Table 2.

Sample messages and descriptions of educational content from patient-centered interventions

Authors	Year	Intervention	Sample Content or Description of Patient Specific Content	Results
Bushar et al. [25] Jordan et al. [33]	2017 2015	Text4Baby – a free national mobile health service for pregnant women that sends three weekly text messages for the duration of a woman’s pregnancy. In October 2012 Text4baby launched an interactive influenza module	Educational messages were tailored to specific concerns, for example if a woman was concerned about cost, she would get the following message: Low-cost flu shots are available this year. Talk to your doctor, health plan or local drug store. Or call CDC at 800-232-4636 for a location near you.	Tailored educational messages did not improve the likelihood of receiving the vaccine [33], but women who recalled the messages when surveyed later were 1.44 times more likely to have gotten vaccinated [25] APR = 1.44, 95% CI = 1.30, 1.58
Chamberlain et al. [42] Chamberlain et al. [43]	2015 2016	Randomized controlled trial testing a multi-component intervention that included interventions on the patient- (interactive iPad-based tutorial, maps to local pharmacies/health departments), provider- (provider-to-patient talking points, peer-to-peer vaccine promotion education) and practice-level (vaccine champions, lapel buttons, posters, brochures)	“Included text and audio/video content covering the importance of vaccination during pregnancy, dangers of influenza and pertussis to infants, safety of antenatal vaccination, timing of antenatal vaccination and an introduction to childhood vaccination. Videos included obstetric physicians talking about antenatal vaccination as well as two testimonials from mothers whose infants contracted influenza and pertussis”	Overall influenza acceptance: 9.0% Study-adjusted antenatal influenza RD: 3.6%, 95% CI: −4.0, 11.2
Frew et al. [35] Frew et al. [36]	2014 2014	Randomized controlled trial testing gain-framed messages versus loss-framed messages based in Prospect Theory	Gain-frame messages “…articulate maternal benefits associated with vaccination” Loss-frame messages “…illustrate negative consequences of foregoing immunization”	Gain vs. Loss: OR = 1.0353, 95% CI = 0.387, 2.767 Gain vs control: OR = 0.5176, 95% CI = 0.203, 1.322) Loss vs. control: OR = 0.5000, 95% CI = 0.192, 1.304
Frew et al. [37]	2016	Randomized controlled trial testing affective versus cognitive messaging (a video versus an iBook) based in the Elaboration Likelihood Model	Affective Messaging Intervention: “Pregnant Pause” – a nine-minute video featuring normative and persuasive influences Cognitive Messaging Intervention: “Vaccines for a Healthy Pregnancy” – an information dense, interactive tutorial	Pregnant Pause vs. Control: RR = 1.10, 95% CI = 0.30, 4.01 Vaccine for a Healthy Pregnancy vs. Control: RR=0.57, 95% CI = 0.11, 2.88
Goodman et al. [93]	2015	Randomized controlled trial testing impact of CDC created video Protect Yourself, Protect Your Baby	Short video addressing vaccine health beliefs that are predictive of vaccine behaviors	Intervention vaccine receipt: 28% Control vaccine receipt: 25% (p=0.70)
Hoppe et al. [31]	2011	Multi-component intervention to improve H1N1 influenza vaccine uptake among pregnant women in an obstetrics clinic	Influenza prevention video in waiting room to increase awareness of the virus. No description of written educational materials given.	76% of eligible patients received the vaccine (compared to national coverage of about 38%)
Jung et al. [26]	2016	Women were exposed to four paragraphs about the flu vaccine and intent to vaccinate was measured after each paragraph	The four paragraphs are summarized as follows: Pregnant women are at increased risk of sever disease and death from influenza Influenza vaccination will protect both pregnant women and their newborns against influenza Influenza vaccination is safe throughout pregnancy If the government offered the influenza vaccine free of charge, would you receive it?	56.0% planned to receive vaccine during next pregnancy (overall). Among previously vaccinated women intent to receive after the education paragraphs was as follows: 1. 63.9%, 2. 72.3%, 3. 66.3%, 4. 71.2%. Among unvaccinated women: 1. 16.3%, 2. 30.9%, 3. 23.4%, 4. 36.5%
McCarthy et al. [32]	2012	Retrospective assessment of a multi-component intervention that included education campaign for patients and providers,	English language patient brochure included information on the benefits, efficacy and safety of influenza vaccination during pregnancy	Influenza coverage increased from 30% to 40% from 2010 to 2011 (p = 0.03)
Meharry et al. [27]	2014	Randomized controlled trial testing the impact of an educational pamphlet on vaccine uptake and an additional statement on vaccine benefits	Pamphlet had information on the cover and six sections summarized below: 0. Cover – displayed a new mother holding her infant and conversing with a healthcare provider with the phrase “A Two-For-One Benefit” beneath 1. Overview of influenza 2. Risk of the disease to mother and unborn baby 3. Risk of disease for newborn baby 4. Safety of influenza vaccine 5. Additional prevention techniques 6. Additional resources Benefits statement: “If you have the flu shot during pregnancy, you will also help protect your baby against influenza from birth to 6 months”	66.9% overall were vaccinated; pamphlet-only (72.9%, p < 0.01), pamphlet+statement (86.1%, p<0.001), control (46.9%)
Moniz et al. [23]	2013	Randomized controlled trial testing impact of a text messaging program containing messages about influenza on top of general preventative healthcare messages	Text messages are described as including information “…addressing the benefits and safety of influenza vaccination during pregnancy.”	General Preventative Messages (31% vaccinated); Flu Messages (33% vaccinated); Percent difference = 1.7 (−11.1, 14.5) p = 0.88
Stockwell et al. [28]	2014	Randomized controlled trial evaluating a text-message intervention that included both educational text messages and text message reminders	The three messages that included educational information are summarized below: Pregnant women and their newborns are at an increased risk for influenza-related illness Vaccine safety Doctors recommend the influenza vaccine during pregnancy	Intervention (49.3%), Control (46.6%); Percent Difference 2.7% (95% CI: −3.2%, 8.6%); AOR = 1.3 (1.003, 1.69)
Wong et al. [29]	2016	Randomized controlled trial testing a one-on-one educational session versus a standard educational pamphlet	In person intervention covered the following topics: Influenza vaccine recommendations Complications associated with influenza infection during pregnancy Safety of influenza vaccination Potential benefits for pregnant women and infants Where and how to get the vaccine	Intervention (21.1%); Control (10.0%); RD = 11.1 (95% CI: 3.3–19.0, p=0.006)
Yudin et al. [34]	2017	Randomized controlled trial testing the impact of a text-message educational intervention based in the Health Belief Model	Sample text messages are listed below: Message 1: The flu can be serious for pregnant women. We recommend a flu vaccine for all pregnant women. Message 3: The flu vaccine is safe to get when you are pregnant. We recommend a flu vaccine for all pregnant women.	Overall vaccination rate 29%; Intervention (31%) vs. Control (27%) p = 0.51
Yudin et al. [30]	2010	Pre-/Post-Intervention Assessment	Pamphlet is described as containing information about influenza and vaccine safety during pregnancy and breastfeeding and vaccine recommendations	2006: 19% 2007: 56% (p < 0.001)

Abbreviations: APR = adjusted prevalence ratio, CI = confidence interval, RD = risk difference, OR = odds ratio, RR = risk ratio, AOR = adjusted odds ratio