Leveraging Community Health Workers and a Responsive Digital Health System to Improve Vaccination Coverage and Timeliness in Resource-Limited Settings: Protocol for a Cluster Randomized Type 1 Effectiveness-Implementation Hybrid Study.
Leveraging Community Health Workers and a Responsive Digital Health System to Improve Vaccination Coverage and Timeliness in Resource-Limited Settings: Protocol for a Cluster Randomized Type 1 Effectiveness-Implementation Hybrid Study.
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DOI：
10.2196/52523
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发表时间：
2024-01-12
影响因子：
1.7
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中科院分区：
文献类型：
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坦桑尼亚是大多数未接种疫苗和接种不足儿童居住的20个国家之一。此前的研究发现，坦桑尼亚在儿童疫苗接种的覆盖率和及时性方面存在巨大的城乡差异，农村地区的儿童更有可能延迟接种或不接种疫苗。有必要进一步研究，以确定有效和可扩展的干预措施，可以弥合儿童疫苗接种方面的城乡差距，同时考虑到疫苗接种的多方面障碍。该方案描述了一项1型有效性-实施混合研究，以评估Chanjo Kwa Wakati（斯瓦希里语及时接种疫苗），这是一种基于社区的数字健康干预措施，旨在提高疫苗接种的及时性。该干预措施结合了人力资源（社区卫生工作者），低成本数字战略（电子通信，数字病例管理和任务自动化），疫苗接种知识干预以及行为经济学的见解（提醒和激励），以促进及时的儿童疫苗接种。本研究将在坦桑尼亚的两个主要农村地区（Shinyanga和姆万扎）进行，这两个地区有大量未接种疫苗或接种不足的儿童。40个农村卫生机构及其集水区（集群）将被随机分配到早发或迟发研究组，每个集群将入组3个母子配对队列（1个回顾性队列和2个前瞻性队列）。将对1200名儿童（n=600，50%为干预组儿童，n = 600，50%为非干预组儿童）在出生后第一年内建议的所有疫苗接种的及时性和覆盖率进行观察。主要有效性结果将是五价疫苗（Penta 3）第三剂的及时性。定量调查、疫苗接种记录、研究日志、忠诚度检查表以及对母亲和关键信息提供者的定性访谈将为覆盖、有效性、采用、实施和维护（RE-AIM）框架的5个结构提供信息。研究结果将用于制定实施蓝图，以指导今后调整和扩大Chanjo Kwa Wakati。该研究于2022年8月获得资助。数据收集预计将从2024年2月持续到2027年7月。这项研究将解决缺乏严格证据证明基于社区的数字健康干预措施对促进撒哈拉以南非洲儿童疫苗接种覆盖率和及时性的有效性的问题，并确定潜在的实施战略，以促进在低收入和中等收入国家部署疫苗接种促进干预措施。ClinicalTrials.gov NCT 06024317; https://www.clinicaltrials.gov/study/NCT06024317 PRR1-10.2196/52523
Tanzania is 1 of 20 countries where the majority of unvaccinated and undervaccinated children reside. Prior research identified substantial rural-urban disparities in the coverage and timeliness of childhood vaccinations in Tanzania, with children in rural settings being more likely to receive delayed or no vaccinations. Further research is necessary to identify effective and scalable interventions that can bridge rural-urban gaps in childhood vaccination while accounting for multifaceted barriers to vaccination. This protocol describes a type 1 effectiveness-implementation hybrid study to evaluate Chanjo Kwa Wakati (timely vaccination in Kiswahili), a community-based digital health intervention to improve vaccination timeliness. The intervention combines human resources (community health workers), low-cost digital strategies (electronic communication, digital case management, and task automation), a vaccination knowledge intervention, and insights from behavioral economics (reminders and incentives) to promote timely childhood vaccinations. The study will be conducted in 2 predominantly rural regions in Tanzania with large numbers of unvaccinated or undervaccinated children: Shinyanga and Mwanza. Forty rural health facilities and their catchment areas (clusters) will be randomized to an early or delayed onset study arm. From each cluster, 3 cohorts of mother-child dyads (1 retrospective cohort and 2 prospective cohorts) will be enrolled in the study. The timeliness and coverage of all vaccinations recommended during the first year of life will be observed for 1200 children (n=600, 50% intervention group children and n=600, 50% nonintervention group children). The primary effectiveness outcome will be the timeliness of the third dose of the pentavalent vaccine (Penta3). Quantitative surveys, vaccination records, study logs, fidelity checklists, and qualitative interviews with mothers and key informants will inform the 5 constructs of the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework. The results will be used to develop an implementation blueprint to guide future adaptations and scale-up of Chanjo Kwa Wakati. The study was funded in August 2022. Data collection is expected to last from February 2024 to July 2027. This study will address the lack of rigorous evidence on the effectiveness of community-based digital health interventions for promoting vaccination coverage and timeliness among children from sub-Saharan Africa and identify potential implementation strategies to facilitate the deployment of vaccination promotion interventions in low- and middle-income countries. ClinicalTrials.gov NCT06024317; https://www.clinicaltrials.gov/study/NCT06024317 PRR1-10.2196/52523
影响因子：
5.5
作者：
Yelverton, Valerie;Hair, Nicole L.;Ghosh, Suvomita Happy;Mfinanga, Sayoki Godfrey;Ngadaya, Esther;Baumgartner, Joy Noel;Ostermann, Jan;Vasudevan, Lavanya
通讯作者：
Vasudevan, Lavanya
影响因子：
3.8
作者：
Ostermann, Jan;Hair, Nicole L.;Moses, Sara;Ngadaya, Esther;Mfinanga, Sayoki Godfrey;Brown, Derek S.;Baumgartner, Joy Noel;Vasudevan, Lavanya
通讯作者：
Vasudevan, Lavanya