BOSTON – A six month quality improvement project using personalized text message reminders to prompt patients about upcoming vaccinations demonstrated initial improvements in vaccine adherence at a community-based pediatric clinic, according to a researcher at the 2014 National Association of Pediatric Nurse Practitioners Annual Conference.

Approximately 33 million U.S. children live in wireless-only households (45.7%), but fewer than 20% of pediatric group practices currently have an immunization patient reminder system in place, Rachel Ness, DNP, C-NP, of the Medical University of South Carolina’s College of Nursing, reported during a poster session.

So Ness used the IVision Mobile Text Reminder System to send text message reminders at two times — one week and three days before vaccination due dates. Participants included a randomly selected cohort of 42 caregivers of infants aged younger than 30 days who had a mobile telephone number on file.

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The text-message reminder schedule adhered to the practice’s policy of vaccinating every six weeks. On-time vaccination was defined as participants who received a shot within 30 days of a specified due date. Participants were given the option to opt out with each reminder.

In the first six weeks of the project, there was a correlation between delivered text-message reminders and on-time vaccine adherence, Ness found.

Compared with historical data from the state-wide immunization database FLSHOTS, on-time vaccination increased from about 50% to 90% at the first three week immunization among the 33 participant who had confirmed delivered text messages, and from 75% to 95% at the six week immunization among the 42 patients with confirmed delivered messages.

However, improvements in immunization adherence declined at the 3 and 4.5 month marks to below preproject levels.

Overall, 65.2% of text messages were confirmed delivered, 23% were “buffered” and delivery was unable to  be confirmed, 8.2% failed to be delivered because phones were out of reach or turned off, and 6.3% could not be confirmed as either delivered or failed.

Participants who received “delivered” messages were more likely “on time” for multiple scheduled vaccines; whereas, those who received  “failed” or “buffered” receipts were less likely to be on time, the researchers found.

“Future projects should follow infants for longer lengths of time and focus on caregiver perception of the vaccination schedule,” Ness concluded.


  1. Ness RN. #W13. “Increasing Immunization Adherence in Infants through Text Message Immunization Reminders.” Presented at: 2014 National Association of Pediatric Nurse Practitioners Annual Conference. March 11-14, 2014; Boston.