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ORIGINAL ARTICLE
Year : 2015  |  Volume : 13  |  Issue : 4  |  Page : 509-513

Effectiveness of short message service reminder scheme in Greater Hyderabad Municipal Corporation for children's vaccination: A telephonic survey


Department of Public Health Dentistry, Sri Sai College of Dental Surgery, Vikarabad, Hyderabad, Telangana, India

Date of Web Publication7-Dec-2015

Correspondence Address:
M Sushma
Sri Sai College of Dental Surgery, Kothrepally, Vikarabad, Hyderabad, Telangana - 501 101
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-5932.171193

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  Abstract 

Background: Greater Hyderabad Municipal Corporation (GHMC) cares for every child. It has introduced a short message service (SMS) reminder scheme for children's vaccination, to make their life healthier and secure. SMS as a reminder tool can be extremely effective in health care. Aim: To assess the effectiveness of vaccination SMS reminder scheme by GHMC on mobile phones of parents. Materials and Methods: A cross-sectional study was conducted on 349 subjects whose children were born between January 1, 2014 and June 30, 2014 using telephonic survey method from five hospitals selected randomly. Telephone calls were made to interview using a structured questionnaire. Results: Among 349 subjects, 279 participated in the study for phone interview and 70 subjects (20.1%) did not participate. Among 279 subjects, 21.8% (76) subjects received SMS from GHMC whereas 43.8% (158) did not receive, 4.58% (16) subjects do not know how to read SMS, 7.2% (25) subjects did not see the messages and 2.6% (9) subjects were not sure if they were receiving the SMS from GHMC or not. Majority of subjects 71.9% wished to get the reminder SMS from GHMC regularly. Conclusion: The use of SMS reminder scheme for children's vaccination was encouraged by majority of subjects. However, the GHMC scheme was efficient in reaching only 21.8% of the subjects.

Keywords: Effectiveness, short message service reminder, telephonic survey, vaccination


How to cite this article:
Anjum S, Reddy P P, Monica M, Rao K Y, Abbas I, Sushma M. Effectiveness of short message service reminder scheme in Greater Hyderabad Municipal Corporation for children's vaccination: A telephonic survey. J Indian Assoc Public Health Dent 2015;13:509-13

How to cite this URL:
Anjum S, Reddy P P, Monica M, Rao K Y, Abbas I, Sushma M. Effectiveness of short message service reminder scheme in Greater Hyderabad Municipal Corporation for children's vaccination: A telephonic survey. J Indian Assoc Public Health Dent [serial online] 2015 [cited 2019 Aug 25];13:509-13. Available from: http://www.jiaphd.org/text.asp?2015/13/4/509/171193


  Introduction Top


Today almost 2 million children under the age of 5 years die every year in India and another 1 million or more are disabled for life.[1] Timely vaccination is critical for babies and children to enjoy the full benefits of vaccination. Delayed or missed vaccination, especially in infants, puts them at risk of serious diseases and infections. Unfortunately, this is particularly severe among the poor as they are always busy trying to earn a livelihood. Vaccines are one of the best public health tools available to achieve the goal of decreasing child mortality.[2] A major reason for poor childhood vaccine coverage is the lack of awareness among parents regarding the need for immunization and completing the entire series of vaccines.[2] Furthermore, parents often forget to vaccinate the child on time in the absence of a vaccination calendar maintained in a disciplined manner.[3] This result in a significant drop-out between vaccines delivered at birth and later in the infancy period.[2]

Globally, nonattendance for immunization appointments remains a challenge to healthcare providers.[4] Technology, ever present in the society, offers new, and emerging innovative methods to improve vaccination coverage. The short message service (SMS) has been arguably the most popular wide-area wireless data service worldwide.[5] As text messaging becomes an indispensable convenience of modern life in many parts of the world, cell phone users place high expectations on it as an instant and reliable means for data communication. Even more importantly, SMS is being considered for mission-critical applications such as emergency alerts and notification for natural disasters, for which reliable operation is of paramount importance.[5] SMS as a reminder tool can be extremely effective in health care too. Customized SMS messages can be designed as personally tailored messages with text and/or pictures, to remind parents regarding vaccination for their children as per schedule. Vaccination reminder services in several countries have been effective in increasing compliance by 20%.[1] It will be a sad story if India is not able to stop vaccine-preventable diseases.

