Numerous preventative services were delayed during the coronavirus disease 2019 (COVID-19) pandemic, including well child care (WCC) visits.1, 2, 3 Following pandemic shutdowns, vaccination rates decreased, with rates for non-Hispanic Black children disproportionately worsening4 and vaccine hesitancy increasing.5, 6 Systematic outreach approaches hold potential to re-engage these patients. A recent meta-analysis of randomized trials reviewed the effectiveness of patient automated recall systems (i.e., notifying patients they are behind on care) for pediatric and adult patients.7 Indeed, numerous studies exist speaking to the efficacy of automated recall systems, including those delivering text messages.8, 9, 10

There remains a need for research that identifies the degree to which combinations of patient recall messages improve outcomes, and how these approaches differ by the age of a child.7 Some studies have shown the effect of phone call attempts initiated by a staff member on increasing vaccination rates in adults11 and adolescents.12 However, it’s unclear how automated outreach attempts, followed by personal contact attempts, might impact WCC visits among pediatric patients.

We sought to assess the effectiveness of varied outreach approaches (e.g., automated calls/text messages with or without personalized calls/texts) on the scheduling and completion of WCC visits and receipt of the measles, mumps, and rubella (MMR) vaccine among children due for preventative services. We hypothesized that two automated outreach messages would be superior to one message, and messages followed by a personal contact attempt would outperform messages without it.