Flutext 4 U - The effect of provider and parent strategies on influenza vaccination rates in children and adolescents with special risk medical conditions.

Flutext-4U will be the first study to examine influenza vaccination text messaging in the context of children who are medically at-risk of severe influenza complications. It has a high probability of making a significant contribution to the field. Flutext-4U addresses a major gap in our understanding of how text messaging may serve as an intermedium to mediate coverage. This research will support changes to the way preventative care for high-risk children is managed and meet the target group’s expectations of care. Increasing coverage in one of our most vulnerable populations will have a significant impact on influenza and all-cause respiratory hospitalisations. Any effects in coverage will assist other Australian jurisdictions. The trial is a randomised controlled trial (RCT) with two parallel arms, whereby participants are randomly allocated to either trial arm 1 (standard care group) or trial arm 2 (intervention group). Participants randomised to trial arm 2 will receive all specific interventions being studied. Trial Arm 1 is the comparator treatment receiving only tertiary practice / provider-level interventions. Trial Arm 2 (intervention group): Participants randomised to trial arm 2 will receive all of the Flutext-4U intervention components being studied during the implementation period of the study (April to July 2021): 1. Tertiary Practice / Provider-level interventions: Medical case note reminder prompts in the form of stickers on the front and bookmarks inserted into the clinical notes section of case notes. Participating clinicians from the departments of Respiratory, Cardiology, Diabetes, Rheumatology, Neurology and Gastroenterology will be responsible for confirming patients with a special risk medical condition and eligible for free influenza vaccination under the Australian Government Funded Annual Influenza Program and attending a hospital outpatient appointment between April and July 2021. The case note reminder prompts will be administered by the study coordinator and placed in the case notes of identified patients of participating clinicians (from the departments listed above) to facilitate vaccine recommendation for their patients identified as having a special risk medical condition and eligible for a free flu vaccine regardless of their age. 2. Ensuring vaccine availability and ease of access at the WCH (standard care): the study coordinator has engaged the Immunisation Nurses at the WCH Immunisation Clinic on level one (drop in centre) and the Vaccinology and Immunology Research Trials Unit Nurses to work together and provide support for the potential increase in demand to avoid having to turn people away or make them wait long periods of time. Availability of the vaccine will be monitored by the WCH Immunisation Nurses who will inform the study coordinator of anticipated arrival of the vaccine on site, ready for roll out and for the trial intervention period to begin. They will also monitor the availability of the vaccine throughout the trial intervention period to ensure stock is available. 3. Primary Care Provider-level interventions: one hard copy letter to communicate with the child’s treating (referring) GP advising them that the child is identified as having a special risk medical condition and is at an increased risk of serious influenza complications and seeking their assistance as part of the child’s treating team to improve influenza vaccine uptake. Letters will be sent once only by the study coordinator with help from the WCH ICT Applications staff to identify the GPs. Vaccination uptake among the trial population will be assessed on the Australian Immunisation Register (AIR) with the place of vaccine administration being included in the evaluation. A survey will also be sent to parents at the end of the trial intervention period to ask what prompted their decision to get the vaccine this year with 'GP advice' being a response option. 4. Parent-level interventions: Three SMS reminders (two-weeks apart, sent between April and the end of July 2021. Parental SMS text message reminders will be sent in a non-directive educational approach automatically to the child’s parent (on behalf of the WCH) advising them that their child/adolescent is eligible for funded influenza and where they can receive it. Text messages will cease once the child is immunised. Text messages will comprise: i) the influenza vaccination message reminder text, ii) an option to reply, if the vaccine has been received and iii) an influenza vaccine decision making question. As text messaging incurs a small cost it is important to determine whether parent SMS messaging achieves a clinically relevant increase in uptake or if other tertiary and primary provider based initiatives are more worthy of allocating resources.