targeted populations. There was an increase of 62.1% in the number of those who intended to get vaccinated and the number of participants reported to have the vaccination in the intervention group. Altogether, 57.7% of the intervention group agreed text messaging was suitable for receiving educational information. Among the text messages, statements that were developed according to the construct of perceived susceptibility of the Health Belief Model were reported to be the most compelling factor by participants in the intervention group who received the influenza vaccine. It is clear from this and other studies that mobile technology such as text messages can be used in strategies addressing problems resulting from poor medical adherence. Another possible focus of the contribution is enrichment in the development of educational information under the framework of the Health Belief Model targeted to different populations. This study offers a starting point for synergy in healthcare-led research on multi-component approaches in future vaccination programmes and researches related to various health promotion strategies.