title: Encouraging Influenza Vaccination Among Text4baby Pregnant Women and Mothers.
abstract: BACKGROUND
  Pregnant women, postpartum women, and infants are at high risk for complications from influenza. From October to November 2012, Text4baby, a free national text service for pregnant women and mothers of infants aged <1 year, implemented a module of interactive messages encouraging maternal influenza vaccination. A program evaluation examined whether a text-based reminder or tailored education improved self-reported influenza vaccination or intent to be vaccinated later in the influenza season among Text4baby participants.
  
  
  METHODS
  Nearly one third (28,609/89,792) of enrollees responded to a text asking about their vaccination plans. Those planning to receive vaccination were randomly assigned to receive an encouragement message or an encouragement message plus the opportunity to schedule a reminder (n=3,021 at follow-up). Those not planning to be vaccinated were randomly assigned to receive general education or education tailored to their reason for non-vaccination (n=3,820 at follow-up). The effect of the enhanced messages was assessed using multinomial logistic regression in 2013-2014.
  
  
  RESULTS
  A reminder increased the odds of vaccination at follow-up among mothers (AOR=2.0, 95% CI=1.4, 2.9) and of continued intent to be vaccinated later in the season (pregnant, AOR=2.1, 95% CI=1.4, 3.1; mother, AOR=1.7, 95% CI=1.1, 2.5). Among mothers not planning to be vaccinated because of cost, those who received a tailored message about low-cost vaccination had higher odds of vaccination at follow-up (AOR=1.9, 95% CI=1.1, 3.5). Other tailored messages were not effective.
  
  
  CONCLUSIONS
  Text reminders and tailored education may encourage influenza vaccination among this vulnerable population; both have now been incorporated into Text4baby.
authors.affiliation: School of Nursing, University of South Florida, Tampa, Florida; Johns Hopkins Global mHealth Initiative, Johns Hopkins University, Baltimore, Maryland. Electronic address: ejordan2@health.usf.edu.
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Jordan
authors.affiliation: National Healthy Mothers, Healthy Babies Coalition, Alexandria, Virginia.
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Bushar
authors.affiliation: Consultant, Decatur, Georgia.
authors.forename: Juliette S
authors.initials: JS
authors.lastname: Kendrick
authors.affiliation: Voxiva, Inc., Washington, District of Columbia.
authors.forename: Pamela
authors.initials: P
authors.lastname: Johnson
authors.affiliation: Biostatistics Center, Department of Biostatistics, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Jiangxia
authors.initials: J
authors.lastname: Wang
mesh_terms: D005260:Female; D006801:Humans; D017589:Immunization Programs; D007252:Influenza Vaccines; D011247:Pregnancy; D017010:Reminder Systems; D060145:Text Messaging
chemical_list: D007252:Influenza Vaccines