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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.

Background: Many studies assess provider-patient communication through text messaging; however, minimal research has addressed communication among physicians. The purpose of this study was to evaluate the use of text messaging by pediatric hospitalists., Materials and Methods: A brief, anonymous, electronic survey was distributed through the American Academy of Pediatrics Section on Hospital Medicine Listserv in February 2012. Survey questions assessed work-related text messaging., Results: Of the 106 pediatric hospitalist respondents, 97 met inclusion criteria. Most were female (73%) and had been in practice <10 years (67%). Ninety-one percent of responders used a smartphone. More than half sent (60%) and received (61%) work-related text messages, some (12%) more than 10 times per shift. More than half (53%) received work-related text messages when not at work. When asked to identify all potential work recipients, most often sent work-related text messages to other pediatric hospitalists (64%), fellows or resident physicians (37%), and subspecialists/consulting physicians (28%). When asked their preferred mode for brief communication, respondents' preferences varied. Many (46%) respondents worried privacy laws can be violated by sending/receiving text messages, and some (30%) reported having received protected health information (PHI) through text messages. However, only 11% reported their institution offered encryption software for text messaging., Conclusions: Physicians were using text messaging as a means of brief, work-related communication. Concerns arose regarding transfer of PHI using unsecure systems and work-life balance. Future research should examine accuracy and effectiveness of text message communication in the hospital, as well as patient privacy issues.

Objective: Identify perceptions regarding benefits of and barriers to receiving text messages for immunization reminders and preferred content for such text messages., Design: Structured interviews., Setting: Outpatient pediatric resident and faculty clinic., Participants: A convenience sample of 54 low-income urban Latino parents of children aged < or = 2 years., Main Outcome Measures: Parent perspectives on text message reminders., Results: Most respondents were female (70%), married (63%), and fluent only in Spanish (89%). Most (83%) had a health literacy score in the adequate range. All (100%) reported being interested in receiving immunization reminders by text message, and 81% reported being willing to receive general appointment reminders by text message. Parents made 72 comments regarding benefits of text message immunization reminders. The most common sub-category was usefulness of the reminders (53%). These comments reflected participants' busy schedules and the beneficial nature of text messages in reminding parents of appointments. Fifty-six comments were provided regarding barriers to receiving text message reminders. Most comments (77%) indicated no identifiable barriers. Twenty percent described barriers related to technology, such as costs or lack of text messaging service. Parents generated 108 comments regarding preferred content of reminders. The topics most frequently identified were appointment date and time (32%), names of the vaccines (19%), and the child's name (11%)., Conclusions: Low-income Latino parents perceive text message immunization reminders as a feasible alternative to more traditional forms of communication.

Background: Text messaging is a widespread, cost-effective method for communicating. It is widely used by both parents and teens. The study objective was to survey teens and their parents to assess the capability and willingness of teens to receive healthcare-related text messages from their physician., Subjects and Methods: Parents and teens (12-17 years old) at an adolescent clinic were asked to complete surveys. Surveys were available in hard copy or electronically (via Survey Monkey) using computer kiosks in the waiting room. Approval was received from two local Institutional Review Boards., Results: Of the 93 pairs who began the survey, 47 pairs (51%) qualified and completed both the teen and parent surveys. Over 85% of teens were willing to receive texts from their doctor. Teens were most interested in appointment reminders (81%), immunization reminders (53%), and general test results (for example, strep [53%]). Parents' willingness to allow teens to receive text messages directly varied by content. Many parents preferred to also receive a copy of any text message sent to their teen., Conclusions: Both parents and teens endorse using text messages for appointment reminders. Parents appear willing for their teens to receive some health information directly. Future research should evaluate the efficacy of using text messages for communication with teens to improve care and utilization of services for adolescents.

Appointment reminders help parents deal with complex immunization schedules. Preferred content of text-message reminders has been identified for English-speakers. Spanish-speaking parents of children under three years old were recruited to develop Spanish text-message immunization reminders. Structured interviews included questions about demographic characteristics, use of technology, and willingness to receive text reminders. Each participant was assigned to one user-centered design (UCD) test: card sort, needs analysis or comprehension testing. Respondents (N=54) were female (70%) and averaged 27 years of age (SD=7). A card sort of 20 immunization-related statements resulted in identification of seven pieces of critical information, which were compiled into eight example texts. These texts were ranked in the needs assessment and the top two were assessed for comprehension. All participants were able to understand the content and describe intention to act. Utilizing UCD testing, Spanish-speakers identified short, specific text content that differed from preferred content of English-speaking parents.

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.

