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Noncompliance and delay in vaccination have caused millions of preventable deaths worldwide particularly in low-and middle-income countries (LMICs). The main reasons for delay in vaccinations or dropout from vaccination programs are vaccine hesitancy, lack of knowledge, forgetting due date, lack of trust, and religious and social barriers. Recently, various mobile health (mHealth) interventions such as voice call, text message reminders have been implemented in LMICs to improve awareness of vaccine availability and provide timely reminders. However, the implication and impact assessment of mHealth interventions with behavior change message for improving vaccination coverage and timeliness is limited. In this project, a three-armed cluster randomized controlled trial (cRCT) will be conducted to assess the impact and cost-effectiveness of mHealth interventions with behavioral change approach on vaccination coverage and timeliness in Bangladesh. A total of 7800 caregivers of children aged less than 4 weeks will be recruited and randomly allocated equally to each arm: control, voice call, and short message service (SMS) reminders with behavioral change message. The primary outcomes will include coverage of full immunization among children in first year of life, and secondary outcomes will be coverage for each vaccine, timeliness, and infant mortality.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Automatic voice call | Experimental | An automatic voice call will be sent on 3 days and one day before the scheduled visit at 6 weeks, 10 weeks, and 14 weeks for the three doses of DPT vaccine and age 9 months for MCV1 vaccine. |
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| Text with behavior change messages | Experimental | The study participant will receive the text message 3 and 1 days before the vaccination schedule |
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| Control | Active Comparator | The participant of the control group will receive only standard care. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Automated voice reminders with behavior change messages | Behavioral | An automatic voice call with behavior change messages will be sent on 3 days and one day before the scheduled visit at 6 weeks, 10 weeks, and 14 weeks for the three doses of DPT vaccine and age 9 months for MCV1 vaccine. The reminder will be sent in local language. |
| Measure | Description | Time Frame |
|---|---|---|
| Full vaccination | Full vaccination coverage by 12 months of age is defined as receiving all scheduled vaccines (BCG, 3 doses of DPT, 3 doses of polio, and 1 dose of MCV1). | 1 year |
| Vaccine Timeliness | Timeliness of vaccination: measured by whether each vaccine was administered within 2 weeks of the recommended schedule (at ages 6 weeks, 10 weeks, 14 weeks, and 9 months) | 1 year |
| Measure | Description | Time Frame |
|---|---|---|
| Vaccination coverage | Coverage of individual vaccines, including BCG, DPT1-3, polio1-3, and MCV1 | 1 year |
| Cost-effectiveness of the intervention | Cost-effectiveness (assessed by calculating the cost per additional fully vaccinated child in each intervention group) |
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Inclusion Criteria:
You are the infant's caregiver (mother, father, or legal guardian).
The infant is less than 4 weeks (28 days) old at the time of enrollment.
You reside within the jurisdiction of the designated community health center and have no plans to move within the next 12 months.
Depending on your assigned group, you can do one of the following:
(Note: For the voice call group, literacy is not an issue.)
You understand the content of this study and have completed the required informed consent form.
Exclusion Criteria:
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The intervention consists of two components: phone call, and text message. An automatic voice call and SMS will be sent on 3 days and one day before the scheduled visit at 6 weeks, 10 weeks, and 14 weeks for the three doses of DPT vaccine and age 9 months for MCV1 vaccine. The caregivers of intervention groups will receive either voice call or text messages in local language.
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| Text with behavior change message | Behavioral | SMS will be sent on 3 days and one day before the scheduled visit at 6 weeks, 10 weeks, and 14 weeks for the three doses of DPT vaccine and age 9 months for MCV1 vaccine. |
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| Control | Other | The participant of the control group will receive only standard care. |
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| 1 year after |