Dissemination and implementation of SMS mobile technology to improve child vaccinations in Guatemala
BACKGROUND: Despite immunizations being one of the most successful and cost-effective public health interventions, vaccine coverage in low and middle income countries (LMICs) has remained a significant challenge with over 20 million infants unimmunized and at risk for unnecessary morbidity and mortality. Patient reminder systems have proven to be an important mechanism for improving childhood vaccination coverage and can be adapted to mobile health technologies, such as Short Message Service (SMS) texts, which have tremendous and untapped potential for disease management in LMICs where the majority of mobile subscribers reside.
GAP: Despite the positive results of many research studies, the translation of research findings to clinical practice and policy has been historically poor, and there remains little understanding of the barriers and facilitators to program adoption and more widespread dissemination.
HYPOTHESIS: This study adds a mixed methods design to complement a concurrent randomized controlled pilot trial evaluating the effect of SMS reminders on increasing immunization timeliness and coverage for the infant vaccination series in a rural and urban site in Guatemala. Understanding the real-world context in which an SMS immunization reminder system is implemented will be imperative for successful program adoption, replication, and scale-up.
METHODS: This study is a mixed-methods approach that will integrate qualitative data to critically inform the future Dissemination and Implementation (D&I) of the SMS immunization reminder system in terms of feasibility and acceptability (primary outcomes) and perceived facilitators and barriers (secondary outcomes) to the program through (1) focus group discussions with parents, (2) key informant interviews with nurses, physicians, clinic administrators, Information Technology Systems directors, and Ministry of Health personnel, and (3) contextual data analysis.
IMPACT: Developing, implementing, and disseminating an SMS system that is generalizable, scalable, and effectively increases childhood immunization rates in resource-limited settings would have significant and timely implications towards improving worldwide vaccine coverage and ultimately reducing childhood morbidity and mortality. Additionally, this study could provide a future platform in LMICs for the delivery of other childhood clinical preventive services and health surveillance systems.