SMS mobile technology to improve early childhood vaccine coverage in Guatemala

描述(由申请人提供)：移动技术，如短消息服务(SMS)文本，在低收入和中等收入国家(LMIC)的疾病管理方面具有巨大的未开发潜力。这方面的一个重要例子涉及改进儿童疫苗接种系列。免疫接种是最成功和最具成本效益的公共卫生干预措施之一，但数以百万计的一岁以下儿童免疫不足，过早死亡、长期后遗症和因疫苗可预防的原因致残的风险增加。提供婴儿初级系列疫苗的一个主要障碍，特别是在发展中国家，是提供者在与父母就这些疫苗的必要性和及时性进行沟通方面存在困难。许多LMIC没有有效的预防性卫生服务和良好的儿童护理，这使得提供免疫接种和其他儿童健康计划变得更加困难。迫切需要采取干预措施，改善提供全面托儿服务(如免疫接种)的保健机构与幼儿父母之间的沟通，以改善健康结果(如疫苗接种的及时性、接受度和覆盖率)。短消息服务(SMS)文本消息是一种在全球范围内广泛使用的可访问的低成本通信手段。在过去的两年里，研究小组开发并展示了危地马拉短信免疫提醒系统的可行性和消费者的接受度，该系统允许医护人员收集儿童疫苗接种的数据，并向父母/监护人发送短信提醒参加疫苗接种预约。在这项拟议的探索性和发展性研究中，我们将优化、实施和评估一种基于证据的集中式方法，该方法使用研究团队开发的短信提醒/召回系统的修改版本来增加免疫接种。该项目将评估我们改进的集中化方法在危地马拉两个不同的社会经济和地理区域的有效性潜力，包括在危地马拉市进行的试点测试，该系统是在危地马拉开发的，并在贫困的特里菲尼奥地区进行新的引入，在那里，研究小组建立了长期的公私合作伙伴关系，提供产前、孕产妇和儿科护理。这项研究在美国和危地马拉的公共、私营和政府机构之间提供了一种创新的伙伴关系，可以作为支持国际研究网络和建设LMIC研究能力的重要范例。这项研究有可能显著改善疫苗的交付和覆盖率，并有机会实现项目的可伸缩性。重要的是，这种独特的合作所建立的技术和管理基础设施将成为未来提供其他临床预防服务的平台 是可以建造的。

DESCRIPTION (provided by applicant): Mobile technologies, such as Short Message Service (SMS) texts, have tremendous and untapped potential for disease management in low- and middle-income countries (LMICs). One important example of this involves improving the childhood vaccination series. Immunization is one of the most successful and cost-effective public health interventions, and yet millions of children under the age of one remain under-immunized and at increased risk for premature death, long-term sequelae, and disability due to vaccine-preventable causes. A major barrier to delivering the infant primary series, especially in developing countries, is the difficulty providers have in communicating with parents about the need for and timeliness of these vaccines. Many LMICs do not have functioning preventive health services and well child care, making the delivery of immunizations and other child health programs more difficult. There is an urgent need for interventions that improve communication between health care facilities providing comprehensive child care services (e.g. immunizations) and parents of young children to improve health outcomes (e.g. the timeliness, acceptance, and coverage of vaccinations). Short Message Service (SMS) text messages are an accessible and low-cost means of communication that are widely used globally. Over the past two years, the study team developed and demonstrated the feasibility and consumer acceptability of an SMS immunization reminder system in Guatemala which allowed healthcare workers to collect data on child immunizations and send text message reminders to parents/guardians to attend vaccination appointments. In this proposed exploratory and developmental study, we will optimize, implement, and evaluate an evidence-based centralized method of increasing immunization delivery using a modified version of the SMS reminder/recall system developed by the study team. The project will evaluate the potential for efficacy of our modified centralized approach in two different socio-economic and geographic regions of Guatemala, including a pilot test in Guatemala City where the system was developed and a new introduction in the impoverished southwest Trifinio region where the study team has a well-established and long-term public-private partnership to provide prenatal, maternal, and pediatric care. This study provides an innovative partnership between public, private, and governmental institutions both in the United States and Guatemala that can serve as an important example of supporting international research networks and building research capacity in LMICs. This study has the potential to significantly improve vaccine delivery and coverage with the opportunity for program scalability. Importantly, the technical and administrative infrastructure created by this unique collaboration will be a platform on which the future delivery of other clinical preventive services can be built.