To Evaluate the Role of Mobile Phone SMS Text Messages in Improving Vaccine Coverage Among Children in Pakistan - A Mix Methods Study Design

Routine childhood immunization (RCI) in Pakistan is well below the recommended coverage of 90% with rates as low as 16% in certain regions (Pakistan DHS 2012-3). This has led to continued polio transmission, large measles outbreaks and thousands of deaths from vaccine-preventable diseases (Kazi.Bull WHO 2016). Mobile phone communication is widespread in developing countries, and has proven a potential method in directly connecting pregnant women and mothers to health services (Kharbanda. Expert Review of Vaccine 2014). In our previous pilot phase trial, SMS reminders increased vaccination uptake from 26 to 31% for RCI at 14 weeks schedule, but the difference was not statistically significant. We propose conducting a mixed methods proof of concept cluster randomized trial (CRT) to assess the effectiveness of different types of SMS messaging to improve RCI and understand the perceptions and barriers that may affect SMS-based interventions at community and family levels. Our study will be conducted at urban and rural sites in Pakistan. This study examines an important public health question - do low cost, automated SMS messages improve RCI coverage in resource-constrained settings? Further, it will compare the effectiveness of reminder, educational and interactive text messages for improving RCI and will generate socio-cultural data regarding the impact of family health beliefs and organization that will be important for setting up the appropriate interventions in other LMICs.