Objective: To pilot test the Text Reminders for Immunization Compliance in Kids (TRICKs) program to evaluate its feasibility and potential to increase immunization coverage., Design: Randomized controlled trial (RCT)., Setting: Pediatric clinic., Participants: Parents of newborns being discharged from a local hospital who intended to seek child health care at the University-sponsored pediatric resident and faculty clinic., Intervention: Text message immunization reminders prior to immunization due dates., Main Outcome Measures: Receipt and timeliness of immunizations at 2, 4 and 6 months of age., Results: Participants (N=90) were English (83%) or Spanish (17%) speaking. The majority were female (83%), on public insurance (59%), and had adequate health literacy (96%). Parents were married or a member of an unmarried couple (62%). Over 66% had a high school diploma or less. Greater numbers of intervention children received immunizations and were "on time" using per protocol analysis; though not statistically significance. Limitations include sample size, problematic text messaging software, and loss of phone service at 7 months for 40% of intervention parents. However, post-intervention interviews (N=18) indicated strong support for TRICKs; 83% found the text message reminders very helpful and 17% somewhat helpful., Discussion: Pilot testing allowed us to assess processes, including recruitment, retention, and software, which will increase the success of an RCT. Software with built-in backup systems is needed for follow-up when mobile service is interrupted. However, in spite of limitations, immunization rates were higher in the text message reminder group, though not statistically significant. Parent support and interest was high. A fully powered RCT is needed with follow-up over the full 4-3-1-3-3-1 series. Based on our results, for 80% power where we expected 90% compliance in the intervention group and 80% in the control group we need 219 per group, plus increases to address drop out and loss of follow-up., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: Adherence to childhood immunization schedules is a function of various factors. Given the increased use of technology as a strategy to increase immunization coverage, it is important to investigate how parents perceive different forms of communication, including traditional means and text-message reminders., Objective: To examine current forms of communication about immunization information, parents' satisfaction levels with these communication modes, perceived barriers and benefits to using text messaging, and the ideal content of text messages for immunization reminders., Methods: Structured interviews were developed and approved by two Institutional Review Boards. A convenience sample of 50 parents was recruited from two local pediatric clinics. The study included a demographics questionnaire, the shortened form of the Test of Functional Health Literacy for Adults (S-TOFHLA), questions regarding benefits and barriers of text communication from immunization providers, and preferred content for immunization reminders. Content analyses were performed on responses to barriers, benefits, and preferred content (all Cohen's kappas > 0.70)., Results: Respondents were mostly female (45/50, 90%), white non-Hispanic (31/50, 62%), between 20-41 years (mean = 29, SD 5), with one or two children (range 1-9). Nearly all (48/50, 96%) had an S-TOFHLA score in the "adequate" range. All parents (50/50, 100%) engaged in face-to-face contact with their child's physician at appointments, 74% (37/50) had contact via telephone, and none of the parents (0/50, 0%) used email or text messages. Most parents were satisfied with the face-to-face (48/50, 96%) and telephone (28/50, 75%) communication. Forty-nine of the 50 participants (98%) were interested in receiving immunization reminders by text message, and all parents (50/50, 100%) were willing to receive general appointment reminders by text message. Parents made 200 comments regarding text-message reminders. Benefits accounted for 63.5% of comments (127/200). The remaining 37.5% (73/200) regarded barriers; however, no barriers could be identified by 26% of participants (13/50). Parents made 172 comments regarding preferred content of text-message immunization reminders. The most frequently discussed topics were date due (50/172, 29%), general reminder (26/172, 26%), and child's name (21/172, 12%)., Conclusions: Most parents were satisfied with traditional communication; however, few had experienced any alternative forms of communication regarding immunizations. Benefits of receiving text messages for immunization reminders far outweighed the barriers identified by parents. Few barriers identified were text specific. Those that were, centered on cost if parents did not have unlimited texting plans.

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 child's 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., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Introduction: Immunization schedules are complicated and difficult for parents to remember. Parents are willing to receive text message reminders. However, it is unknown whether physicians are willing to implement such a system. The purpose of this study was to evaluate the feasibility of a text messaging reminder system from the physician's perspective., Materials and Methods: Surveys were distributed in the winter of 2009-2010 by e-mail, facsimile, and telephone interview to 149 family physicians and pediatricians who provide immunizations in Sedgwick County, Kansas., Results: A 69% response rate was achieved. Nearly all (92%) respondents reported that they currently communicate information about immunization schedules to parents using traditional methods such as verbal reminders or appointment cards; however, none (0%) currently use text or email to generate reminders to parents. Even when asked to assume they had all of the necessary resources, almost one-third (31%) reported that they were "very unwilling" or "unwilling" to use a general text-messaging program, 43% were "neutral" or "undecided," and only 27% were "willing" or "very willing." Physician willingness to use a text-messaging program was not related to their reported gender (χ²(2)=0.224, p=0.894), specialization (χ² (2)=4.363, p=0.113), years in practice (F(2, 91)=0.435, p=0.149), or comfort level with technology (χ²(4)=1.861, p=0.761)., Conclusions: There is a hesitancy to implement a text message reminder system for childhood vaccine schedules. This may be due to the lack of empirical evidence supporting the use of this technology for health reminders or the lack of willingness to implement another system. Further investigation is needed to determine why few physicians are willing to implement text messaging for immunization reminders.