Including health literacy in 160 characters or less: Creating a text messaging system for immunization education

BACKGROUND: Programs that promote the 4-3-1-3-3 shot series among children two years old and younger greatly reduce preventable childhood diseases. In the past, computers have generated automated calls and e-mails for appointment reminders to families. However, these programs require access to computers, which most low-income, non-English-speaking families may not have. Mobile phones are accessible and widely used among all income groups. Because of this, texting messaging reminders and related immunization information might help increase parental health literacy regarding immunizations. OBJECTIVE/PURPOSE: The purpose of this study was to develop an intervention to improve parent's health literacy through an innovative text messaging system regarding immunization schedules for kids. METHODS: Structured interviews were held with 50 English- and 50 Spanish-speaking parents. The interview included demographic information, questions about current technology use and ability, and the S-TOFHLA. Participants then engaged in one of three human factors assessments (card sort, needs analysis or comprehension testing) to help identify optimal content for text messages. RESULTS: Parents can differentiate between what is critical information (e.g. physician's name and phone number) and what is unnecessary information (e.g. how the vaccine-preventable disease spreads). In addition, health literacy appears to be less than “adequate” in the Medicaid population and this may influence the critical information that should appear in text messages for immunization reminders. In addition, Spanish-speaking parents identified slightly different optimal content for messages than English-speaking parents. DISCUSSION/CONCLUSIONS: This study successfully utilized human factors strategies in the creation of culturally sensitive immunization schedule information to enhance parental health literacy regarding immunizations and increase the use of this preventive care in underserved children.