The Mobile Solutions for Immunization (M-SIMU) Trial: A Protocol for a Cluster Randomized Controlled Trial That Assesses the Impact of Mobile Phone Delivered Reminders and Travel Subsidies to Improve Childhood Immunization Coverage Rates and Timeliness in Western Kenya

Dustin G Gibson, E Wangeci Kagucia, Benard Ochieng, Nisha Hariharan, David Obor, Lawrence H Moulton, Peter J Winch, Orin S Levine, Frank Odhiambo, Katherine L O'Brien, Daniel R Feikin, Dustin G Gibson, E Wangeci Kagucia, Benard Ochieng, Nisha Hariharan, David Obor, Lawrence H Moulton, Peter J Winch, Orin S Levine, Frank Odhiambo, Katherine L O'Brien, Daniel R Feikin

Abstract

Background: Text message (short message service, SMS) reminders and incentives are two demand-side interventions that have been shown to improve health care-seeking behaviors by targeting participant characteristics such as forgetfulness, lack of knowledge, and transport costs. Applying these interventions to routine pediatric immunizations may improve vaccination coverage and timeliness.

Objective: The Mobile Solutions for Immunization (M-SIMU) trial aims to determine if text message reminders, either with or without mobile phone-based incentives, sent to infant's parents can improve immunization coverage and timeliness of routine pediatric vaccines in rural western Kenya.

Methods: This is a four-arm, cluster, randomized controlled trial. Villages are randomized to one of four study arms prior to enrollment of participants. The study arms are: (1) no intervention (a general health-related text message will be texted to this group at the time of enrollment), (2) text message reminders only, (3) text message reminders and a 75 Kenyan Shilling (KES) incentive, or (4) text message reminders and a KES200 incentive. Participants assigned to study arms 2-4 will receive two text message reminders; sent 3 days before and one day before the scheduled immunization visit at 6, 10, and 14 weeks for polio and pentavalent (containing diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenza type b antigens) type b antigens) vaccines, and at 9 months for measles vaccine. Participants in incentive arms will, in addition to text message reminders as above, receive mobile phone-based incentives after each timely vaccination, where timely is defined as vaccination within 2 weeks of the scheduled date for each of the four routine expanded program immunization (EPI) vaccination visits. Mother-infant pairs will be followed to 12 months of age where the primary outcome, a fully immunized child, will be ascertained. A fully immunized child is defined as a child receiving vaccines for bacille Calmette-Guerin, three doses of pentavalent and polio, and measles by 12 months of age. General estimating equation (GEE) models that account for clustering will be employed for primary outcome analyses.

Results: Enrollment was completed in October 2014. Twelve month follow-up visits to ascertain immunization status from the maternal and child health booklet were completed in February 2016.

Conclusions: This is one of the first studies to examine the effect of text message reminders on immunization coverage and timeliness in a lower income country and is the first study to assess the effect of mobile money-based incentives to improve immunization coverage.

Trial registration: Clinicaltrials.gov NCT01878435; https://ichgcp.net/clinical-trials-registry/NCT01878435 (Archived by WebCite at http://www.webcitation.org/6hQlwGYJR).

Keywords: CCT; Kenya; M-PESA; SMS; conditional cash transfer; immunization; incentive; mHealth; measles; mobile; pentavalent; reminders; text message.

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 2
Figure 2
Map of villages coded by study arm.
Figure 1
Figure 1
CONSORT diagram of study design.

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