Text Messaging for Immunizations
Edward M. Castillo, PhD, MPH
San Diego Beacon Community
Department of Emergency Medicine
University of California, San Diego
Project Goals
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Assess the feasibility of using short message service (SMS), or text messaging for population health in a community clinic population
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Assess the feasibility of utilizing the regional immunization registry for immunization forecasting
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Randomized trial to assess the impact of SMS on childhood immunization rates 2
Target population
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Community Clinic Population
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Be at least 18 years of age
Primary caregiver of a child approximately 12 month of age
Have a personal cell phone
Have an ability to send and receive text messages on their cell phone at enrollment
Indicate English or Spanish as primary language
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Clinic Participation
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Collaborating Community Clinics 
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San Diego Immunization Registry (SDIR) reporting
Supported by the San Diego Beacon Community in HRSA funding
Interested in the San Diego Regional HIE
Low immunization rates (<70%)
Staff Support
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Minimal impact on staff workflow
Enrollment by Beacon staff
$10 reimbursement per month 4
Texting Platform Architecture
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Text Messages
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4 targeted messages/month
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Intervention Group
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English or Spanish
1st requiring a response
Incorporating SDIR (manually), education, and well‐
baby visit appointment reminder
Control Group
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Age specific general milestone and health information
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Study Data and Outcomes
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Study screening questionnaire
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Contact and Demographic survey
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Eligibility, willingness and texting capability
Demographics, type of texting plans, service providers
Pre/post study survey
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Vaccination status, health engagement, use of IT for healthcare education
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Study Data and Outcomes
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Satisfaction survey
SDIR reported vaccination status at 19 month of age
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4 DTaP, 3 Polio (IPV), 1 MMR, 3 Hib, 3 HepB, 1 Varicella, + 4 Pneumococcal Other data
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2‐way message replies
No response follow‐up/loss to follow‐up 10
Participant Enrollment
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Preliminary Results
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480 patients screened, 143 enrolled
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Reasons not enrolled: age, technical issues with SMS platform, not primary clinic 89% thought messages helped them remember to schedule appointments
98% thought messages help them remember to keep appointments
Chart review required for immunization status
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Not currently feasible to use for real time immunization forecasting
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Implications for Public Health
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Potential for PH:
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Using SMS for public health interventions is feasible in this population
Using SMS for immunization education and appointment reminders Using SMS for real time forecasting and reporting within a clinic system and potentially an HIE given more complete records
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Acknowledgments
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Theodore Chan, MD
Anupam Goel, MD
Kevin Patrick, MD
Amy Pan, PhD
Participating Community Clinics
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Borrego Health
Children’s Primary Care Medical Group, Inc
Neighborhood Healthcare
Operation Samahan
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Contact Info
Edward Castillo, PhD, MPH
Assistant Professor
Department of Emergency Medicine
University of California, San Diego
emcastillo@ucsd.edu
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