Improving Influenza Vaccination Rates in Nurses Through Electronic Text Message Reminders : a Randomised Controlled Trial

The Study aims to evaluate the efficacy of text messaging reminders in promoting influenza vaccination among nurses in a Hong Kong local hospital. The primary outcome is the receipt of influenza vaccine by end of February 2016 as reported by the participants. The secondary outcomes include the proportion of participants seeking out influenza vaccination and the proportion of participants of intervention group receptive to electronic text messaging communication and education. According to a study by WHO in 2005, influenza vaccines offer approximately 70-90% protection against clinical diseases in healthy adults. Despite the recommendation suggested by the CHP of Hong Kong that vaccination should be received by the high risks groups such as healthcare providers including nurses, vaccination rate of nurses is remained low with the Annual Seasonal Influenza Uptake Rate at 14.41% in 2013 in Hong Kong. This finding corresponded to those overseas studies that the influenza vaccine rate of nurses was among the lowest of all healthcare providers.

Although numerous interventions have been employed to promote Influenza vaccination, the cost of these approaches are high whilst have not resulted in the large or long-lasting increase that has been desired. Moreover, there are factors that inhibit nurses from receiving vaccination. Studies showed that nurses perceived themselves low risk from influenza. Other reasons such as misunderstanding and myths about influenza can be acquired from the vaccine, concerns about the efficacy and side effects of vaccine, and lack of time or forgot.

Nurses also perceived there is absence of an immediate threat to their health, especially for the younger nurses. Hence, tend not to seek out influenza vaccination. A study found that one of the stipulated reasons nurses for choosing to be vaccinated against influenza was their concern about spreading the disease to their patients if the nurses got influenza, which was the second highest reason other than concern about getting influenza themselves. The findings coherence with the caring nature of persons who entered nursing. Other findings also found that recall system and educational information with the emphasis on recommended vaccination are ranked as the second and third most effective strategies to improve or maintain vaccination coverage.

Nowadays, using electronic reminder system is not new to nurses in Hong Kong. The implementation of Clinical Dash Board was introduced about 10 years ago and has been used to generate messages to alert nurses to deal with their varied unfinished clinical works as well as appointment of the patients under their care. At the same time, mobile technologies were considered by many to be the next frontier in health behaviour change because they were considered to be the vehicles to deliver personal and adaptive health information anywhere in real time. It is suggested by some researchers that electronic text messaging might hold a more promising result in serving as a reminder. There is a growing body of researches on text messaging for a range of health and mental health problems. However, none of these studies reported on receiving text messages in promoting vaccination uptake of nurses, the single largest group of healthcare providers who close encounter with people that are highly susceptible to influenza and other upper respiratory diseases. It is the intention of this study to look into the issue so as to evaluate the efficacy of text messaging reminders in promoting influenza vaccination among nurses.

Subjects of the study included qualified nurses who are employed in a Hong Kong local hospital, owned smart phones with electronic text messaging function, and are willing to provide their active mobile telephone numbers. However, qualified nurses who have already received influenza vaccination prior the commencement of vaccination period of 2015-16, or who have history of allergies to egg, chicken proteins or neomycin or any component of vaccine, or who have history of moderate to severe reaction to influenza vaccination, or who have history of Guillain-Barré Syndrome will be excluded.