mHealth: A Narrative Synthesis of Evidence of Its Application in Improving Childhood Immunization Coverage

Several supply- and demand-side factors, as well as other context-specific factors, are associated with the poor uptake and completion rates of childhood vaccination, and the consequent high mortality rates from vaccine-preventable diseases (VPDs), especially in developing countries. Among the approaches to address these factors are interventions such as public education or knowledge translation and, recently, the adoption of mobile health technology through provision of immunisation reminders on mobile devices (short messaging service (SMS) and telephone calls) and apps have demonstrated promising results in improving immunisation coverage in Kenya, Guatemala, Zimbabwe, Pakistan, and China, albeit with a few inconsistencies. The aim of this review was to explore the diversity and quality of evidence regarding the application of mHealth in improving childhood immunisation coverage.

The authors contend that, although narrative reviews often take a less formal and rigorous approach compared to a systematic review and meta-analysis, they can be an educational tool in continuing medical education, especially when a blended approach such as reporting methodology, search terms, databases used, and inclusion and exclusion criteria are provided, as was the case in this review.

Following a brief search on Scimago Journal and Country Rank using a combination of relevant subject areas and subject categories, they evaluated 15 articles - mainly systematic reviews and randomised controlled trials (RCTs) - published in 12 top Q1 impact factor journals between 2010 and 2017.

Overall, the researchers found moderate- to high-quality literature evidence suggesting the efficacy of mHealth interventions used singly or in combination with other interventions in improving childhood immunisation coverage across several rural and urban settings around the world. The ubiquitous availability of mobile phones and devices suggest that the targeted application of mobile phone technologies to improving childhood immunisation uptake and completion rates can be very successful in addressing demand side factors such as forgetting immunisation appointments, not knowing the vaccine schedule, or incurring transportation costs to clinics/hospitals, to improve immunisation uptake. Building on the established evidence of the efficacy of SMS in addressing demand-side factors affecting childhood immunization coverage, some researchers have explored the comparative effectiveness of SMS alone versus a combination of SMS and other incentives such as financial incentives, especially in populations with perceived low literacy rates, low- to high-background immunisation rates, and questionable acceptability of SMS among segments of the population.

While these evidences represent the larger consensus, the authors recommend that more attention should be given to detailed analysis of factors or circumstances that lead to negative results of these interventions in areas where such have been observed or reported. Futhermore, although mHealth interventions are generally perceived to be cost-effective, further studies are required to provide wider and more concrete evidence of its cost-effectiveness ratio compared to other types of interventions aimed at improving childhood immunisation coverage.