Modernizing Reminder Systems for Improving Update of Immunization of Children in Island Health

Brett Hodson, ManagerHelen Von Buchholz, Project LeaderTricia Fothergill, PHN Coordinator

June 9, 2015

Acknowledgements

Shelia Machin for the work she produced for her Master’s degree that helped push us to at least

try different things using social media and texting.

“…today, more than ever in the history of the world, we have the ability to tell our stories in an unfiltered way thanks to things like social media. We don’t have to depend on the mass media to pick up our message and hope they get the word out. We don’t have to hope that the right someone is in the right place when our tri-folds are placed on a folding table. We don’t have to be boring anymore”

-Jim Garrow

https://medium.com/rebel-public-health/public-health-is-boring-d7c9b9792787?source=featured

Why this Project?

• Nurses report an increase in client preference or reliance on text messaging for communication

• Increase emphasis on internet sources of information about vaccines and immunization

• Current emphasis on ‘recalling’ instead of ‘reminding’ clients to schedule child health clinic appointments

Goal of Project

“To determine the effectiveness of reminder systems (text messaging, social media, and enhanced clinic visit scheduling procedures) that results in children immunized on schedule through the intervention period when compared to current state.”

Objectives

• Standardized future state ‘intervention’ workflow for reminder systems using text messaging and social media.

• Improved parent satisfaction with Island Health reminder systems.

• Increased number of parents who proactively schedule and present at a child health clinic appointment.

• Reduced amount of time/effort put into recall (audit) activities directed at parents of children who are not immunized on schedule.

• Improved staff satisfaction with Island Health reminder systems

Expected Outcomes

• Effective, efficient modernized reminder system, leading to higher on-time immunization completion rates

• Reduction in the amount of resources dedicated to recall activities

• Satisfied clients and staff

What We Did

• Established project team with potential pilot sites (Saanich, Port Hardy, Nanaimo)

• Consolidated published peer review literature on text reminder systems

• Relied on information in Machin (2013) Public Health Nurse Use of Social Media to Promote Immunization.

• Conducted reference focus group sessions• Client Survey• Tested applications• Developed proposed future state workflow• Established social media planning infrastructure presence

Text Reminders: What We Learned• Permissive policy for texting if used for appointments, with

limited personal info

• Available literature was positive toward text reminders

• Focus group members and literature indicated texts needed to stick out from others and include specifics

“I get over a 100 texts a day. I won’t notice this one”

• 84% of survey participants (n=300) preferred phone call reminder for their appointment date as compared to e-mail (40%) or text message (17%).

Undaunted, we carried on…

• Tested the Immunizebc.ca text reminder application with focus group– Easy to make mistakes, unclear on how to correct them

(e.g. appointment date instead of birth date)– Updated appointment dates with erroneous info if

entered– Not confident in current state it would be successful– Recommendations for improvements sent to

Immunizebc.ca– Phone App suggested by focus group member so tested

immunizeCA smart phone app

Unfinished Business

• Did not carry on with text reminder project– Immunizebc.ca reminder application changes

were not implemented until late March 2015– Implemented changes, but still some issues with

messages received• Will complete test when all improvements

made

Social Media Platform

To become the established source of truth for vaccine, immunization, and public health information in the Nanaimo community

Promote on-time immunization

Project Start Up

• Lack of organizational infrastructure/support– Centralized communications model– Policy on use of social media by employees (not

programs)– No practical tools to guide use of social media

• Organization shifted to permissive distributed model of program based social media use

Tools Developed and Used

• Creating an Official Island Health Social Media Channel – Social Media Strategy Outline

• Social Media Posting and Etiquette Guide• Social Media Response Guidelines• Moderation Policy • Facebook Tips• Tear Sheets• Incentives

What We Learned

• Organizational inertia can get in the way of change• People respond to incentives

– Water bottles, gift cards• Paid Facebook ads generated relatively significant

benefit in a short period of time • Technology (browser limitations) got in the way• Establishment is easy, maintaining is where the work is• Hep A case at a local Superstore provided an

opportunity to coordinate immunization messages, and help Communications understand the operations better

Outcomes

• 409 “Likes” as of May 20, 2015– 563 on iboostimmunity– 755 on immunizebc– 2281 on Island Health

Next Steps• Continue with text reminder QI project• Conduct more rigorous evaluation of the

impact of social media as a tool for promoting on time immunization

• Identify opportunities to expand social media use in other communities

Contact Info

• e-mail: brett.hodson@viha.ca• Twitter: @hodson4qph