{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T20:06:41Z","timestamp":1792094801508,"version":"4.4.0"},"reference-count":30,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T00:00:00Z","timestamp":1762905600000},"content-version":"unspecified","delay-in-days":11,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Office of Innovation"},{"name":"Vaccine Alliance"},{"DOI":"10.13039\/100006641","name":"UNICEF","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006641","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,10,16]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the effects of behaviourally informed short message service (SMS) reminders on demand for human papillomavirus (HPV) immunisation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Individually randomised, five-group, controlled parallel trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>A country-wide trial in Georgia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>55\u2009176 girls aged 10\u201312, the entire population of unvaccinated girls of this age in the country, for whom there existed caregiver contact details.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>Girls were randomised into five arms (four with n=11\u2009035, with one n=11\u2009036). Caregivers of the girls in four of the arms (treatment groups) were sent different versions of an SMS reminder (SMSR), reminding them that the girl was due to receive the HPV vaccine. The control group was sent no SMSR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome<\/jats:title>\n                    <jats:p>The primary outcome was a girl\u2019s HPV vaccination status at the end of the trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Blinding<\/jats:title>\n                    <jats:p>Girls and their caregivers were blinded to group assignment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Numbers analysed<\/jats:title>\n                    <jats:p>The number of participants analysed in the four treatment groups was 10,784, 10,802, 10,794 and 10,820, with 10\u2009828 analysed in the control group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Each of the SMSRs was more effective than the control (no reminder) in encouraging HPV vaccination. Girls whose caregiver(s) were sent version 3 had 65% greater odds of receiving the vaccine relative to the control group (OR=1.65; 95%\u2009CI 1.38 to 1.97). Among girls whose caregivers received version 1, version 2 and version 4 of the SMS, the odds of receiving the HPV vaccine were respectively 42% (OR=1.42; 95%\u2009CI 1.18 to 1.70), 34% (OR=1.34; 95%\u2009CI 1.12 to 1.61) and 35% (OR=1.35; 95%\u2009CI 1.13 to 1.62) higher compared with the girls in the control arm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We find a positive and statistically significant effect for each version of the SMSR, relative to the control condition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT05536674\">NCT05536674<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-087080","type":"journal-article","created":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T13:00:27Z","timestamp":1763038827000},"page":"e087080","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Effectiveness of SMS reminders to increase demand for HPV immunisation: a randomised controlled trial in Georgia"],"prefix":"10.1136","volume":"15","clinical-trial-number":[{"clinical-trial-number":"nct05536674","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-8378-4261","authenticated-orcid":false,"given":"Niall","family":"Daly","sequence":"first","affiliation":[{"name":"Behavioural Insights Team, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Merriam","sequence":"additional","affiliation":[{"name":"Behavioural Insights Team, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3692-9271","authenticated-orcid":false,"given":"Giulia","family":"Tagliaferri","sequence":"additional","affiliation":[{"name":"Behavioural Insights Team, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergiu","family":"Tomsa","sequence":"additional","affiliation":[{"name":"UNICEF Europe and Central Asia Regional Office, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viviane M","family":"Bianco","sequence":"additional","affiliation":[{"name":"UNICEF Europe and Central Asia Regional Office, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lika","family":"Gamgebeli","sequence":"additional","affiliation":[{"name":"UNICEF Georgia Country Office, Tbilisi, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nino","family":"Lortkipanidze","sequence":"additional","affiliation":[{"name":"UNICEF Georgia Country Office, Tbilisi, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,11,13]]},"reference":[{"key":"2025120413264245000_15.11.e087080.1","unstructured":"World Health Organization . Cervical cancer: fact sheet, Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/cervical-cancer"},{"key":"2025120413264245000_15.11.e087080.2","unstructured":"National Center for Disease Control and Public Health (NCDC) . Cancer in Georgia, Available: https:\/\/test.ncdc.ge\/Handlers\/GetFile.ashx?ID=61a5547b-8e8b-482b-8425-12f8bdfbb7bb"},{"key":"2025120413264245000_15.11.e087080.3","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.l1161","article-title":"Prevalence of cervical disease at age 20 after immunisation with bivalent HPV vaccine at age 12-13 in Scotland: retrospective population study","volume":"365","author":"Palmer","year":"2019","journal-title":"BMJ"},{"key":"2025120413264245000_15.11.e087080.4","unstructured":"World Health Organization . COVID-19 pandemic fuels largest continued backslide in vaccinations