Carolyn R. Ahlers-Schmidt

Text messaging immunization reminders: Feasibility of implementation with low-income parents

Text messaging reminder systems are a cost-effective way of improving attendance in a variety of healthcare settings (Downer et al., 2006; Geraghty et al., 2008; Koshy et al., 2008; Leong et al., 2006). Due to the complicated nature of the child immunization schedule (Massoudi, 2003), and the penetration of mobile phones among hard-to-reach populations (Blumberg and Luke, 2008), text messaging may be a successful strategy to increase immunizations (Vilella et al., 2004). The only identified study regarding text message immunization reminders suggests parents of adolescents are open to receiving such text reminders (Kharbanda et al., 2009). However, this study involved focus groups of only 28 parents. A major public health goal is to increase immunization rates among children to 90% to prevent the circulation of vaccinepreventable diseases (Massoudi, 2003). In particular, programs that promote the 4-3-1-3-3 series among children 2 years of age and younger have been found to dramatically reduce the incidence of these diseases (Nelson et al., 2007). The purpose of this formative study was to determine the feasibility of developing text immunization reminders for parents of young children. A brief survey was administered to 200 consecutive parents of children under six years of age at a Midwestern Pediatric Residency clinic. The survey was approved by two local Institutional Review Boards. All questions were fixed response, and included current use of a cell phone, type of text messaging service, and interest in receiving text messages from health care providers. Finally, respondents provided demographic information. Surveys were completed by 190 parents (95%). The majority were female (165; 87%), had a high school diploma or less (114; 60%), had a household income less than

A Comparison of Perceptions of Fever and Fever Phobia by Ethnicity

20,000 a year (117; 62%), and received public insurance (153; 81%). Nearly all participants owned a cellular phone (174; 92%) and of those, 96% (167) could receive text messages. In addition, 81% (141) had an unlimited text messaging plan. Ninety percent (156) of cell phone owners would be open to receiving text messages from their doctor or nurse. Parents with unlimited text capabilities were more likely (97%) to be open to receiving text messages from health care providers than those with limited text plans (64%) (χ(1)=32.98, pb .001). Of those respondents who own a cell phone andwere interested in receiving text messages from their health care provider (156), 99% (155) would be open to receiving appointment reminders, 87% (135) immunization reminders, 76% (119) test results, and 46% (72) general health tips. Most respondents (136; 87%) would prefer to receive immunization reminders one week or less before the shots are due. Of those parents who would enroll in a text immunization reminder service, 19% (29) would pay up to

Improving Safe Sleep Environments for Well Newborns in the Hospital Setting

9.99 a year for the program, but the majority (97; 62%) would only enroll if the program was free or covered by insurance.

Content of text messaging immunization reminders: What low-income parents want to know

Background. The purpose of our study was to compare caregiver perceptions of fever between ethnicities in a population with a large percentage of Hispanics. Methods. A 20-item, cross-sectional survey was collected from English- and Spanish-speaking parents of children. Questions addressed level of parental worry, parental definition of fever and high fever, and other items related to fever and its potential outcomes and treatments. Results. Responses indicated 57% of all parents report being “very worried” when their child is febrile. Results also indicated that parental fear of fever varies by race. Worry was also significantly higher in parents of younger children, and in parents with fewer years of education. However, Hispanic ethnicity was the single most predictive factor for fever worry. Conclusions. Fever phobia continues to exist. The prevalence appears to differ by ethnicity, making it important for physicians to use every patient encounter for culturally sensitive fever education.

Using Human Factors Techniques to Design Text Message Reminders for Childhood Immunization

Objective. Following the “Back to Sleep” campaign, deaths from sudden infant death syndrome (SIDS) were reduced. However, SIDS and sleep-related deaths continue to occur. Studies demonstrate that modeling by health care workers influences parents to place infants supine for sleep. Recently, additional emphasis has been placed on environment. The purpose of this study was to improve sleep position and environment in the hospital. Methods. A Plan-Do-Study-Act cycle was initiated. Sleeping infants were observed at baseline. A bundled intervention was implemented; infants were again observed. Parents were surveyed. Results. At baseline, 25% (36/144) of sleeping infants were safe; the majority of unsafe sleep was a result of environment. Postintervention, significantly more (58%; 145/249) had safe sleep (P < .0001). Most parents planned to use the supine position (95%; 96/101); none planned to cosleep. Many intended to adjust their infants’ home sleep environment. Conclusion. Using a multifaceted approach significantly improved infant safe sleep practice in the hospital setting.

