Brief Title
Mobile Phone SMS Messages and Automated Calls in Improving Vaccine Coverage Among Children in Pakistan
Official Title
To Evaluate the Role of Mobile Phone SMS Messages and Automated Calls in Improving Vaccine Coverage Among Children in Pakistan
Brief Summary
Routine childhood immunization (RCI) in Pakistan is well below the recommended coverage of
90% with rates as low as 16% in certain regions (Pakistan DHS 2012-3). This has led to
continued polio transmission, large measles outbreaks and thousands of deaths from
vaccine-preventable diseases (Kazi.Bull WHO 2016). Mobile phone communication is widespread
in developing countries and has proven a potential method of directly connecting pregnant
women and mothers to health services (Kharbanda. Expert Review of Vaccine 2014). The
investigators propose conducting a mixed methods proof of concept cluster randomized trial
(CRT) to assess the effectiveness of different types of SMS messaging and automated calls to
improve RCI and understand the perceptions and barriers that may affect SMS and automated
call-based interventions at participants levels. the investigators will conduct the study at
urban and rural sites in Pakistan. The investigators will examine an important public health
question - do low cost, automated SMS, and automated messages improve RCI coverage in
resource-constrained settings? Further, investigators will compare the effectiveness of
reminder, educational and interactive text messages for improving RCI and will generate
socio-cultural data regarding the impact of participants health beliefs that will be
important for setting up the appropriate interventions in other LMICs.
Detailed Description
SMS text messages have shown to be effective for mobile health or mHealth having a
considerable impact on disease prevention efforts in developing countries. Mobile phone and
SMS texting provide an excellent solution to challenges like travel and complex intercultural
contact. SMS based interventions have been quite effective in different programs,
particularly in treatment adherence, smoke cessation, health care appointment attendance,
antenatal care attendance and compliance with immunization. In addition adding incentives to
SMS messages have shown a positive association, however, there is a cost implication for
scaling up this model at a country level. Given the mobile phone access and acceptability in
the LMIC, there is great potential for SMS based intervention to improve Immunization
coverage in LMIC setup.
One major reservation for SMS based interventions is the level of literacy. However, there
has been mixed input related to the preference of phones calls as compared to text messages
in populations of low literacy and resource-constrained settings. Mobile phone text messages
in local languages, pictorial messages and in combination with a phone call can further
reduce this gap.
Most of the studies evaluating the impact of text messages on vaccination have been conducted
in the United States with a major focus on flu vaccine among children and teenagers. The
participants covered in these studies are from low income background at an academic medical
center and is quite different from resource constraint settings of LMICs due to poor
immunization registries and electronic records. There is limited data from LMICs set up on
the role of SMS based interventions for improvement of RI coverage and conventional one-way
reminder text messages were used by most of the studies as the intervention. Overall very few
investigators compared reminders, educational and interactive SMS messages related to
childhood vaccination uptake. Although some of the investigators have shown some behavior
change for improvement in vaccination coverage, more rigorous application of health behavior
change model needs to be applied to understand the impact of reminder, educational and
interactive messages on behavior change related to improvement in RI coverage. Very few
studies have compared the effect of educational, reminders and interactive messages in
improving uptake and on-time routine immunization.
In this study the investigators would like to examine an important public health question -
do low cost, automated SMS messages and calls improve RI coverage among participants in
resource-constrained settings? In this study, we would like to compare the effectiveness of
reminder, educational and interactive text messages and phone calls for improving RI uptake
in Pakistani participants.
Study Type
Interventional
Primary Outcome
The primary outcome will measure the number of children who got vaccinated for routine immunization scheduled at 6, 10 and 14 weeks of life
Secondary Outcome
The secondary outcome will measure the mean improvement in on-time vaccination for routine immunization scheduled at 6, 10 and 14 weeks of life
Condition
Tuberculosis
Intervention
SMS messages and automated calls
Study Arms / Comparison Groups
1. One way SMS messages.
Description: Parents/caregiver will receive one way educational/reminder/proactive SMS messages related to routine immunization once a week till 20 weeks of age.
Publications
* Includes publications given by the data provider as well as publications identified by National Clinical Trials Identifier (NCT ID) in Medline.
Recruitment Information
Recruitment Status
Behavioral
Estimated Enrollment
3850
Start Date
January 2018
Completion Date
September 2018
Primary Completion Date
July 2018
Eligibility Criteria
Inclusion Criteria:
- The inclusion criteria includes being a child from the HDSS site, being less than 14
days of age with parent/guardian or at least one person in the household having a
working mobile phone connection and parent/guardian providing consent to participate
in the study.
Exclusion Criteria:
- The exclusion criteria includes a child from outside HDSS area or family plans to stay
in the catchment area for less than 20 weeks
Gender
All
Ages
N/A - 14 Days
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Contacts
Abdul M Kazi, MBBS,MPH, +922134864232, [email protected]
Administrative Informations
NCT ID
NCT03341195
Organization ID
4320-Ped_ERC-16
Responsible Party
Principal Investigator
Study Sponsor
Aga Khan University
Collaborators
Grand Challenges Canada
Study Sponsor
Abdul M Kazi, MBBS,MPH, Principal Investigator, The Aga Khan University, Pakistan
Verification Date
November 2017