SMS text message reminders to improve infant vaccination coverage in Guatemala: A pilot randomized controlled trial

Gretchen J Domek, Ingrid L Contreras-Roldan, Sean T O'Leary, Sheana Bull, Anna Furniss, Allison Kempe, Edwin J Asturias, Gretchen J Domek, Ingrid L Contreras-Roldan, Sean T O'Leary, Sheana Bull, Anna Furniss, Allison Kempe, Edwin J Asturias

Abstract

Background: Patient reminder systems are an evidence-based way to improve childhood vaccination rates but are difficult to implement in low- and middle-income countries (LMICs). Short Message Service (SMS) texts may offer a potential low-cost solution, especially in LMICs where mobile phones are becoming more ubiquitous.

Objective: To determine if an SMS-based vaccination reminder system aimed at improving completion of the infant primary immunization series is feasible and acceptable in Guatemala.

Methods: A pilot randomized controlled trial was conducted at two public health clinics in Guatemala City. Infants aged 8-14 weeks presenting for the first dose of the primary immunization series were enrolled in March-April 2013. Participants randomized into the intervention received three SMS reminders one week before the second and third dose. A follow-up acceptability survey was administered to both groups.

Results: The participation rate was 86.8% (321/370); 8 did not own a cell phone and 12 could not use SMS. 96.9% of intervention parents were sent at least one SMS reminder prior to visit 2 and 96.3% prior to visit 3. Both intervention and usual care participants had high rates of vaccine and visit completion, with a non-statistically significant higher percentage of children in the intervention completing both visit 2 (95.0% vs. 90.1%, p=.12) and visit 3 (84.4% vs. 80.7%, p=.69). More intervention vs. usual care parents agreed that SMS reminders would be helpful for remembering appointments (p<.0001), agreed to being interested in receiving future SMS reminders (p<.0001), and said that they would be willing to pay for future SMS reminders (p=.01).

Conclusion: This proof of concept evaluation showed that a new application of SMS technology is feasible to implement in a LMIC with high user satisfaction. Larger studies with modifications in the SMS system are needed to determine effectiveness (Clinical Trial Registry NCT01663636).

Keywords: Childhood; Immunization; Reminder-recall; SMS; Text messaging; mHealth.

Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Figures

Fig. 1
Fig. 1
CONSORT diagram.
Fig. 2
Fig. 2
Comparison* of those who agree vs. those who do not agree with the statement ‘Would be willing to pay for text message reminders’ by monthly income level.

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Source: PubMed

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