Department of Research, Direct Consulting and Logistics Limited, Federal Capital Territory, Abuja, Nigeria.
Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health Baltimore, Baltimore, MD, USA.
BMC Public Health. 2022 Dec 17;22(1):2370. doi: 10.1186/s12889-022-14822-1.
Short Message Service (SMS) reminders have improved vaccine uptake in low- and middle-income countries (LMICs). However, the limited use of SMS reminders in LMICs requires evaluating the intervention's internal and external validity to improve adoption and sustainability. Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we qualitatively assessed the impact of a SMS reminder intervention implemented in Kebbi State, Northwest Nigeria between May 20, 2019 and May 31, 2020. This will guide and inform future SMS reminder interventions to improve childhood immunization uptake in LMICs.
In June 2020, we conducted 14 focus group discussions, 13 in-depth interviews, and 20 key informant interviews among 144 purposively selected participants from five local government areas of Kebbi State. For analysis, we used a deductive approach to develop preliminary codes based on the RE-AIM framework and the inductive approach to generate themes that emerged from the interviews.
The perceived importance and impact of the SMS reminder in improving demand and uptake for vaccinations were the consistent contributing factors that encouraged participants' participation. Other facilitators included the involvement of health workers in supporting SMS reminder registration and community gatekeepers using existing structures to convey messages on scheduled immunization services. Policymakers adopted the intervention because it aligns with the state's priority to improve immunization coverage. Similarly, the SMS reminder appealed to health workers and program managers because it reduced their workload and served as a performance monitoring tool to track immunization and intervention defaulters. Despite these, low mobile phone ownership and the inability to read text messages due to the low literacy level were the main barriers during implementation. Finally, data availability on cost-effectiveness and the intervention's impact on improving coverage was critical for scalability.
Our study demonstrated that SMS reminders in local languages could improve vaccination demand and uptake in resource-constrained settings due to their perceived importance and impact. Addressing the cited implementation barriers and promoting the facilitators is critical to its adoption and sustainability. Costing and impact data are needed to collaborate findings on the effectiveness of the SMS reminder to improve childhood vaccination uptake.
短信提醒服务（SMS）在中低收入国家（LMICs）提高了疫苗接种率。然而，在 LMICs 中有限地使用 SMS 提醒服务需要评估干预措施的内部和外部有效性，以提高接受度和可持续性。我们使用可及性、有效性、适用性、实施性和维持性（RE-AIM）框架，定性评估了 2019 年 5 月 20 日至 2020 年 5 月 31 日在尼日利亚西北部的凯比州实施的 SMS 提醒干预措施的影响。这将为未来改善中低收入国家儿童免疫接种率的 SMS 提醒干预措施提供指导和信息。
在 2020 年 6 月，我们在凯比州的五个地方政府区，对 144 名经刻意挑选的参与者进行了 14 次焦点小组讨论、13 次深入访谈和 20 次关键知情者访谈。在分析中，我们使用演绎法根据 RE-AIM 框架和归纳法制定初步代码，从访谈中生成主题。
SMS 提醒对改善需求和接种率的重要性和影响是参与者参与的一致促进因素。其他促进因素包括卫生工作者参与支持 SMS 提醒注册和社区守门人利用现有结构传达关于计划免疫服务的信息。决策者采用该干预措施是因为它符合该州提高免疫覆盖率的优先事项。同样，SMS 提醒也吸引了卫生工作者和项目管理人员，因为它减轻了他们的工作量，并作为监测免疫和干预措施违约者的绩效工具。尽管如此，由于移动电话拥有率低和由于文化程度低而无法阅读短信，在实施过程中存在主要障碍。最后，有关成本效益和干预措施对提高覆盖率的影响的数据的可用性对于可扩展性至关重要。
我们的研究表明，由于 SMS 提醒的重要性和影响，在资源有限的环境中，使用当地语言的 SMS 提醒可以提高疫苗接种的需求和接种率。解决已确定的实施障碍并促进促进因素对其采用和可持续性至关重要。需要成本效益和影响数据，以促进关于 SMS 提醒提高儿童疫苗接种率的有效性的研究结果的合作。
