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

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Highlights

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A novel SMS vaccine reminder platform was created in a LMIC.
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SMS vaccine reminders were proven feasible to implement in a LMIC.
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SMS vaccine reminders were acceptable to use in a LMIC with high user satisfaction.
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SMS vaccine reminders have the potential for widespread scalability at low cost.

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).

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Most cited references 29

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Efficacy of text messaging-based interventions for health promotion: a meta-analysis.

Katharine J Head, Seth M Noar, Nicholas T Iannarino … (2013)

This meta-analysis investigated the efficacy of text messaging-based health promotion interventions. Nineteen randomized controlled trials conducted in 13 countries met inclusion criteria and were coded on a variety of participant, intervention, and methodological moderators. Meta-analytic procedures were used to compute and aggregate effect sizes. The overall weighted mean effect size representing the impact of these interventions on health outcomes was d = .329 (95% CI = .274, .385; p < .001). This effect size was statistically heterogeneous (Q18 = 55.60, p < .001, I(2) = 67.62), and several variables significantly moderated the effects of interventions. Smoking cessation and physical activity interventions were more successful than interventions targeting other health outcomes. Message tailoring and personalization were significantly associated with greater intervention efficacy. No significant differences were found between text-only interventions and interventions that included texting plus other components. Interventions that used an individualized or decreasing frequency of messages over the course of the intervention were more successful than interventions that used a fixed message frequency. We discuss implications of these results for health promotion interventions that use text messaging. Copyright © 2013 Elsevier Ltd. All rights reserved.

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The effect of mobile phone text-message reminders on Kenyan health workers' adherence to malaria treatment guidelines: a cluster randomised trial

Dejan Zurovac, Raymond K Sudoi, Willis S Akhwale … (2011)

Summary Background Health workers' malaria case-management practices often differ from national guidelines. We assessed whether text-message reminders sent to health workers' mobile phones could improve and maintain their adherence to treatment guidelines for outpatient paediatric malaria in Kenya. Methods From March 6, 2009, to May 31, 2010, we did a cluster-randomised controlled trial at 107 rural health facilities in 11 districts in coastal and western Kenya. With a computer-generated sequence, health facilities were randomly allocated to either the intervention group, in which all health workers received text messages on their personal mobile phones on malaria case-management for 6 months, or the control group, in which health workers did not receive any text messages. Health workers were not masked to the intervention, although patients were unaware of whether they were in an intervention or control facility. The primary outcome was correct management with artemether-lumefantrine, defined as a dichotomous composite indicator of treatment, dispensing, and counselling tasks concordant with Kenyan national guidelines. The primary analysis was by intention to treat. The trial is registered with Current Controlled Trials, ISRCTN72328636. Findings 119 health workers received the intervention. Case-management practices were assessed for 2269 children who needed treatment (1157 in the intervention group and 1112 in the control group). Intention-to-treat analysis showed that correct artemether-lumefantrine management improved by 23·7 percentage-points (95% CI 7·6–40·0; p=0·004) immediately after intervention and by 24·5 percentage-points (8·1–41·0; p=0·003) 6 months later. Interpretation In resource-limited settings, malaria control programmes should consider use of text messaging to improve health workers' case-management practices. Funding The Wellcome Trust.

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Can the ubiquitous power of mobile phones be used to improve health outcomes in developing countries?