A major advantage of SMS as a communication tool is that automated messages can be generated at specific times through computer programming, hence minimizing the need for valuable human resources. Messages are delivered directly with minimal intrusiveness while maintaining the privacy of the household members.[6] Most importantly, the cost of sending automated SMS messages is extremely low, once the original infrastructure is established. In the last few years, there has been a steady uptake of mobile phone SMS reminders to increase medical attendance rates.[7]

Through the Information Kerala Mission with the support of the National Rural Health Mission, Hospital Kiosk in Kerala has put forward an integrated program of SMS reminder scheme for children's timely vaccination. The parents should register the birth of their children online in the hospitals to receive SMS alerts of their children regular mandatory vaccination.[8]

The Greater Hyderabad Municipal Corporation (GHMC) earlier known as the Municipal Corporation of Hyderabad is the urban planning agency and the local government that oversees Hyderabad and Secunderabad, a bordering city to Hyderabad. In June 2013, the Health and Sanitation department of GHMC introduced SMS Reminder Service similar to the children's timely vaccination SMS Reminder Scheme in Kerala. The scheme alerts parents about the immunization schedule of their children through a text message on their mobile.

A total of 221,039 children from various hospitals were registered online from June 6, 2013 to June 30, 2014. The SMS service is a supply-side communication intervention employed by GHMC to increase vaccination rate of children in the city. As it is a newly introduced scheme, assessment of the SMS alerts was not done yet to check the reliability of the service. The public awareness, their suggestions for further improvement and feasibility in dental settings needs an assessment of this SMS service.

Hence, the objectives of the present study are:

  • To evaluate the reliability of SMS reminders
  • To evaluate the effectiveness of SMS reminders in improving the compliance of immunization schedule for children in the city
  • To know the reasons or barriers among the subjects in getting their children vaccinated.



  Materials and Methods Top


A cross-sectional epidemiological study was conducted on 349 subjects whose children were born between January 1, 2014 and June 30, 2014. Official permission was obtained from the Health and Sanitation Department of GHMC. Voluntary verbal informed consent was obtained from all the subjects participating after explaining the purpose of the study in detail. The study was approved by the Ethics Committee of Sri Sai College of Dental Surgery, Vikarabad.

A multistage random sampling procedure was followed to select the sample. Geographically, Hyderabad was divided into five zones - central, North, East, South, and West zones. Using lottery method, senior programer, randomly selected five hospitals with one hospital from each of these five zones, covering all the zones of GHMC area. The total number of births that occurred from January 1, 2014 to June 30, 2014 in these five hospitals was 3493. The contact details of these subjects were obtained from GHMC office.

Sample size calculation

n = (z 2.p.q)/d 2; where n = size of the sample;

z = value of standard variate at a given confidence interval (C.I); here C.I set at 95% for which z value is 1.96; P = 0.13 (estimated from pilot study); q = 1 − p = 0.87

d = 5% = 0.05 (acceptable error); therefore, n = 174; design effect = 2n = 348

To select the sample proportionately from all the five hospitals, 10% of the subjects from total number of births from each zone were selected randomly as the required sample to reach the total sample of 349 [Figure 1].
Figure 1: Distribution of subjects based on different zones under Greater Hyderabad Municipal Corporation

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The subjects in the pilot study were not included in the main study. An interviewer administered questionnaire was developed and finalized after a pilot study was done on 70 subjects to check the feasibility and understanding of the questionnaire and to note any difficulties encountered during the survey. Content validity ratio (1.0) was calculated, and questionnaire reliability was checked using Cronbach's alpha (0.78). The questionnaire consisted of demographic data (age, sex of the child, education, and occupation of mother and father of the child), questions related to the child's vaccination status and GHMC SMS delivery status. Data were collected in the month of July 2014; through telephonic interview method with an average time for each call being 4 min. Descriptive statistics was calculated using Microsoft Excel.