in three decades, Available: https:\/\/www.who.int\/news\/item\/15-07-2022-covid-19-pandemic-fuels-largest-continued-backslide-in-vaccinations-in-three-decades"},{"key":"2025120413264245000_15.11.e087080.5","unstructured":"United Nations Children\u2019s Fund (UNICEF) . Immunization Data, Available: https:\/\/data.unicef.org\/resources\/dataset\/immunization"},{"key":"2025120413264245000_15.11.e087080.6","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1097\/LGT.0000000000000729","article-title":"Impact of COVID-19 Pandemic on Human Papillomavirus Vaccine Uptake in Israel","volume":"27","author":"Lavie","year":"2023","journal-title":"J Low Genit Tract Dis"},{"key":"2025120413264245000_15.11.e087080.7","doi-asserted-by":"publisher","DOI":"10.1177\/1529100618760521"},{"key":"2025120413264245000_15.11.e087080.8","doi-asserted-by":"publisher","DOI":"10.1126\/science.abm0475"},{"key":"2025120413264245000_15.11.e087080.9","unstructured":"World Health Organization . Behavioural and social drivers of vaccination: tools and practical guidance for achieving high uptake, Available: https:\/\/apps.who.int\/iris\/handle\/10665\/354459"},{"key":"2025120413264245000_15.11.e087080.10","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2021-006237","article-title":"Nudging toward vaccination: a systematic review","volume":"6","author":"Re\u00f1osa","year":"2021","journal-title":"BMJ Glob Health"},{"key":"2025120413264245000_15.11.e087080.11","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.1038\/s41562-025-02165-x","article-title":"Nationwide demonstration of improved COVID-19 vaccination uptake through behavioural reminders","volume":"9","author":"Behrendt","year":"2025","journal-title":"Nat Hum Behav"},{"key":"2025120413264245000_15.11.e087080.12","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-020-10132-6","article-title":"A feasibility trial of parent HPV vaccine reminders and phone-based motivational interviewing","volume":"21","author":"Staras","year":"2021","journal-title":"BMC Public Health"},{"key":"2025120413264245000_15.11.e087080.13","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1016\/j.pec.2017.02.004","article-title":"Communication technologies to improve HPV vaccination initiation and completion: A systematic review","volume":"100","author":"Francis","year":"2017","journal-title":"Patient Educ Couns"},{"key":"2025120413264245000_15.11.e087080.14","doi-asserted-by":"crossref","DOI":"10.3390\/vaccines9070687","article-title":"A Systematic Review of Interventions to Improve HPV Vaccination Coverage","volume":"9","author":"Mavundza","year":"2021","journal-title":"Vaccines (Basel)"},{"key":"2025120413264245000_15.11.e087080.15","doi-asserted-by":"crossref","DOI":"10.1073\/pnas.2115126119","article-title":"A 680,000-person megastudy of nudges to encourage vaccination in pharmacies","volume":"119","author":"Milkman","year":"2022","journal-title":"Proc Natl Acad Sci U S A"},{"key":"2025120413264245000_15.11.e087080.16","doi-asserted-by":"crossref","DOI":"10.1073\/pnas.2101165118","article-title":"A megastudy of text-based nudges encouraging patients to get vaccinated at an upcoming doctor\u2019s appointment","volume":"118","author":"Milkman","year":"2021","journal-title":"Proc Natl Acad Sci U S A"},{"key":"2025120413264245000_15.11.e087080.17","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.43388","article-title":"Effects of Ownership Text Message Wording and Reminders on Receipt of an Influenza Vaccination: A Randomized Clinical Trial","volume":"5","author":"Buttenheim","year":"2022","journal-title":"JAMA Netw Open"},{"key":"2025120413264245000_15.11.e087080.18","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-021-06728-2","article-title":"Designing an SMS reminder intervention to improve vaccination uptake in Northern Nigeria: a qualitative study","volume":"21","author":"Obi-Jeff","year":"2021","journal-title":"BMC Health Serv Res"},{"key":"2025120413264245000_15.11.e087080.19","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2021-005035","article-title":"Short message service (SMS) reminders for childhood immunisation in low-income and middle-income countries: a systematic review and meta-analysis","volume":"6","author":"Eze","year":"2021","journal-title":"BMJ Glob Health"},{"key":"2025120413264245000_15.11.e087080.20","article-title":"Patient reminder and recall interventions to improve immunization rates","volume":"1","author":"Jacobson Vann","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"2025120413264245000_15.11.e087080.21","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1103170108"},{"key":"2025120413264245000_15.11.e087080.22","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.jadohealth.2018.12.026","article-title":"Short Message Service Reminders to Parents for Increasing Adolescent Human Papillomavirus Vaccination Rates in a Secondary School Vaccine Program: A Randomized Control Trial","volume":"65","author":"Tull","year":"2019","journal-title":"J Adolesc Health"},{"key":"2025120413264245000_15.11.e087080.23","doi-asserted-by":"crossref","DOI":"10.2196\/26356","article-title":"Personalized Reminders for Immunization Using Short Messaging Systems to Improve Human Papillomavirus Vaccination Series Completion: Parallel-Group Randomized Trial","volume":"9","author":"Wynn","year":"2021","journal-title":"JMIR Mhealth Uhealth"},{"key":"2025120413264245000_15.11.e087080.24","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-021-07296-1","article-title":"Acceptability of mobile-phone reminders for routine childhood vaccination appointments in Nigeria - 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