Warren A. Kaplan (2006)

Background The ongoing policy debate about the value of communications technology in promoting development objectives is diverse. Some view computer/web/phone communications technology as insufficient to solve development problems while others view communications technology as assisting all sections of the population. This paper looks at evidence to support or refute the idea that fixed and mobile telephones is, or could be, an effective healthcare intervention in developing countries. Methods A Web-based and library database search was undertaken including the following databases: MEDLINE, CINAHL, (nursing & allied health), Evidence Based Medicine (EBM), POPLINE, BIOSIS, and Web of Science, AIDSearch (MEDLINE AIDS/HIV Subset, AIDSTRIALS & AIDSDRUGS) databases. Results Evidence can be found to both support and refute the proposition that fixed and mobile telephones is, or could be, an effective healthcare intervention in developing countries. It is difficult to generalize because of the different outcome measurements and the small number of controlled studies. There is almost no literature on using mobile telephones as a healthcare intervention for HIV, TB, malaria, and chronic conditions in developing countries. Clinical outcomes are rarely measured. Convincing evidence regarding the overall cost-effectiveness of mobile phone " telemedicine" is still limited and good-quality studies are rare. Evidence of the cost effectiveness of such interventions to improve adherence to medicines is also quite weak. Conclusion The developed world model of personal ownership of a phone may not be appropriate to the developing world in which shared mobile telephone use is important. Sharing may be a serious drawback to use of mobile telephones as a healthcare intervention in terms of stigma and privacy, but its magnitude is unknown. One advantage, however, of telephones with respect to adherence to medicine in chronic care models is its ability to create a multi-way interaction between patient and provider(s) and thus facilitate the dynamic nature of this relationship. Regulatory reforms required for proper operation of basic and value-added telecommunications services are a priority if mobile telecommunications are to be used for healthcare initiatives.

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Author and article information

Contributors

Gretchen J. Domek

Ingrid L. Contreras-Roldan

Sean T. O’Leary

Sheana Bull

Anna Furniss

Allison Kempe

Edwin J. Asturias

Journal

Journal ID (nlm-ta): Vaccine

Journal ID (iso-abbrev): Vaccine

Title: Vaccine

Publisher: Elsevier Science

ISSN (Print): 0264-410X

ISSN (Electronic): 1873-2518

Publication date PMC-release: 05 May 2016

Publication date (Print): 05 May 2016

Volume: 34

Issue: 21

Pages: 2437-2443

Affiliations

[a ]Department of Pediatrics, University of Colorado Anschutz Medical Campus, B065, 13123 E. 16th Ave., Aurora, CO 80045, USA

[b ]Center for Global Health, Colorado School of Public Health, Mail Stop A090, 13199 E Montview Blvd, Suite 310, Aurora, CO 80045, USA

[c ]Center for Health Studies, Universidad del Valle de Guatemala, 18 Av. 11-95, Zona 15, Vista Hermosa III, Guatemala City, Guatemala

[d ]Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Mail Stop F443, 13199 E Montview Blvd, Suite 300, Aurora, CO 80045, USA

[e ]Department of Community and Behavioral Health, Colorado School of Public Health, 13001 E 17th Place, B119, Bldg 500, Rm E3345A, Aurora, CO 80045, USA

Author notes

[* ]Correspondingauthor at: Center for Global Health, Colorado School of Public Health, Mail Stop A090, 13199 E. Montview Blvd, Suite 310, Aurora, CO 80045, USA. Tel.: +1 303 724 6285; fax: +1 303 724 6286.Center for Global Health, Colorado School of Public HealthMail Stop A090, 13199 E. Montview Blvd, Suite 310AuroraCO80045USA Gretchen.domek@ 123456childrenscolorado.org

Article

Publisher ID: S0264-410X(16)30061-5

DOI: 10.1016/j.vaccine.2016.03.065

PMC ID: 4859823

PubMed ID: 27026145

SO-VID: ac3b7760-cd1f-404c-927a-5b0a3c7b7cf2

License:

This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

History

Date received : 29 January 2016

Date revision received : 17 March 2016

Date accepted : 19 March 2016

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

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Point-of-Care Testing for Infectious Diseases Super Collection

Most cited references 29

Efficacy of text messaging-based interventions for health promotion: a meta-analysis.

The effect of mobile phone text-message reminders on Kenyan health workers' adherence to malaria treatment guidelines: a cluster randomised trial

Can the ubiquitous power of mobile phones be used to improve health outcomes in developing countries?

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