SMS-Based Video Improves Vaccination Uncertainty in Patients With Rheumatic Disease


An SMS-based, interactive, educational video greatly increased information related to COVID-19 vaccines, confidence in vaccine safety, and an inclination to receive the vaccine.

While SARS-CoV-2 vaccines are strongly recommended by respected institutions such as the European Alliance of Associations for Rheumatology and the British Society for Rheumatology, there is a lot of uncertainty and low confidence in vaccine safety among patients undergoing immunosuppressive treatment. In an attempt to improve the rate of COVID-19 vaccines in this patient population, investigators created an SMS-based interactive educational video. Results indicated that the educational video greatly increased information related to COVID-19 vaccines, confidence in vaccine safety, and an inclination to receive the vaccine, according to an article published in The Lancet.1 

Evidence suggests that vaccine compliance rates can be improved by more than 20% in patients who received a physician recommendation, as recognized by previous studies that have shown mobile SMS can effectively distribute healthcare communications. As a response, investigators developed a multimedia, 8-minute web-based interactive video for mobile phones. Prior to distribution, videos were run by clinicians, a patient group, and a national charity.

On December 21, 2020, information sent to the rheumatology follow-up cohort of 8886 patients, all with a valid mobile phone number in their electronic patient administration system, and included up-to-date information on licensed COVID-19 vaccines, scheduling, safety, frequently asked questions, and links to further resources. Demographics, such as sex, age, medications, and diagnosis, were compiled and compared via mean Likert scores. A formal ethics review was not required for this method of development and evaluation, as it used voluntary, anonymous data.

After a 14-day evaluation period, 2358 (27%) participants viewed the video and 661 completed the evaluation. Only 36% of patients in the 30-49 age range, 47% of patients in the 50-69 age range, and 52% of patients aged 70 or older were aware that the vaccine was both safe and recommended for them prior to the interactive video. After viewing the video, these percentages increased to 88%, 92%, and 94%, respectively.

Likert scores indicated that, after viewing the video, patients felt better informed and were more willing to receive the vaccine, learned more about the safety of the vaccine, and were more inclined to be vaccinated. The video addressed misconceptions about vaccination data and had the greatest effect in patients in the 70+ category, which also represented the most at-risk patient population.

“Patients completing the evaluation were generally representative of our patient population,” stated investigators. “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.”

Older patients appeared to have learned more about the vaccine (50–69 years: mean difference (MD) 0·4, p=0·003; ≥70 years: MD 0·4, p=0·002) and were more confident in the vaccine (50–69 years: MD 0·3, p=0·008; ≥70 years: MD 0·3, p=0·02) than their younger counterparts in the 30-49 age group. They were also more likely to schedule a vaccine (50–69 years: MD 0·4, p=0·002; ≥70 years: MD 0·5, p=0·001) after receiving the SMS video.

Another interesting conclusion is that while, previously, older cohorts were thought to have less digital accessibility. However, the participants in this study appeared to had equal access to healthcare communications on their mobile phones.

The study was limited by the lack of a comparator group and the related uninvestigated factors may have influenced the differences in impact and response rates throughout the cohorts. Additionally, investigators acknowledge that patients with more limited accessibility to digital platforms missed out on this particular style of communication.

“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 behavior as a result,” concluded investigators. “This work adds to the evidence supporting SMS-linked technology in distributing targeted patient educational materials and its role in a pandemic. Further research on vaccine uptake and implementation at regional and national levels could counter misinformation around vaccination programs and help to save lives.”


Bateman J, Cox N, Rajagopala L, et al. COVID-19 vaccination advice via SMS-based video to improve vaccination uncertainty in at-risk groups. Lancet Rheumatol. 2021;3(6):e399-e401. doi:10.1016/S2665-9913(21)00148-X

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