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An Artificial Intelligence-Based, Personalized Smartphone App to Improve Childhood Immunization Coverage and
Abdul Momin Kazi1, Saad Ahmed Qazi2,3, Sadori Khawaja1
1Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
Insights
This study evaluates a mobile app to improve routine childhood immunization (RCI) in Pakistan, addressing low uptake due to awareness gaps and COVID-19 disruptions. Findings will inform app feasibility for enhancing RCI coverage in low- and middle-income countries.
Area of Science:
- Public Health
- Digital Health Interventions
- Vaccinology
Background:
- Low immunization uptake rates in Pakistan are a significant public health concern.
- Barriers include lack of awareness, forgetfulness, misinformation, and COVID-19 related disruptions.
- Innovative, cost-effective interventions are needed to improve routine childhood immunization (RCI) coverage.
Purpose of the Study:
- To evaluate a personalized mobile app's effectiveness in improving on-time RCI visits at 10 and 14 weeks.
- To assess the feasibility of integrating an artificial intelligence model into the app.
- To explore caregiver perceptions and influencing factors for mobile-based vaccination interventions.
Main Methods:
- A mixed-methods randomized controlled trial comparing a mobile app intervention to standard care.
- Recruitment of caregivers of newborns/infants at Aga Khan University Hospital.
- Development of app content based on qualitative findings on caregiver perceptions and barriers to RCI.
Main Results:
- Pretrial qualitative interviews completed; randomized controlled trial enrollment is ongoing.
- Study exit interviews will be conducted at 14-week immunization visits or via phone at 18 weeks.
- Data collection is in progress to assess app impact and user experience.
Conclusions:
- The study will provide insights into the feasibility, acceptability, and usability of an Android-based smartphone app for RCI in Pakistan.
- Results will inform the potential of digital health tools to improve childhood vaccination coverage in low- and middle-income countries.
- This research addresses a critical need for scalable solutions to enhance immunization rates.
Background:
The immunization uptake rates in Pakistan are much lower than desired. Major reasons include lack of awareness, parental forgetfulness regarding schedules, and misinformation regarding vaccines. In light of the COVID-19 pandemic and distancing measures, routine childhood immunization (RCI) coverage has been adversely affected, as caregivers avoid tertiary care hospitals or primary health centers. Innovative and cost-effective measures must be taken to understand and deal with the issue of low immunization rates. However, only a few smartphone-based interventions have been carried out in low- and middle-income countries (LMICs) to improve RCI.
Objective:
The primary objectives of this study are to evaluate whether a personalized mobile app can improve children's on-time visits at 10 and 14 weeks of age for RCI as compared with standard care and to determine whether an artificial intelligence model can be incorporated into the app. Secondary objectives are to determine the perceptions and attitudes of caregivers regarding childhood vaccinations and to understand the factors that might influence the effect of a mobile phone-based app on vaccination improvement.
Methods:
A mixed methods randomized controlled trial was designed with intervention and control arms. The study will be conducted at the Aga Khan University Hospital vaccination center. Caregivers of newborns or infants visiting the center for their children's 6-week vaccination will be recruited. The intervention arm will have access to a smartphone app with text, voice, video, and pictorial messages regarding RCI. This app will be developed based on the findings of the pretrial qualitative component of the study, in addition to no-show study findings, which will explore caregivers' perceptions about RCI and a mobile phone-based app in improving RCI coverage.
Results:
Pretrial qualitative in-depth interviews were conducted in February 2020. Enrollment of study participants for the randomized controlled trial is in process. Study exit interviews will be conducted at the 14-week immunization visits, provided the caregivers visit the immunization facility at that time, or over the phone when the children are 18 weeks of age.
Conclusions:
This study will generate useful insights into the feasibility, acceptability, and usability of an Android-based smartphone app for improving RCI in Pakistan and in LMICs.
Trial Registration:
ClinicalTrials.gov NCT04449107; https://clinicaltrials.gov/ct2/show/NCT04449107.
International Registered Report Identifier (Irrid):
DERR1-10.2196/22996.
