COVID-19 vaccination advice via SMS-based video to improve vaccination uncertainty in at-risk groups

COVID-19 continues to present challenges worldwide. In an attempt to tackle the disease, SARS-CoV-2 vaccines have been rapidly developed and vaccination programmes are being rolled out. Guidance from both the European Alliance of Associations for Rheumatology and the British Society for Rheumatology recommend that patients on immunosuppressive treatment should receive a SARS-CoV-2 vaccine.¹ Emerging data highlight the need for specialist advice to improve the uptake of COVID-19 vaccines in patients with autoimmune rheumatic diseases; evidence suggests that vaccine uptake in these patients can be improved by more than 20% with physician recommendation, and it is increasingly recognised that timely specialist input is required.2, 3, 4 Low confidence in vaccine safety has been the main factor that has hindered vaccine uptake in patients with rheumatic disease.⁵ Previous work has shown the utility of mobile SMS for the rapid distribution of urgent health-care communications.⁶ As such, we developed a multimedia video message focused on vaccine education that was distributed by mobile SMS messaging, a successful and well established method of communication in our rheumatology follow-up cohort of more than 10 000 patients.⁷

We developed an 8-min interactive web-based educational video that was designed for mobile phones. We included UK information on current licensed COVID-19 vaccines, vaccination scheduling, safety, frequently asked questions, and links to established resources. Videos were piloted with clinicians, our patient participation group, and a national charity. Videos were included as links in a SMS message and communicated to all patients who had a valid mobile phone number on our electronic patient administration system. To evaluate this intervention, patients were sent web-based evaluations by SMS, which also gathered data on sex, age, current medications, and diagnosis. We used the Likert scale on responses to evaluate patient perceptions of the video. Mean Likert scores were calculated, and comparisons were made between patients in different age, sex, and diagnostic groups. Evaluations were collected 14 days after distribution of the video; data were analysed using SPSS, version 27. Executive institutional approval confirmed that this service development and evaluation, using voluntary anonymous respondent data, did not require a formal ethics review. Additional consent is not required to send health-care SMS messages under EU General Data Protection Regulation.

We sent the SMS messages containing the video link on Dec 21, 2020 to 8886 (of the 10 981) patients who had a valid mobile phone number on our system. After 14 days, we had 2358 video views (27%) and 661 patients completed the evaluation (appendix). Pre-intervention, 36% of patients aged 30–49 years reported being aware that the vaccine was safe and recommended for them, compared with 47% of patients aged 50–69 years and 52% of patients aged 70 years or older. The educational video significantly increased these percentages, to 88% in patients aged 30–49 years, 92% in patients aged 50–69 years, and 94% in those aged 70 years or older. We received no responses from recipients aged 18–29 years.

Likert scores showed that patients felt better informed about the vaccine (mean score 4·1 on a scale of 1–5), were more confident about receiving the vaccine (4·2), learned more about the safety of the vaccine (4·2), and were more likely to seek vaccination (4·1) as a result of the interactive video. Responders thought the video was a helpful way to share information (4·4).

Compared with patients in the 30–49 years age group, older patients learned significantly more about the vaccine (50–69 years: mean difference (MD) 0·4, p=0·003; ≥70 years: MD 0·4, p=0·002), were more confident about having the vaccine (50–69 years: MD 0·3, p=0·008; ≥70 years: MD 0·3, p=0·02), and were more likely to have the vaccine (50–69 years: MD 0·4, p=0·002; ≥70 years: MD 0·5, p=0·001). The results were not affected by sex or rheumatic disease diagnosis.

These data show that our vaccine information video was highly effective at addressing misconceptions around vaccination and had the greatest effect in patients aged 70 years or older, who constitute an at-risk group. Whereas digital accessibility in older age groups was previously thought to be a barrier, our older cohorts appeared equally able to access health-care communications on their mobile phones, which perhaps reflects the shift to using digital technology in this age group in the general population.7, 8 Patients completing the evaluation were generally representative of our patient population. Our youngest patients returned no evaluations, which might relate to a range of factors, including the suggested long wait for vaccination in this age group in the UK at the time of distribution of the video.

Our patients reported lower confidence in vaccine safety when compared with other reported data.2, 5 We acknowledge that patients with limited digital accessibility will be missed out using this style of communication and that alternative provisions will be required;⁹ further research exploring how best to engage with these rheumatology patient cohorts is needed. However, there is broad scope for the application of this technology in other groups of patients.

There are several limitations of this work. We did not include a comparator group and, although we can hypothesise reasons for the differences in impact and response rates across our cohort, many factors might have influenced these differences, which require further investigation.

In conclusion, to our knowledge, this is the first published intervention using a targeted COVID-19 vaccine education video and the first to be delivered to patients with autoimmune rheumatic diseases. Our findings echo those of others who have reported low awareness of vaccine information and safety.² Crucially, the oldest age group, which constitutes the most at-risk population, found the video most informative and were more likely than those in younger age groups to change their behaviour as a result. This work adds to the evidence supporting SMS-linked technology in distributing targeted patient educational materials and its role in a pandemic.⁶ Further research on vaccine uptake and implementation at regional and national levels could counter misinformation around vaccination programmes and help to save lives.

We would like to thank our Patient Participation Group and the Hibbs Lupus Trust for their support, along with the clinical and nursing staff at both sites. Requests for access to the data should be made to the corresponding author. There was no funding source for this study. We declare no competing interests.