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Text Message Quality Improvement Project for Influenza Vaccine in a Low-Resource Largely Latino Pediatric Population

Sloand, Elizabeth; VanGraafeiland, Brigit; Holm, Annie; MacQueen, Augusta; Polk, Sarah

doi: 10.1097/JHQ.0000000000000190
Original Article

ABSTRACT Children with asthma are targeted for influenza vaccine because of their vulnerability to complications, particularly those with low income or family preference for Spanish language. We used text messaging to encourage caregivers to vaccinate. Participants were children (aged >6 months), predominantly low income and Latino, with an asthma diagnosis attending a pediatric clinic. Interactive text messages that described the vaccine and how to make an appointment were sent to parents in English or Spanish, January 2016 to April 2017. Year 1 messages were evaluated by the investigators considering vaccination results and evidence in the literature. Improvements for Year 2 included timing of message, clarity of message, and using the family language of preference. Messages went to 398 (Year 1) and 485 (Year 2) families. Sixty-four percent of families preferred English; 35% preferred Spanish. Children in Spanish-speaking families were significantly more likely than children in English-speaking families to be vaccinated, 66% versus 46%. Text messaging is a straightforward, low-cost health promotion strategy with potential to improve child health. Quality improvement efforts in outpatient settings with low-income and limited English proficiency families are needed. mHealth strategies may help address the needs of vulnerable populations. SQUIRE V.2.0 guidelines were used for manuscript writing and reporting.

For more information on this article, contact Elizabeth Sloand at

Supported by The Helene Fuld Leadership Program for the Advancement of Patient Safety and Quality at the Johns Hopkins University School of Nursing, which supported initial nursing student efforts in this project, and the Johns Hopkins Bayview Medical Center, which provided technical support. Neither supporting agency was involved in the decision to submit this article for publication.

The authors declare no conflicts of interest.

© 2019 National Association for Healthcare Quality
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