Personalized Text Messages and Automated Calls for Improving Vaccine Coverage Among Children in Pakistan: Protocol for a Community-Based Cluster Randomized Clinical Trial

Kazi, Abdul Momin; Ahsan, Nazia; Khan, Ayub; Jamal, Saima; Kalimuddin, Hussain; Ghulamhussain, Naveera; Wajidali, Zabin; Muqeet, Abdul; Zaidi, Fabiha; Subzlani, Meraj; McKellin, William H.; Ali, Asad; Collet, Jean‐Paul

doi:10.2196/12851

Cited by 14 publications

(11 citation statements)

References 20 publications

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“…This paper complements a broader literature showing the potential of text messages as nudges for health-related behaviors such as prevention and disease management (Cole-Lewis and Kershaw, 2010), treatment adherence (Pop-Eleches et al, 2011), child eating behavior (Chai et al, 2019), or vaccination (Kazi et al, 2019). It links to evidence of text messages influencing pro-social behaviors (Konrath et al, 2015).…”

Section: Introductionmentioning

confidence: 73%

Texting Parents about Early Child Development: Behavioral Changes and Unintended Social Effects

Barrera¹,

Macours²,

Premand³

et al. 2020

Policy Research Working Papers

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The Policy Research Working Paper Series disseminates the findings of work in progress to encourage the exchange of ideas about development issues. An objective of the series is to get the findings out quickly, even if the presentations are less than fully polished. The papers carry the names of the authors and should be cited accordingly. The findings, interpretations, and conclusions expressed in this paper are entirely those of the authors. They do not necessarily represent the views of the International Bank for Reconstruction and Development/World Bank and its affiliated organizations, or those of the Executive Directors of the World Bank or the governments they represent.

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Section: Introductionmentioning

confidence: 73%

Texting Parents about Early Child Development: Behavioral Changes and Unintended Social Effects

Barrera¹,

Macours²,

Premand³

et al. 2020

Policy Research Working Papers

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“…The app will have features and capacity for text, voice, pictorial, and video messages. The content of the messages will be based on the previous study that utilized automated SMS text messages and calls in various local languages to improve RCI coverage [ 25 ].…”

Section: Methodsmentioning

confidence: 99%

“…AI is being applied in this study in two different manners. First, AI is being applied to the baseline data and RCT results from a previous study, which is based on an automated SMS text message and voice call intervention [ 25 ]. Paigham-e-Sehat is a recently completed study that includes data from 3300 children, in which RCI-related messages were sent to caregivers via SMS text messages or automated calls to improve their children’s vaccine coverage at 6, 10, and 14 weeks of age.…”

Section: Methodsmentioning

confidence: 99%

“…This system will be tested during this study by validating the system’s prediction ability against the actual outcome of this study. Further, the important predictors and barriers identified in the previous study will be used for extending the work on data obtained from this study [ 25 ] . After the availability of the study results, factors related to the effect of users’ app behavior on the vaccination outcomes, including their preferred modes, timing, and interactivity with the app, will be analyzed through pattern recognition using a mixture of hidden Markov models.…”

Section: Methodsmentioning

confidence: 99%

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An Artificial Intelligence–Based, Personalized Smartphone App to Improve Childhood Immunization Coverage and Timelines Among Children in Pakistan: Protocol for a Randomized Controlled Trial

Kazi¹,

Qazi²,

Khawaja³

et al. 2020

JMIR Res Protoc

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Background The immunization uptake rates in Pakistan are much lower than desired. Major reasons include lack of awareness, parental forgetfulness regarding schedules, and misinformation regarding vaccines. In light of the COVID-19 pandemic and distancing measures, routine childhood immunization (RCI) coverage has been adversely affected, as caregivers avoid tertiary care hospitals or primary health centers. Innovative and cost-effective measures must be taken to understand and deal with the issue of low immunization rates. However, only a few smartphone-based interventions have been carried out in low- and middle-income countries (LMICs) to improve RCI. Objective The primary objectives of this study are to evaluate whether a personalized mobile app can improve children’s on-time visits at 10 and 14 weeks of age for RCI as compared with standard care and to determine whether an artificial intelligence model can be incorporated into the app. Secondary objectives are to determine the perceptions and attitudes of caregivers regarding childhood vaccinations and to understand the factors that might influence the effect of a mobile phone–based app on vaccination improvement. Methods A mixed methods randomized controlled trial was designed with intervention and control arms. The study will be conducted at the Aga Khan University Hospital vaccination center. Caregivers of newborns or infants visiting the center for their children’s 6-week vaccination will be recruited. The intervention arm will have access to a smartphone app with text, voice, video, and pictorial messages regarding RCI. This app will be developed based on the findings of the pretrial qualitative component of the study, in addition to no-show study findings, which will explore caregivers’ perceptions about RCI and a mobile phone–based app in improving RCI coverage. Results Pretrial qualitative in-depth interviews were conducted in February 2020. Enrollment of study participants for the randomized controlled trial is in process. Study exit interviews will be conducted at the 14-week immunization visits, provided the caregivers visit the immunization facility at that time, or over the phone when the children are 18 weeks of age. Conclusions This study will generate useful insights into the feasibility, acceptability, and usability of an Android-based smartphone app for improving RCI in Pakistan and in LMICs. Trial Registration ClinicalTrials.gov NCT04449107; https://clinicaltrials.gov/ct2/show/NCT04449107 International Registered Report Identifier (IRRID) DERR1-10.2196/22996