  Results Top


Among the 349 subjects, 279 subjects were interviewed on the phone. The remaining 70 subjects (20.1%) were not interviewed due to varied reasons such as their contact number was not reachable/switched off/wrong number/out of coverage area/invalid number/not answering the call. These numbers were tried thrice on 3 consecutive days.

The majority of the children were under the age group of 3–7 months. Most of the fathers were employed and mothers were unemployed with 119 (34.1%) fathers and 108 (30.9%) mothers were educated up to degree/postgraduate level. Among the subjects, 76 (21.8%) were aware of the scheme whereas 203 (58.2%) were not aware [Table 1].
Table 1: Distribution of subjects based on awareness regarding GHMC scheme

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[Table 2] shows that 76 (21.8%) received SMS from GHMC whereas 156 (43.8%) did not receive the SMS. About 16 (4.6%) were among the subjects who were unable to read the messages, 5 (7.1%) subjects did not see the messages and 9 (2.6%) subjects were not sure if they were receiving the SMS from GHMC or not.
Table 2: Distribution of subjects based on status of delivery of SMS sent by GHMC

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Based on their child's vaccination status, 259 (74.2%) subjects got their children vaccinated on right time whereas 5 (1.4%) subjects missed, 15 (4.3%) delayed their vaccination with varied reasons such as 6 (1.7%) subjects delayed due to their child's ill health, 2 (0.6%) subjects due to some family problems, 12 (3.4%) subjects due to other reasons.

Among the 76 subjects who received the GHMC message regularly, only 2 (2.63%) delayed their vaccination due to child's ill health. Whereas, 74 (97.3%) received the vaccination regularly. It is also found that, majority of subjects 71.9% wished to get the reminder SMS from GHMC regularly, whereas about 8.0% (28) subjects were not willing to get SMS from GHMC.

[Table 3] shows the age group of the child when they received the SMS from GHMC according to the schedule and also showed that 3.1% (11) subjects were unable to recall the details of when and how many SMS did they receive from GHMC.
Table 3: Distribution of subjects based on when did the subjects receive last SMS from GHMC?

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  Discussion Top


The telecommunication system in India is the 2nd largest in the world after China.[7] India has the fastest growing telecom network in the world with its high population and development potential with the total wireless subscribers to reach 91.87 crore at the end of July 2014. As mobile phones have revolutionized our lives and SMS being an integral part of the mobile phones, the survey here concentrates on the usage of this facility in the public health point of view to the maximum.[6] This study focused on the reliability of the SMS service during both normal and overload operating conditions.[5]

SMS service has many advantages. SMS messaging software allows text messages to be sent at once to a large population.[7] SMS reminders require minimal continued investment in IT infrastructure, given that the IT software is in place for sending automated SMS and integrated with existing electronic patient health records and hospital administrative database systems. Once the system is in place, the cost of running the service increases very little as the number of SMS reminders goes up. In addition, given that the messages are automated, there is no requirement for staff training, allowing for a time, labor, and cost-efficient system. Most young people in developed countries are very familiar with the technology: They own a cell phone.[9]

However, according to the present study the reliability of SMS service was found to be less as the delivery rate of SMS was only 21.8%. This is similar to the study done by Szilagyi et al., in which audiotaped telephone reminders were sent about the scheduled immunization visit. The study showed a lack of success largely owing to changed or inaccurate telephone numbers.[10] Few subjects, 4.6% of the individuals reported that they cannot read the SMS as they were uneducated, and 7.1% individuals do not have the habit of seeing messages as they were not that familiar with the technology. Upon interviewing, these individuals had put forth the need for some other way of vaccination reminder which would benefit them.

