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JAMA Netw Open
. 2026 Jan 2;9(1):e2552149.
doi: 10.1001/jamanetworkopen.2025.52149. Narrative Reminder Recall to Improve Pediatric Influenza Vaccination: A Pilot Randomized Clinical Trial
Joshua T B Williams 1 2 3 , Kate Kurlandsky 1 , Amy B Stein 3 , Neha Bharadwaj 4 , Simon J Hambidge 1 2 , Rocio I Pereira 1 5 , Sonja C O'Leary 1 2 , Deidre Johnson 6 , Sean T O'Leary 2 7
Affiliations
Importance: Seasonal influenza causes morbidity and mortality in vulnerable communities. Narrative reminder recall (ie, digital stories using multimodal narratives that uplift community voices) may be scalable as an equity-promoting intervention to increase vaccination rates.
Objectives: To assess (1) the reach of texts with pediatric influenza vaccine digital stories among caregivers of young children and (2) associations of caregiver intervention assignment with time to child influenza vaccination.
Design, setting, and participants: This pilot randomized clinical trial included caregivers and their children (aged 6 months to 5 years) from 2 safety-net clinics in historically Black neighborhoods in Denver, Colorado between September 16, 2024, and March 31, 2025. Caregivers aged 18 years and older who preferred English and their children, provided they had 1 well visit in the past 18 months and would be aged 6 to 71 months during the influenza season, were included.
Intervention: The digital storytelling intervention included texts with links to 5 stories (3 featuring caregivers who identified as Black or African American) sent in October 2024. Usual care included 1 message sent via an electronic health record messaging portal to caregivers of all children eligible for influenza vaccines.
Main outcomes and measures: The primary outcome was digital story reach (ie, the proportion of caregivers viewing 1 or more digital stories for any length of time). Time to first influenza vaccination was recorded for children. Adjusted Cox proportional hazards modeling (with 95% CI) fit time to vaccination by group and baseline covariates. Kaplan-Meier curves analyzed the proportions of children remaining unvaccinated by group over time.
Results: Intention-to-treat analyses included 200 children (100 per group; mean [SD] age, 29.1 [16.1] months; 96 male [48%]; 77 Black or African American [39%]; 90 Hispanic or Latino/a [45%]; 54 White [27%]) and their 198 caregivers (100 usual care; 98 intervention; mean [SD] age, 30.5 [7.5] years; 176 mothers [89%]; 77 Black or African American [39%]; 87 Hispanic or Latino/a [44%]; 25 White [13%]). Overall, 686 of 686 texts (100%) were delivered; digital stories were viewed by 7 caregivers (7%). More children of intervention caregivers were vaccinated when influenza activity peaked on February 15, 2025, (percentage unvaccinated, 62% [95% CI, 53%-72%] in intervention vs 74% [95% CI, 66%-83%] in usual care; Z test, 1.82; P = .03). In adjusted analyses, children of intervention caregivers were 63% more likely to be vaccinated compared with children of caregivers receiving usual care (adjusted hazard ratio, 1.63; 95% CI, 1.01-2.64).
Conclusions and relevance: In this pilot randomized clinical trial of a text message digital storytelling intervention centering Black families, intervention receipt was associated with improved pediatric influenza vaccination, although intervention reach was low.
Trial registration: ClinicalTrials.gov Identifier: NCT06274359.
. 2026 Jan 2;9(1):e2552149.
doi: 10.1001/jamanetworkopen.2025.52149. Narrative Reminder Recall to Improve Pediatric Influenza Vaccination: A Pilot Randomized Clinical Trial
Joshua T B Williams 1 2 3 , Kate Kurlandsky 1 , Amy B Stein 3 , Neha Bharadwaj 4 , Simon J Hambidge 1 2 , Rocio I Pereira 1 5 , Sonja C O'Leary 1 2 , Deidre Johnson 6 , Sean T O'Leary 2 7
Affiliations
- PMID: 41493783
- DOI: 10.1001/jamanetworkopen.2025.52149
Importance: Seasonal influenza causes morbidity and mortality in vulnerable communities. Narrative reminder recall (ie, digital stories using multimodal narratives that uplift community voices) may be scalable as an equity-promoting intervention to increase vaccination rates.
Objectives: To assess (1) the reach of texts with pediatric influenza vaccine digital stories among caregivers of young children and (2) associations of caregiver intervention assignment with time to child influenza vaccination.
Design, setting, and participants: This pilot randomized clinical trial included caregivers and their children (aged 6 months to 5 years) from 2 safety-net clinics in historically Black neighborhoods in Denver, Colorado between September 16, 2024, and March 31, 2025. Caregivers aged 18 years and older who preferred English and their children, provided they had 1 well visit in the past 18 months and would be aged 6 to 71 months during the influenza season, were included.
Intervention: The digital storytelling intervention included texts with links to 5 stories (3 featuring caregivers who identified as Black or African American) sent in October 2024. Usual care included 1 message sent via an electronic health record messaging portal to caregivers of all children eligible for influenza vaccines.
Main outcomes and measures: The primary outcome was digital story reach (ie, the proportion of caregivers viewing 1 or more digital stories for any length of time). Time to first influenza vaccination was recorded for children. Adjusted Cox proportional hazards modeling (with 95% CI) fit time to vaccination by group and baseline covariates. Kaplan-Meier curves analyzed the proportions of children remaining unvaccinated by group over time.
Results: Intention-to-treat analyses included 200 children (100 per group; mean [SD] age, 29.1 [16.1] months; 96 male [48%]; 77 Black or African American [39%]; 90 Hispanic or Latino/a [45%]; 54 White [27%]) and their 198 caregivers (100 usual care; 98 intervention; mean [SD] age, 30.5 [7.5] years; 176 mothers [89%]; 77 Black or African American [39%]; 87 Hispanic or Latino/a [44%]; 25 White [13%]). Overall, 686 of 686 texts (100%) were delivered; digital stories were viewed by 7 caregivers (7%). More children of intervention caregivers were vaccinated when influenza activity peaked on February 15, 2025, (percentage unvaccinated, 62% [95% CI, 53%-72%] in intervention vs 74% [95% CI, 66%-83%] in usual care; Z test, 1.82; P = .03). In adjusted analyses, children of intervention caregivers were 63% more likely to be vaccinated compared with children of caregivers receiving usual care (adjusted hazard ratio, 1.63; 95% CI, 1.01-2.64).
Conclusions and relevance: In this pilot randomized clinical trial of a text message digital storytelling intervention centering Black families, intervention receipt was associated with improved pediatric influenza vaccination, although intervention reach was low.
Trial registration: ClinicalTrials.gov Identifier: NCT06274359.