WHAT’S KNOWN ON THIS SUBJECT: In previous studies, researchers have established the role of mobile phone messaging in improving health outcomes. However, there are few studies in which researchers have evaluated the role of compliance-linked incentives versus mobile phone messaging to improve childhood immunization coverage.
WHAT THIS STUDY ADDS: A biometric-linked, cloud-based immunization record platform was used for positive identification and tamper-proof delivery of automated compliance-linked incentives. We demonstrate that incentives are an important intervention for improving the timeliness and coverage of childhood immunizations in a resource-poor setting.
STUDY OBJECTIVES: Young children in resource-poor settings remain inadequately immunized. We evaluated the role of compliance-linked incentives versus mobile phone messaging to improve childhood immunizations.
STUDY METHODOLOGY: Children aged ≤24 months from a rural community in India were randomly assigned to either a control group or 1 of 2 study groups. A cloud-based, biometric-linked software platform was used for positive identification, record keeping for all groups, and delivery of automated mobile phone reminders with or without compliance-linked incentives (Indian rupee Rs30 or US dollar $0.50 of phone talk time) for the study groups. Immunization coverage was analyzed by using multivariable Poisson regression.
STUDY RESULTS: Between July 11, 2016, and July 20, 2017, 608 children were randomly assigned to the study groups. Five hundred and forty-nine (90.3%) children fulfilled eligibility criteria, with a median age of 5 months; 51.4% were girls, 83.6% of their mothers had no schooling, and they were in the study for a median duration of 292 days. Median immunization coverage at enrollment was 33% in all groups and increased to 41.7% (interquartile range [IQR]: 23.1%–69.2%), 40.1% (IQR: 30.8%–69.2%), and 50.0% (IQR: 30.8%–76.9%) by the end of the study in the control group, the group with mobile phone reminders, and the compliance-linked incentives group, respectively. The administration of compliance-linked incentives was independently associated with improvement in immunization coverage and a modest increase in timeliness of immunizations.
CONCLUSIONS: Compliance-linked incentives are an important intervention for improving the coverage and timeliness of immunizations in young children in resource-poor settings.
Source: Seth R, Akinboyo I, Chhabra A, et al. Mobile Phone Incentives for Childhood Immunizations in Rural India. Pediatrics. 2018;141(4):e20173455
The online version of this article, along with further information and resources, is located on the World Wide Web at:
http://pediatrics.aappublications.org/content/early/2018/03/12/peds.2017-3455
Ankur Chhabra 