Pairing mobile reminders with incentives improves rural immunization rates

By Dave Muoio
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A study of more than 500 children in rural India suggests that pairing SMS reminders with incentives more effectively produces desired health outcomes than the mobile reminders alone.

Published today in Pediatrics, the study was a collaboration between researchers from Johns Hopkins Medicine and the Indian nonprofit child health organization Bal Umang Drishya Sanstha (BUDS) that sought to improve childhood immunization rates in poorer communities.

"Vaccinations and booster shot schedules are designed to work optimally if given within a specific window of time, and even in resource poor areas such as rural India, an estimated 90 percent of households have mobile phones,” Dr. Sanjay Jain, professor of pediatrics at the Johns Hopkins University School of Medicine and the study’s senior author, said in a statement.

In the study, researchers enrolled 608 Indian children aged two years or younger living in a rural community to a control group or two intervention arms. The first of these delivered automated mobile phone reminders for childhood immunizations to the children’s caretakers, while the second provided the reminders alongside a compliance-linked incentive, in this case approximately 30 minutes of phone talk time valued at $0.50 cents (30 Indian rupees). The primary outcome of interest was immunization coverage.

Among the 549 children who fulfilled the eligibility criteria, the median age was five months. These children were enrolled in the study for a median duration of 292 days. Nearly 84 percent of the children’s mothers had no formal education, and 85.8 percent had family incomes under roughly $375 (25,000 rupees) per month.

Compared to a median immunization coverage rate of 33 percent across all groups at enrollment, immunization among the control group increased to 41.7 percent. While the median immunization rate among group who received mobile alerts alone increased to just 40.1 percent, those whose caretaker’s reminders included an incentive achieved a median rate of 50 percent. According to the researchers, these compliance-linked incentives alongside the reminders was independently associated with immunization coverage gains, as well as a less robust increase in the timeliness of those immunizations.

"It is quite innovative when simple incentives on devices that are used daily can impact a fundamental public health improvement," Dr. Ibukun Akinboyo, pediatric infectious diseases postdoctoral fellow at Johns Hopkins University School of Medicine and study author, said in a statement. "The study highlights that we can leverage available resources, such as the widespread use of mobile phones, to improve vaccination coverage and hopefully decrease rates of preventable childhood infections."