PMID- 31148544 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20201001 IS - 1929-0748 (Print) IS - 1929-0748 (Electronic) IS - 1929-0748 (Linking) VI - 8 IP - 5 DP - 2019 May 30 TI - Personalized Text Messages and Automated Calls for Improving Vaccine Coverage Among Children in Pakistan: Protocol for a Community-Based Cluster Randomized Clinical Trial. PG - e12851 LID - 10.2196/12851 [doi] LID - e12851 AB - BACKGROUND: A major reason for poor childhood vaccine coverage in developing countries is the lack of awareness among parents and caregivers regarding the need for immunization and the importance of completing the entire series of vaccines. Short message service (SMS)-based interventions have been quite effective in different programs such as smoking cessation, treatment adherence, health care scheduled appointment attendance, antenatal care attendance, and compliance to immunization. However, there are limited data from low- and middle-income countries on the role of SMS and automated call-based messages and interventions to improve routine immunization (RI) coverage. OBJECTIVE: The primary objective of this study is to evaluate whether automated mobile phone-based personalized messages (SMS or automated call) can improve RI uptake at 6, 10, and 14 weeks of age per the expanded program immunization schedule, compared with a usual care control group. Secondary objectives include assessing the effects of different types of automated SMS text or calls on RI coverage at 20 weeks of age. METHODS: This is a mixed methods study using a clustered randomized controlled trial with 4 intervention arms and 1 control arm, augmented by qualitative interviews for personalizing the message. The study is being conducted in Pakistan (an urban site in Karachi and a rural site Matiari). In Karachi, 250 administrative structures are taken as 1 cluster, whereas in Matiari, a catchment area of 4 Lady Health Workers is considered as 1 cluster. The intervention targets families to receive weekly 1-way or 2-way (interactive) personalized automated SMS or automated phone call messages regarding vaccination. Possible barriers to vaccination are assessed in each family at the time of inclusion to determine the type of personalized messages that should be sent to the family to increase the chance of a positive response. Finally, in-depth interviews using purposive sampling are conducted before and after the trial to determine the family's vaccination experience and related factors. RESULTS: All study participants for the cluster randomized trial were enrolled by January 14, 2019. Study exit interviews at 20-weeks follow-up visits will be completed by June 2019. CONCLUSIONS: The results of this study will be useful to understand the respective effects of SMS text messages versus automated phone-based communication to improve RI coverage and timelines. Moreover, information regarding families' perceptions of vaccination and the daily life challenges for timely visits to the vaccine clinic will be used for developing more complex interventions that use mobile phone messages and possibly other approaches to overcome barriers in the uptake of correct and timely immunization practices. TRIAL REGISTRATION: ClinicalTrials.gov NCT03341195; https://clinicaltrials.gov/ct2/show/NCT03341195 (Archived by WebCite at http://www.webcitation.org/78EWA56Uo). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/12851. CI - (c)Abdul Momin Kazi, Nazia Ahsan, Ayub Khan, Saima Jamal, Hussain Kalimuddin, Naveera Ghulamhussain, Zabin Wajidali, Abdul Muqeet, Fabiha Zaidi, Meraj Subzlani, William McKellin, Asad Ali, Jean-Paul Collet. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 30.05.2019. FAU - Kazi, Abdul Momin AU - Kazi AM AUID- ORCID: 0000-0001-8253-1777 AD - Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan. AD - Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC, Canada. FAU - Ahsan, Nazia AU - Ahsan N AUID- ORCID: 0000-0002-4200-3918 AD - Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan. FAU - Khan, Ayub AU - Khan A AUID- ORCID: 0000-0002-0473-2992 AD - Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan. FAU - Jamal, Saima AU - Jamal S AUID- ORCID: 0000-0001-9453-0237 AD - Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan. FAU - Kalimuddin, Hussain AU - Kalimuddin H AUID- ORCID: 0000-0001-6244-9063 AD - Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan. FAU - Ghulamhussain, Naveera AU - Ghulamhussain N AUID- ORCID: 0000-0003-0436-3311 AD - Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan. FAU - Wajidali, Zabin AU - Wajidali Z AUID- ORCID: 0000-0002-1656-5116 AD - Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan. FAU - Muqeet, Abdul AU - Muqeet A AUID- ORCID: 0000-0001-6380-0302 AD - Digital Health Resource Center, Aga Khan Development Network, Karachi, Pakistan. FAU - Zaidi, Fabiha AU - Zaidi F AUID- ORCID: 0000-0003-0243-8092 AD - Digital Health Resource Center, Aga Khan Development Network, Karachi, Pakistan. FAU - Subzlani, Meraj AU - Subzlani M AUID- ORCID: 0000-0001-9462-3310 AD - Digital Health Resource Center, Aga Khan Development Network, Karachi, Pakistan. FAU - McKellin, William AU - McKellin W AUID- ORCID: 0000-0002-1217-3035 AD - Department of Sociology, University of British Columbia, Vancouver, BC, Canada. FAU - Ali, Asad AU - Ali A AUID- ORCID: 0000-0001-5274-7665 AD - Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan. FAU - Collet, Jean-Paul AU - Collet JP AUID- ORCID: 0000-0001-9900-0403 AD - Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC, Canada. AD - Beijing Tiantan Hospital and Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China. LA - eng SI - ClinicalTrials.gov/NCT03341195 GR - D43 TW007585/TW/FIC NIH HHS/United States PT - Journal Article DEP - 20190530 PL - Canada TA - JMIR Res Protoc JT - JMIR research protocols JID - 101599504 PMC - PMC6658276 OTO - NOTNLM OT - SMS messages OT - automated call messages OT - cell phones OT - cluster randomized clinical trial OT - developing countries OT - mobile health OT - parents OT - personalized intervention OT - routine immunization OT - text messaging OT - vaccination coverage OT - vaccine barriers COIS- Conflicts of Interest: None declared. EDAT- 2019/06/01 06:00 MHDA- 2019/06/01 06:01 PMCR- 2019/05/30 CRDT- 2019/06/01 06:00 PHST- 2018/11/20 00:00 [received] PHST- 2019/04/02 00:00 [accepted] PHST- 2019/03/14 00:00 [revised] PHST- 2019/06/01 06:00 [entrez] PHST- 2019/06/01 06:00 [pubmed] PHST- 2019/06/01 06:01 [medline] PHST- 2019/05/30 00:00 [pmc-release] AID - v8i5e12851 [pii] AID - 10.2196/12851 [doi] PST - epublish SO - JMIR Res Protoc. 2019 May 30;8(5):e12851. doi: 10.2196/12851.