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“…They fear a graveyard of poor-quality, unproven apps contributing to a fragmented mHealth landscape [ 22 ]. Some experts recommend assessing the barriers and challenges faced by the targeted end users before designing the app to be able to provide mHealth as a good-fit solution [ 20 , 23 ]. A study attributed the failure of technology to its lack of regard for user requirements and experience [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

Operability, Usefulness, and Task-Technology Fit of an mHealth App for Delivering Primary Health Care Services by Community Health Workers in Underserved Areas of Pakistan and Afghanistan: Qualitative Study

Zaidi¹,

Kazi²,

Riaz³

et al. 2020

J Med Internet Res

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Background The recent proliferation of digital health technology in low- and middle-income countries has made it possible for community health workers (CHWs) to use mobile health (mHealth) to perform tasks such as data collection and training. Although most studies focus on the prospect of digital apps to motivate and connect CHW, only a few have captured end-user experiences with mobile-based apps. We examined the experience of frontline health workers with a move towards digitalized real-time data to record maternal and childcare services in remote areas of Afghanistan and Pakistan. Objective Our study aimed to explore CHW perceptions on the operability of the mHealth app in a community setting, usefulness of the app in the delivery of assigned maternal and childcare functions, and the task-technology fit with monitoring information systems. Methods The Hayat app, designed to digitalize and facilitate electronic record keeping, was evaluated to be embedded into mainstream health systems. The app had 2 components: smartphone app for data entry and web dashboard for visualization of the maternal, newborn, and child health reports. Using a qualitative exploratory study design, we conducted a total of 8 focus group discussions with purposively selected lady health workers (LHWs) and CHWs in 3 districts of Pakistan and 3 hamlets of Afghanistan, respectively. Focus group discussions were conducted in the local language, audio recorded, and converted into expanded notes for thematic analysis. Results Although a majority of LHWs used the app with ease, some initially faced difficulties in operating it and requested a longer duration of training. Contrary to LHWs, the CHWs were able to use the app without difficulty, as they were using it only to register clients. Overall, use of the mHealth app in both countries resulted in a positive impact on health education sessions, easier communication with parents or clients, tracking of routine immunization defaulters and follow-ups, improved data validity, easily accessible vaccination schedules, and faster registration. In addition to building up their image in the community and personal development, the improved reporting and monitoring mechanisms also set the stage for the LHWs to get recognized for their hard work. CHWs in Afghanistan also reported the app provided immediate access to information when requested by their supervisor. Although the Hayat app eliminates the need to carry multiple registers and helps in recalling client information at the touch of a button, technical issues around connectivity and data inputting tabs were highlighted by the participants. Conclusions The digitization of records not only provided CHWs support in their daily routine but also strengthened monitoring mechanisms and improved motivation. We recommend conducting end user experience studies before embedding apps into mainstream health systems as high acceptability does not always result in high uptake of digital technology.

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Personalized Text Messages and Automated Calls for Improving Vaccine Coverage Among Children in Pakistan: Protocol for a Community-Based Cluster Randomized Clinical Trial

Cited by 14 publications

References 20 publications

Texting Parents about Early Child Development: Behavioral Changes and Unintended Social Effects

Texting Parents about Early Child Development: Behavioral Changes and Unintended Social Effects

An Artificial Intelligence–Based, Personalized Smartphone App to Improve Childhood Immunization Coverage and Timelines Among Children in Pakistan: Protocol for a Randomized Controlled Trial

Operability, Usefulness, and Task-Technology Fit of an mHealth App for Delivering Primary Health Care Services by Community Health Workers in Underserved Areas of Pakistan and Afghanistan: Qualitative Study

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