Retrospective assessment methods are subject to measurement errors since the precise recall of the details asked declines considerably due to memory deficits.[11] In the present study, 2.6% of individuals were not sure in giving the details if they have received the SMS from GHMC or not and also 3.1% of the individuals who received SMS from GHMC were unable to recall the details of when and how many SMS did they receive from GHMC.

Irrespective of the SMS received from the GHMC, the timely vaccination rate of the children was high (74.2%). However, this should not be misinterpreted that the vaccination rate in India is high. Interestingly it was noticed that, in spite of them not depending on the SMS for timely vaccination, the majority of subjects (71.9%) wished to get the SMS reminder from GHMC regularly. This was similar to the study was done by Bangure et al., in which all subjects were willing to receive the SMS reminders.[4] In the study done by Stockwell and Fiks, it was described that the one field where text messaging so far has been successful in both pediatric and adult populations is vaccination reminder.[12] In a national study, 56% of the 1612 parents surveyed were willing to register their cell number with their child's usual vaccination provider, and another 18% were undecided.[11]

In the present study, 28 individuals (8%) did not wish to get any SMS from GHMC due to varied reasons such as the fear of costing them for SMS, spam SMS, depending on SMS would be problematic if there is any delay in the messages from GHMC. This was also reported in the study done by Anhøj and Møldrup [13] that it might be difficult to find participants due to the fact that they would have to supply their private cell phone number or for fear of receiving spam SMS.[11] Those individuals who provided a mobile phone contact number may have been more motivated patients and more likely to attend their appointment, irrespective of being sent an SMS reminder.[9]

Reasons for not getting the children vaccinated were also studied. In the present study, 5.7% (20) did not get their child vaccinated due to reasons such as not knowing the place where to get vaccinated due to shifting of their residence area recently, difficulty in remembering the schedule on the day of vaccination, child ill health, and family problems.

Public opinion on improvements to SMS reminder format was also taken. Many of the individuals requested for the details of cost of vaccination to be provided in SMS, details of nearby hospitals with vaccination provision, Regular Government, polio vaccination reminder also to be sent through SMS. In the study done by Foley and Neill, which assessed SMS service and its effect on patient attendance reported various reasons for missing dental appointments. The reasons include, the patient/carer forgetting their appointment, confusion over the date, time and location of the appointment, illness, and transportation difficulty. The study also mentioned the use of SMS text messages as a reminder may reduce the failure to attend rate for outpatient pediatric dental appointments.[9]

As usual along with many advantages, it also has few potential limitations. The study population is restricted to only cell phone users.[12] Its success is strongly associated with the accuracy and updation of the subjects telephone numbers.[10] In countries with a low proportion of cell phone users, the presented method might be less appropriate. The particular subgroups like children or the elderly, who are less familiar with the technology and illiterate, might have problems understanding the procedure or show reactivity. Furthermore, there might be a restriction to not exceed more than 160 characters (less for some carriers) constraining the amount of information that can be included.[7],[12]

Based on above analysis, automated SMS reminder service looks to be a promising tool requiring minimum time, labor, and cost. Hence we suggest, regular feedbacks and self-evaluation of service should be done for maximum efficiency. Technical considerations in the SMS service should be looked into and rectified regularly. Also, SMS Reminders in local languages may benefit the natives.

Recommendations

It can be introduced in the dental set up to promote oral health and to improve patient's services. The use of text messaging can be effective for nonvaccination related interventions like in promoting medication adherence for contraception as well as HIV and smoking cessation treatment. Also on changing other health behaviors or improving self-management of chronic disease.[12],[14],[15]

Follow-up studies are needed that provide evidence for the effectiveness of these strategies in improving vaccine coverage and timeliness. Research should aim at synergistically reducing the tragic consequences of vaccine-preventable disease.


