Asking parents how they want to be reminded of the need for their child’s second dose of the human papillomavirus (HPV) vaccine appears to increase the likelihood of their child completing the three-dose series, a recent study found.

“For the promise of the HPV vaccine to be realized, rates of vaccine initiation and series completion must be markedly increased,” wrote Dr. Allison Kempe of the University of Colorado, Aurora, and her associates. “Results of this study demonstrate that preference-based recall could have a major impact on increasing HPV series completion rates and in increasing the timeliness of full vaccination” (Pediatrics. 2016 Feb 26. doi: 10.1542/peds.2015-2857 ). “The intervention was most effective for younger adolescents, and reminding the adolescent, in addition to the parent, did not increase effectiveness.”

The researchers randomly assigned three pediatric practices from Kaiser Permanente Colorado to offer usual care and four practices to the intervention, during January to June 2013. They limited the practices to those with a similar proportion of African American and Hispanic patients, a similar number of patients aged 11-17 years, and a similar proportion of Medicaid-covered patients. At the start of the study, the intervention sites had an 18% rate for the first dose of the HPV vaccine and a 6% series completion rate, compared with 20% and 7%, respectively, at the control sites.

When parents brought their children in for the first dose of the HPV vaccine, staff at the intervention practices asked the parents if they wanted to receive a reminder about the next dose. If they did, they chose whether they wanted a text message, an email, or an automated phone message (they could choose up to two) and whether they wanted their child contacted as well. Parents of 43% of the 867 eligible adolescents participated.

The researchers compared HPV vaccines series completion rates between those 374 adolescents and the 555 eligible adolescents at the control practices. At the intervention practices, 83% of the teens received the second dose, and 63% completed the vaccine series. At the control practice, 71% of the teens received the second dose, and 38% completed the series – similar to the 33% completion rate of unenrolled teens at the intervention practices. Overall, 46% of all the teens – enrolled and unenrolled – at the intervention practices completed the series, compared with 38% at the control practices – for an adjusted risk ratio of 1.22 (P less than .01)

The most popular recall method was text messaging alone, requested by 39% of parents and particularly preferred by parents of Hispanic adolescents. Both text and email were requested by 19% of parents, while 18% of parents requested email only, 9% requested text and phone, and 9% requested phone only. Only 6% requested phone and email, yet this was the only recall method associated with higher series completion rates that significantly differed from the other methods. Nearly one in five parents (19%) requested the practice to remind their child too, but these reminders had no apparent impact on completion rates.

“Whether this method [of preference-based recall] could also increase initiation of the series also should be examined, as barriers to initiation and to completion have been shown to differ,” the authors wrote.

The Centers for Disease Control and Prevention funded the study. The authors reported no disclosures.


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