The role of human papillomavirus vaccination in promoting delivery of other preventive and medical services.

OBJECTIVE: Adolescents infrequently present for preventive health visits. The 3-dose human papillomavirus (HPV) vaccine may result in increased health care visits and thus indirectly improve health services for teens. We examined whether other health services were delivered in conjunction with the second (HPV2) or third (HPV3) dose of the HPV vaccine. METHODS: We conducted a chart review for girls 9 to 20 years of age (n = 571) who received HPV2 or HPV3 within 4 months of its due date at any of 9 clinical sites. Analyses were limited to the 422 visits (72%) where HPV vaccine was specified as a reason for the visit. A generalized linear model was used to evaluate the impact of site of care on delivery of other health services. RESULTS: Nearly half (43%) of adolescents received another medical or preventive health service at the time of HPV2 or HPV3 vaccine administration. Most common services were 1 or more other vaccines (30%) or medical services (35%). Older teens were more likely than younger teens to receive reproductive health services and sexually transmitted infection screening. After controlling for age and adjusting for clustering within sites, receiving care at an academic health center versus a private practice was strongly associated with increased odds of receiving other medical or preventive health services at follow-up (odds ratio 2.07; 95% confidence interval 1.44-2.97). CONCLUSIONS: Adolescents, especially those receiving care at an academic health center, often received other health services at the time of HPV2 or HPV3 vaccination. Because visits occurred within 6 to 8 months of the prior vaccine dose, our findings suggest vaccine visits may lead to improved delivery of adolescent health services.

Text message reminders to promote human papillomavirus vaccination.

OBJECTIVE: To implement and evaluate text message reminders for the second (HPV2) and third (HPV3) vaccine doses. DESIGN: Site-based intervention. SETTING: Nine pediatric sites (5 academic and 4 private) located in New York City. PARTICIPANTS: Parents of adolescents 9-20 years who received HPV1 or HPV2 during the intervention period, January-June 2009. INTERVENTION: Parents who enrolled received up to three weekly text message reminders that their daughter was due for her next vaccine dose. OUTCOME MEASURE: On-time receipt of the next vaccine dose, within one month of its due date. RESULTS: During the intervention period, of 765 eligible HPV vaccine events, 434 enrollment instructions were distributed to parents (56.7% of doses). Parents of 124 adolescent girls (28.6% of those handed instructions) activated text message reminders. Comparing children of parents who enrolled versus those who did not, on-time receipt of next HPV vaccine dose occurred among 51.6% (95% CI 42.8-60.4%) versus 35.0% (95% CI 29.6-40.2%) of adolescents (p=.001). Similarly, among a historical cohort of adolescents, receiving HPV1 or HPV2 in the six months prior to the intervention period, on-time receipt of next vaccine dose was noted for 38.1% (95% CI 35.2-41.0%) (p=.003). Increases in receipt of next vaccine dose among intervention subjects were sustained at 4 months following the vaccine due date. Using a logistic regression model, after controlling for insurance and site of care, intervention subjects were significantly more likely than either control population to receive their next HPV vaccine dose on-time. CONCLUSION: Among those choosing to enroll, text message reminders were an effective intervention to increase on-time receipt of HPV2 or HPV3.

Text4Health: a qualitative evaluation of parental readiness for text message immunization reminders.

We conducted focus groups and individual interviews in a diverse population of parents to qualitatively explore preferences and readiness for text message immunization reminders. We used content analysis to review and independently code transcripts. Text message reminders were well-accepted by parents; many thought they would be more effective than standard phone or mail reminders. Parents preferred text message reminders to be brief and personalized. Most parents were able to retrieve sample text messages but many had difficulty with interactive texting.