667 - Parental Perceptions of Behavioral Science-Informed COVID-19 and Influenza Vaccine Text Messages: An AAP PROS Study

Publication Number: 667.5690

Celibell Y. Vargas, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Alessandra Torres, American Academy of Pediatrics, Itasca, IL, United States; Denise Smith Rodd, American Academy of Pediatrics, Itasca, IL, United States; Janani Ramachandran, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Everly Macario, American Academy of Pediatrics, Itasca, IL, United States; Donna L. Harris, AAP, itasca, IL, United States; Miranda Griffith, The American Academy of Pediatrics, Itasca, IL, United States; Alisa Stephens-Shields, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Mary Kate Kelly, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Tim Proctor, Physician's Computer Company, South Portland, ME, United States; Fabiana H. Izquierdo, Pediatric Associates, Plantation, Florida, Aventura, FL, United States; Alexander G. Fiks, Children's Hospital of Philadelphia, Merion Station, PA, United States; Melissa S. Stockwell, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States

Background: COVID-19 and influenza vaccination rates remain low. Vaccine text message reminders can improve rates, but little is known about what COVID-19 and influenza vaccine framing and content resonates most with families.

Objective: To assess parents’ reactions to various COVID-19 and influenza vaccine text message reminders.

Design/Methods: As part of the NIH-funded Text4Vax Study, we developed a series of 7 text message reminders based on our previous studies and the FrameWorks Institute’s Immunization Toolkit. Messages incorporated behavioral science principles (enhanced active choice, gain-frame, scarcity, social desirability, advanced planning) as well as the domains of the WHO Working Group’s Increasing Vaccination Model (what people think/feel, social processes, practical issues). Each message had up to 3 alternate phrasings (Fig 1). Parents of children 6 months-17 years-old were referred by 4 practices (PA, SC, TX, WY) from the AAP Pediatric Research in Office Settings (PROS) network to participate in pre-test interviews. During interviews, parents were texted messages to review, graded each A–F, rated how motivating the messages were and then suggested edits. Messages were iteratively refined and alternative messages with lower grades discarded. Interviews continued until saturation was achieved with parental endorsement of the final messages.

Results: We interviewed 18 parents (11 English/7 Spanish) who had 39 children (Table 1). All parents were interested in having multiple vaccines in one message. All parents preferred when messages included their child’s name but did not want multiple messages if they had more than one child. They wanted messages to include the practice’s name and phone number, and a number to call or a link to schedule appointments. Parents generally supported vaccine planning prompts and messages centered around not “missing out.” More parents preferred the mention of vaccines keeping their child healthy over vaccination being easy. More parents endorsed messages on how vaccines help get a body ready to challenge a virus and preferred those that talked about being “healthier when everyone is vaccinated” versus “protecting the community.” However, some families did not like messages about low vaccine supplies or ones that used metaphors related to software updates without more context.

Conclusion(s): Incorporating COVID-19 and influenza vaccine text message reminders into pediatric practices was supported by parents, who offered specific framing and content preferences that will inform implementation.

Table 1: Parent and Child Characteristics


Figure 1: COVID-19 and Influenza Vaccine Text Message Reminders