Using SMS to increase vaccination rates among secondary school kids

In a world where preventable diseases claim countless young lives, ensuring the well-being of our children has never been more critical. Reflecting the United Nations’ Sustainable Development Goal (SDG) 3 - Good Health and Well-being - the Australian Government’s National Immunisation Program funds a variety of vaccines, including the three-dose Human Papillomavirus (HPV) vaccine. Yet, current vaccine levels are below the required amount for herd immunity.

In Victoria, the HPV vaccination is delivered by local councils through secondary schools. However, many students whose parents or guardians have consented to the vaccination are not getting all three doses, partly because some of them miss the school session.

Councils don’t usually send reminders prior to school visits. However, research in similar contexts has shown it may be an effective way of improving vaccination rates.

Australia’s immunisation program provides funding for an array of vaccines, including the three-dose Human Papillomavirus (HPV) vaccine which protects against genital warts and most cervical cancers. In Victoria, this is federally funded and administered by the local government to secondary school kids in year 7.

At the time of this study, vaccine levels were under 80%, which is the target required for herd immunity. Behavioural science offers strategies for policymakers to achieve their health goals, such as parent reminders via email, letter or SMS, to the parents or guardians of adolescent children who are due or overdue for the vaccine. Reminder strategies are important for adolescent populations who have less contact with healthcare providers and are less likely to be informed

The challenge:
How to get secondary school students to get all three doses of the HPV vaccine
Department of Premier and Cabinet (Public Sector Innovation Fund and Behavioural Insights Unit) and Department of Health & Human Services.

What did we do?

We investigated the effectiveness of Short-Message-Service (SMS) reminders in increasing vaccination rates by conducting a Randomised Controlled Trial with 4,386 students whose parents/guardians had consented to vaccination.

The parents/guardians were allocated into three groups. Two groups received SMS messages. One message used a motivational technique (i.e. noting the importance of vaccines to prevent diseases) while the other used self-regulatory framing (i.e. encouraging the receiver to make a plan). The third (control) group did not receive an SMS.

What did we find?

The research revealed that SMS reminders improved vaccination rates by 3.29% in the intervention groups. 

This may sound like a small increase but is significant in the broader context and may be a useful technique in contributing to ‘herd immunity’ – the point at which enough of the population is vaccinated to eliminate a communicable disease over time.

What's next?

Based on the findings, SMS reminders to parents/guardians lead to greater uptake of HPV vaccination in Victoria. The results of the trial underscore for policymakers the value of utilising both new media and behavioural science interventions. By pairing this with regulation, this can increase the uptake of vaccination rates. 

While the trial resulted in lifted vaccination rates, there remains scope for enhancement. For example, the primary reason for a child missing the vax is that they’re not at school; a proposed recommendation is additional intervention approaches that seek to ensure student attendance may further reduce this gap

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