Study tests limits of public health texting efficacy

By Jonah Comstock

A , published in the journal Obstetrics and Gynecology, found that text messaging was ineffective at changing the minds of pregnant women who were not intending to get the influenza vaccine. In their study of 158 urban, low-income pregnant women, researchers found that text messages had no effect on whether expectant mothers got the vaccine, a treatment doctors consider to be especially important for expectant mothers.

"We know that pregnant women have a really increased risk, and we know that the vaccine is very safe and very effective, and despite that it's vastly underutilized," study author Dr. Michelle Moniz told

All participants in the study received health text messages regularly, containing tips and information about pregnancy. However, only the intervention group received text messages specifically educating and instructing them about the flu vaccine. In both groups, only 32 percent of women got the vaccine, according to the clinic's records.

The participants in the study were overwhelmingly low-income, uninsured, and unmarried women with a high school education or less, the kind of underserved population often targeted in texting interventions. The study specifically excluded women who had already gotten the vaccine, or who stated their intent to get it at their initial appointment.

The women's stated reasons for not receiving the vaccine might shed some light on why the text messages were ineffective. Twenty-three percent said they were afraid of vaccine side effects, 15 percent said they disliked shots, and another 15 percent said they had a previous bad experience with the flu vaccine.

With the exception of side effects, these aren't reasons that can necessarily be fixed with education. Text messages can be effective at reminding people of things they already know they should do, or for educating people about things they don't know. However, they might not be the best vehicle for persuading people to do something they have already decided against, for whatever reason.

"Despite these concerns, more than half [of the study participants] reported that they would get or consider getting the flu shot if it were recommended to them by their prenatal care provider," Moniz wrote in the paper. "The text messaging program assessed in this investigation did not translate into higher maternal vaccination rates, suggesting that it was not an effective replacement for direct face-to-face recommendation of influenza vaccination."

In actuality, Moniz told, the vaccine is considered very safe and effective and is recommended for pregnant women by both the CDC and the American College of Obstetricians and Gynecologists. There's even mounting evidence that the vaccine conveys neonatal benefits to the unborn child. Although the text messages in the intervention did include assurances about the safety and effectiveness of the vaccine, they didn't delve deeply into specifics, nor did they include any tailored messaging. Moniz believes that adjusting the content could have a better effect.

"This has been documented again and again in studies looking at influenza vaccination in obstetric populations," Moniz said. "The most powerful tool is clear, unequivocal support of a provider. ... It might be this intervention would work if we sent messages more frequently, or if we stated specifically 'your doctor (by name) wants you to get the flu shot.'"

Despite the lack of uptick in vaccination, the participants in both groups responded positively to the text messages, with 90 percent saying they liked the messages, 89 percent saying they found them helpful, and more than 70 percent saying the messages increased their satisfaction with their prenatal care.

"Although generally we're very enthusiastic about the technology, I think it's important that we continue to approach this in a rigorously scientific way and try to better understand the potential benefits and the potential limitations of this technology," Moniz told