Implementing SMS reminders for routine immunization in Northern Nigeria: a qualitative evaluation using the RE-AIM...

Area of Science:

• Public Health
• Health Communication
• Global Health

Background:

• Short Message Service (SMS) reminders have shown promise in increasing vaccine uptake in low- and middle-income countries (LMICs).
• Evaluating the internal and external validity of SMS reminder interventions is crucial for improving their adoption and sustainability in LMICs.
• The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to assess an SMS reminder intervention in Kebbi State, Nigeria.

Purpose of the Study:

• To qualitatively assess the impact of an SMS reminder intervention on childhood immunization uptake in Kebbi State, Nigeria.
• To identify facilitators and barriers to the adoption and sustainability of SMS reminder interventions in LMICs.
• To inform future SMS reminder interventions aimed at improving immunization coverage in resource-constrained settings.

Main Methods:

• Qualitative study employing 14 focus group discussions, 13 in-depth interviews, and 20 key informant interviews with 144 participants.
• Purposive sampling was used across five local government areas in Kebbi State.
• Data analysis involved a deductive approach using RE-AIM framework codes and an inductive approach to identify emergent themes.

Main Results:

• Participants perceived SMS reminders as important for improving vaccination demand and uptake.
• Facilitators included health worker support, community gatekeeper involvement, and alignment with state priorities.
• Barriers included low mobile phone ownership and low literacy levels preventing text message comprehension. Data on cost-effectiveness and impact are critical for scalability.

Conclusions:

• SMS reminders, particularly in local languages, can enhance vaccination demand and uptake in resource-constrained settings.
• Addressing implementation barriers and promoting facilitators are essential for the adoption and sustainability of SMS reminder interventions.
• Further research on cost-effectiveness and impact is needed to support the widespread use of SMS reminders for improving childhood vaccination coverage.