A feasibility trial of parent HPV vaccine reminders and phone-based motivational interviewing

Abstract

Background We assessed the feasibility and acceptability of a sequential approach of parent-targeted HPV vaccine reminders and phone-based Motivation Interviewing (MI). Methods In 2016, we selected all 11- to 12-year-old boys and girls seen in one clinic whose vaccine records did not include the HPV vaccine (n=286). By gender, we individually randomized parents of adolescents to an interactive text message (74 girls and 45 boys), postcard reminder (46 boys and no girls because of previously demonstrated efficacy), or standard care group (75 girls and 46 boys). Reminders were sent with medical director permission and a HIPAA waiver. Two months after reminders, among the adolescents whose vaccine records still did not include the HPV vaccine, we selected a gender-stratified random sample of 20 parents for phone-based MI. We assessed the percentage of deliverable messages, the percentage of parents’ responding to the interactive text message, parent acceptability of receiving a text message, and MI parent responsiveness and interviewer competence (MI Treatment Integrity Coding system). Results Nearly all messages were deliverable (98% of postcards and 74% of text messages). Six of the 88 parents (7%) receiving text messages scheduled an appointment through our interactive system. The acceptability survey response rate was 37% (38/102). Respondents were favorable toward vaccine reminders for all parents (82%). Among 20 sampled parents, 17 were reached by phone of whom 7 completed MI, 4 had or were getting the HPV vaccine for their child, and 5 expressed disinterest. Across the 7 MI calls, the interviewer was rated 100% MI adherent and scored an average 4.19 rating for Global Spirit. Conclusion Without providing explicit consent to receive vaccine-related messages, parents nonetheless found postcards and interactive text messages acceptable. Centralizing MI to phone calls with trained staff was acceptable to parents and resulted in highly MI-adherent interviews.

Nudging toward vaccination: a systematic review

“…47 A study in the USA evaluated the use of reminders via postcards and text messages, including the conduct of motivational interviewing phone calls guided by a licensed clinical psychologist, which proved feasible and acceptable to parents who were targeted with HPV vaccine reminder messages. 48 The results echoed findings in another study in the USA that used 19 different text-based nudges (varied based on timing and contents of the messages) developed by behavioural scientists and designed to increase influenza vaccine uptake. 49 Overall, results showed a statistically significant boost in vaccination across the nudges, but the top-performing nudge was a reminder that said 'an influenza vaccine has been reserved for you', which was associated with an 11% increase in vaccination uptake.…”

“…use of motivational interviewing phone calls to parents to address commonly asked questions about vaccine. 48 …”

“…41 Reminders (vaccinations due soon) and recalls (vaccinations past due) increase coverage across populations, vaccines and mode of delivery: 1. use of personalised celebration card sent to parents/caregivers before their children's vaccination schedule; 46 2. directly sending individualised letters (in a coloured banner with aboriginal artwork and highlighting the word 'free') 47 or reminders via personalised letters, postcards or text message to increase vaccination uptake; 47-52 3. use of computer-based and phone-based software programs to generate automatic reminder text messages to parents; 53 54 4. use of an electronic health record-based decision support system for clinicians to receive an automated reminder to recommend initial or succeeding doses of vaccines to patients; 55-57 5. use of a familiar and trusted source (eg, own physician vs the national health system) to deliver vaccination reminders/recall; 60 61 6. use of improved screening tools and automatic provider notification or reminders; 58 7. use of an email prompt to spark vaccination intention among employees; 59 8. use of motivational interviewing phone calls to parents to address commonly asked questions about vaccine. 48 An invitation that recommends getting an early shot to increase vaccine effectiveness. 66 Emphasis on disease salience, disease threat and promotion of self-efficacy to increase intention to vaccinate via educational messages, videos or pamphlets among pregnant mothers and parents.…”

Short Message Service Reminder Nudge for Parents and Influenza Vaccination Uptake in Children and Adolescents With Special Risk Medical Conditions

“…Importantly, parental acceptability of the intervention was high, and this may inform any future adaptations of the intervention. The acceptability of reminders has previously been reported, such as text messages for early childhood vaccination and postcards and interactive text messages for human papillomavirus vaccines . A study that examined 3 delivery methods of vaccination reminders for adolescent vaccination found that although postal mail reminders were preferred by most participants, text messaging and email were more effective …”

Exploring HPV vaccine hesitant parents’ perspectives on decision-making and motivators for vaccination

“…Reno et al (2019) also found that motivational interviewing, coupled with a fact sheet, was helpful in motivating vaccination among hesitant parents [19] . However, motivational interviewing has been criticized for being time consuming and impractical [25] . Having resources available in advance for hesitant parents to review could help save time in the clinic.…”