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Evaluating a Mobile Phone-Delivered Text Message Reminder Intervention to Reduce Infant Vaccination Dropout in Arua,
Daniel C Ehlman1, Joseph Magoola2, Patricia Tanifum1
1Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States.
Insights
This study tested mobile phone text message reminders to improve childhood vaccination completion rates in Uganda. The intervention aims to increase timely immunizations and reduce vaccine dropout among young children.
Area of Science:
- Public Health
- Health Informatics
- Global Health
Background:
- Suboptimal vaccine coverage is a global public health issue, with only 49% of Ugandan children aged 12-23 months fully vaccinated by 12 months in 2016.
- Innovative strategies are crucial to enhance vaccination coverage, minimize dropout rates, and raise caregiver awareness for timely child immunizations.
Purpose of the Study:
- To evaluate a personalized, automated mobile phone text message reminder intervention for caregivers.
- The intervention aims to decrease the proportion of children who start but do not complete their vaccination series up to 12 months of age.
- The study focuses on select health facilities in Uganda's Arua district.
Main Methods:
- A two-arm, multicenter randomized controlled trial was conducted in four health facilities.
- Caregivers of children aged 6 weeks to 6 months receiving their first pentavalent vaccine dose were randomized.
- Participants received standard care, with the intervention group receiving personalized text message reminders for subsequent vaccination visits.
Main Results:
- Enrollment of 1961 children was completed in August 2016, out of 3485 screened participants.
- Data collection, including interviews and record reviews, was completed by December 2017.
- Study results are anticipated for release in 2021.
Conclusions:
- Reminder systems can effectively prompt health-seeking behaviors and improve intervention uptake.
- The increasing mobile phone ownership in Uganda supports the use of such technology in vaccination programs.
- Rigorous study designs are essential for evaluating the effectiveness of mobile health interventions in vaccination.
Background:
Globally, suboptimal vaccine coverage is a public health concern. According to Uganda's 2016 Demographic and Health Survey, only 49% of 12- to 23-month-old children received all recommended vaccinations by 12 months of age. Innovative ways are needed to increase coverage, reduce dropout, and increase awareness among caregivers to bring children for timely vaccination.
Objective:
This study evaluates a personalized, automated caregiver mobile phone-delivered text message reminder intervention to reduce the proportion of children who start but do not complete the vaccination series for children aged 12 months and younger in select health facilities in Arua district.
Methods:
A two-arm, multicenter, parallel group randomized controlled trial was conducted in four health facilities providing vaccination services in and around the town of Arua. Caregivers of children between 6 weeks and 6 months of age at the time of their first dose of pentavalent vaccine (Penta1; containing diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae type b antigens) were recruited and interviewed. All participants received the standard of care, defined as the health worker providing child vaccination home-based records to caregivers as available and providing verbal instruction of when to return for the next visit. At the end of each day, caregivers and their children were randomized by computer either to receive or not receive personalized, automated text message reminders for their subsequent vaccination visits according to the national schedule. Text message reminders for Penta2 were sent 2 days before, on the day of, and 2 days after the scheduled vaccination visit. Reminders for Penta3 and the measles-containing vaccine were sent on the scheduled day of vaccination and 5 and 7 days after the scheduled day. Study personnel conducted postintervention follow-up interviews with participants at the health facilities during the children's measles-containing vaccine visit. In addition, focus group discussions were conducted to assess caregiver acceptability of the intervention, economic data were collected to evaluate the incremental costs and cost-effectiveness of the intervention, and health facility record review forms were completed to capture service delivery process indicators.
Results:
Of the 3485 screened participants, 1961 were enrolled from a sample size of 1962. Enrollment concluded in August 2016. Follow-up interviews of study participants, including data extraction from the children's vaccination cards, data extraction from the health facility immunization registers, completion of the health facility record review forms, and focus group discussions were completed by December 2017. The results are expected to be released in 2021.
Conclusions:
Prompting health-seeking behavior with reminders has been shown to improve health intervention uptake. Mobile phone ownership continues to grow in Uganda, so their use in vaccination interventions such as this study is logical and should be evaluated with scientifically rigorous study designs.
Trial Registration:
ClinicalTrials.gov NCT04177485; https://clinicaltrials.gov/ct2/show/NCT04177485.
International Registered Report Identifier (Irrid):
DERR1-10.2196/17262.
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