  Conclusion Top


Though the reliability of the SMS service is less, the effectiveness of the SMS service was found to be more that is, 97.3%. It is found that subjects do agree on the benefit of having reminder for their child's vaccination appointment and were willing to get the SMS from GHMC regularly. Therefore, GHMC mobile phone based strategies are a potentially useful platform to deliver reminders.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Vaccination Alerts Now on Mobile. Available from: http://www.immunizeindia.org/presspdfs/newkerala.pdf. [Last accessed on 2014 Apr 02].  Back to cited text no. 1
    
2.
SMS Reminders to Improve the on Time Vaccination Rates Among Children in Pakistan. Available from: https://www.clinicaltrials.gov/ct2/show/NCT01859546. [Last accessed on 2015 Jan 13].  Back to cited text no. 2
    
3.
SMS Reminder to Parents on Child's Vaccination Date. Deccan Herald, New Delhi; March 13, 2014. Available from: http://www.deccanherald.com/content/391856/sms-reminder-parents-child039s-vaccination.html. [Last accessed on 2014 Jun 12].  Back to cited text no. 3
    
4.
Bangure D, Chirundu D, Gombe N, Marufu T, Mandozana G, Tshimanga M, et al. Effectiveness of short message services reminder on childhood immunization programme in Kadoma, Zimbabwe – A randomized controlled trial, 2013. BMC Public Health 2015;15:137.  Back to cited text no. 4
    
5.
Meng X, Zerfos P, Samanta V, Wong SH, Lu S. Analysis of the reliability of a nationwide short message service. Proc. IEEE INFOCOM, 2007;1811-9.  Back to cited text no. 5
    
6.
Kew S. Text messaging: An innovative method of data collection in medical research. BMC Res Notes 2010;3:342.  Back to cited text no. 6
    
7.
Prasad S, Anand R. Use of mobile telephone short message service as a reminder: The effect on patient attendance. Int Dent J 2012;62:21-6.  Back to cited text no. 7
    
8.
SMS to Alert Parents on Mandatory Vaccines. The New Indian Express. Thiruvananthapuram; November 25, 2013. Available from: www.newindianexpress.com/cities/thiruvananthapuram/SMS-to-alert-parents-on-mandatory-vaccines/2013/11/25/article1909934.ece1. [Last accessed on 2015 Mar 21].  Back to cited text no. 8
    
9.
Foley J, O'Neill M. Use of mobile telephone short message service (SMS) as a reminder: The effect on patient attendance. Eur Arch Paediatr Dent 2009;10:15-8.  Back to cited text no. 9
    
10.
Szilagyi PG, Schaffer S, Barth R, Shone LP, Humiston SG, Ambrose S, et al. Effect of telephone reminder/recall on adolescent immunization and preventive visits: Results from a randomized clinical trial. Arch Pediatr Adolesc Med 2006;160:157-63.  Back to cited text no. 10
    
11.
Kuntsche E, Robert B. Short message service (SMS) technology in alcohol research – A feasibility study. Alcohol Alcohol 2009;44:423-8.  Back to cited text no. 11
    
12.
Stockwell MS, Fiks AG. Utilizing health information technology to improve vaccine communication and coverage. Hum Vaccin Immunother 2013;9:1802-11.  Back to cited text no. 12
    
13.
Anhøj J, Møldrup C. Feasibility of collecting diary data from asthma patients through mobile phones and SMS (short message service): Response rate analysis and focus group evaluation from a pilot study. J Med Internet Res 2004;6:e42.   Back to cited text no. 13
    
14.
Prevention Pays. Text Message Services. Available from: http://www.preventionpays.org/PPTMStextprogram.pdf. [Last accessed on 2015 Mar 21].  Back to cited text no. 14
    
15.
Whitford HM, Donnan PT, Symon AG, Kellett G, Monteith-Hodge E, Rauchhaus P, et al. Evaluating the reliability, validity, acceptability, and practicality of SMS text messaging as a tool to collect research data: Results from the feeding your baby project. J Am Med Inform Assoc 2012;19:744-9.  Back to cited text no. 15
    


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