A Digital Intervention to Reduce Disparities in Well-Child and Immunization Completion in Community Health

Abstract

Objective

Well-child visits and immunizations among children in the United States declined at the onset of COVID-19, and vulnerable populations have been disproportionately affected. We tested an innovative mechanism to use chatbots to engage caregivers in evidence-based preventive care for children.

Design

The Child Health Engagement and Coaching Using Patient-centered Innovation (CHEC-UP) project was developed and implemented as a clinical quality improvement pilot in primary care pediatrics. Artificial intelligence (AI)-enabled chatbots were used to personalize messages and facilitate appointment scheduling over 5 months. The chatbot included a campaign to simultaneously send texts to multiple individuals whose children were within 2 weeks of a recommended wellness visit and vaccines. From the text message, recipients launched either an English- or Spanish-language chatbot from their smartphone and were guided through a predefined automated conversation that provided age-specific education, asked predefined questions, and provided guidance based on recipient answers.

Setting

The pilot study was conducted at a community health center in Chicago, Illinois, that serves roughly 10,500 children, and whose parents or guardians are 82% racial and/or ethnic minorities.

Participants

We targeted outreach to 250 English- and Spanish-speaking families with children of 0–17 years for proactive outreach using chatbots promoting well-child visit completion and up-to-date immunization status. Initially, a special emphasis was placed on the 0–2 age group as the first 2 years represent a critical time for primary prevention of vaccine-preventable diseases.

Interventions

Intervention focused on pre-visit engagement by launching an AI-enabled chatbot to deliver personalized messages and facilitate appointment scheduling via mobile devices. An additional novel component of CHEC-UP entailed disseminating evidence-based anticipatory guidance prior to an appointment.

Results

Chatbots facilitated a relative increase in well-child visits and immunizations by 27% in the in tervention group who engaged with the chatbot. Well-child visits and immunizations in the intervention group demonstrated an absolute increase of 13% compared to the usual care group. Survey results, and patient and clinician interviews revealed a high level of satisfaction with the chatbot. Patients also identified future use cases for chatbots to improve health and well-being.

Conclusions

Engaging patients with chatbots improved vaccination and well-child uptake. Patients were highly satisfied with chatbot engagement. By engaging patients and caregivers, chatbots present the potential to proactively engage patients in care and optimize vaccination uptake and realize one of societies’ greatest public health achievements: decreasing the spread of communicable diseases.