Text Messaging to Motivate Exercise Among Latino Adults at Risk for Vascular Disease: A Pilot Study, 2013

OBJECTIVE The purpose of this project was to gather preliminary data on preferred content for text reminders sent to low-income parents. METHODS A brief, IRB-approved survey was administered to 200 consecutive English-speaking parents of children under 6 years old at a Pediatric Residency clinic. Because text messages can hold only limited content, parents were given three example texts ranging from very basic to very specific information and asked to select the information they would wish to receive. RESULTS Of the 190 parents (95%) who responded, 22.1% (42) were Hispanic and 76.3% (145) were non-Hispanic. Over 80% (153) received Medicaid. Of the 79.5% (151) of respondents interested in receiving text messages who responded to the question regarding content, nearly 50% (74) preferred Option 2, with the remaining respondents divided between Option 1 (43) and Option 3 (35). Results differed significantly between Hispanic and non-Hispanic respondents (χ(2)(2)=6.36, p=0.042). CONCLUSION The majority of parents preferred a message containing the childs name, specific immunization information and physician information. However, Hispanic respondents were significantly more likely to endorse an option that included additional information. PRACTICE IMPLICATIONS Text messaging may be an optimal vehicle for provider-patient communication, however cultural differences should be considered when developing messages.

Internet-Based Information on Long-Acting Reversible Contraception for Adolescents

This study engaged parents to develop concise, informative, and comprehensible text messages for an immunization reminder system using Human Factors techniques. Fifty parents completed a structured interview including demographics, technology questions, willingness to receive texts from their child’s doctor, and health literacy. Each participant was assigned to one user-centered design test: card sort, needs analysis, or comprehension. The majority of respondents were female (90%), White non-Hispanic (62%), and averaged 29 years (SD = 5). Nearly all (96%) had “adequate” health literacy. The card sort, an activity in which end users organize information into categories, identified six pieces of critical information. These were compiled into eight example texts, which were ranked in the needs assessment. The top two were assessed for comprehension, with 100% of participants able to understand the content and describe intention to act. Using user-centered design methods, the authors developed concise, informative text messages that parents indicated would prompt them to schedule their child’s immunization appointment.

One Community’s Perspective on the Withdrawal of Cough and Cold Medications for Infants and Young Children

In 2013, we administered a 15-item survey to determine the extent of text message usage among Latino adults in Kansas; for a subset of the survey participants, we also conducted a 6-week pilot trial to determine the effect of text messaging on exercise behaviors. Among the 82 survey participants, 78% had unlimited text messaging. At baseline, all trial participants were at the stage of contemplation; at 6 weeks, one (9%) trial participant remained at the contemplation stage and the other 10 (91%) participants progressed to the action/maintenance/termination stage. Use of text messaging to motivate exercise is feasible and potentially efficacious among Latinos.

Exposing compassion fatigue and burnout syndrome in a trauma team: a qualitative study

Background:Long-acting reversible contraception (LARC) is safe, effective, and recommended as first-line contraception for adolescents. Despite clear medical recommendations, the type and quality of Internet information regarding LARC for teenagers is unknown. Methods: Data were collected through web queries. Resulting websites were assessed for quality criteria and a priori content themes based on the leading medical societies’ recommendations for adolescent LARC. Results: Of the 238 websites evaluated, 77% made no recommendation of LARC for adolescent females. Of the 55 websites that did recommend LARC, only 40% specifically discussed its use in the adolescent population. Of note, 16% of websites recommending LARC discouraged their use in adolescents. Quality varied among LARC-discussing websites, ranging from 3 to 13 of the 15 criteria assessed. Discussion: Few websites offer up-to-date information regarding the use of LARC, and most fail to discuss LARC use at all. As LARC is highly effective in preventing unplanned pregnancies in adolescents, incomplete or inaccurate information on the Internet present a barrier to promoting its utilization in this at-risk population.

Necesita Una Vacuna: What Spanish-Speakers Want in Text-message Immunization Reminders

The study goals were to assess, via survey (a) parental knowledge regarding the use of over-the counter (OTC) cough and cold medicines in children younger than the age of 6 years and (b) the effects of the Food and Drug Administration (FDA) recommendations on community pediatricians following voluntary withdrawal of these medications. Of the 179 parents surveyed, approximately 60% had used OTC cough and cold medicines in the past, and many parents indicated an inappropriate dose when asked. Parents who were aware of the recall were significantly less likely to continue use (P < .05). All 33 physicians surveyed were aware of the withdrawal of these medications for children younger than age 2 years and most were aware of consideration to remove these medications for children <6 years old. A total of 15% of physicians reported that FDA considerations were likely to change their practice by reducing or discontinuing use of these medications, whereas 6% would continue recommending these medications.