Effectiveness of a smart phone app on improving immunization of children in rural Sichuan Province, China: study protocol for a paired cluster randomized controlled trial

BMC Public Health

Yanfeng Zhang¹  Qiong Wu¹  Ye Li¹  Jeanne Catherine Koepsell⁵  Lin Zhang⁴  Ruikan Yang³  Michelle Helena van Velthoven²  Xiuqin Rao¹  Xiaozhen Du¹  Wei Wang¹  Li Chen¹ 

[1] Department of Integrated Early Childhood Development, Capital Institute of Paediatrics, No. 2 Yabao Road, Chaoyang District, Beijing 100020, P.R. China;Global eHealth Unit, Department of Primary Care and Public Health, Imperial College London, London, United Kingdom;Save the Children China Program, Beijing, China;Save the Children China Program, Chengdu, China;Save the Children, Washington DC, USA

关键词: Feasibility Studies [MeSH];    Usability;    Immunization [MeSH];    Randomized controlled trial;   

Others  :  1131889
DOI  :  10.1186/1471-2458-14-262

 received in 2014-03-06, accepted in 2014-03-14,  发布年份 2014

【 摘 要 】

Background

Although good progress has been achieved in expanding immunization of children in China, disparities exist across different provinces. Information gaps both from the service supply and demand sides hinder timely vaccination of children in rural areas. The rapid development of mobile health technology (mHealth) provides unprecedented opportunities for improving health services and reaching underserved populations. However, there is a lack of literature that rigorously evaluates the impact of mHealth interventions on immunization coverage as well as the usability and feasibility of smart phone applications (apps). This study aims to assess the effectiveness of a smart phone-based app (Expanded Program on Immunization app, or EPI app) on improving the coverage of children’s immunization.

Methods/Design

This cluster randomized trial will take place in Xuanhan County, Sichuan Province, China. Functionalities of the app include the following: to make appointments automatically, record and update children’s immunization information, generate a list of children who missed their vaccination appointments, and send health education information to village doctors. After pairing, 36 villages will be randomly allocated to the intervention arm (n = 18) and control arm (n = 18). The village doctors in the intervention arm will use the app while the village doctors in the control arm will record and manage immunization in the usual way in their catchment areas. A household survey will be used at baseline and at endline (8 months of implementation). The primary outcome is full-dose coverage and the secondary outcome is immunization coverage of the five vaccines that are included in the national Expanded Program on Immunization program as well as Hib vaccine, Rotavirus vaccine and Pneumococcal conjugate vaccine. Multidimensional evaluation of the app will also be conducted to assess usability and feasibility.

Discussion

This study is the first to evaluate the effectiveness of a smart phone app for child immunization in rural China. This study will contribute to the knowledge about the usability and feasibility of a smart phone app for managing immunization in rural China and to similar populations in different settings.

Trial registration

Chinese Clinical Trials Registry (ChiCTR):ChiCTR-TRC-13003960

【 授权许可】

   
2014 Chen et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]WHO: The integrated Global Action Plan for Pneumonia and Diarrhoea (GAPPD). [http://www.who.int/maternal_child_adolescent/documents/global_action_plan_pneumonia_diarrhoea/en/ webcite]
• [2]WHO Regional Office for the Western Pacific: WHO/UNICEF Regional Child Survival Strategy: Accelerated and Sustained Action towards MDG 4. Geneva: WHO Press; 2006.
• [3]WHO, UNICEF: Global immunization data. [http://www.who.int/immunization/newsroom/Global_Immunization_Data.pdf webcite]
• [4]Menzies R, Turnour C, Chiu C, McIntyre P: Vaccine preventable diseases and vaccination coverage in Aboriginal and Torres Strait Islander people, Australia 2003 to 2006. Commun Dis Intell 2008, 32(Suppl):S1-S72.
• [5]Center for Health Statistics and Information of Ministry of Health of People’s Republic of China: an Analysis Report of National Health Services Survey in China, 2008. Beijing: Peking Union Medical College Press; 2009.
• [6]The State Council of China: Outline Program for Development of Chinese Women and Children in 2011–2015. [http://www.gov.cn/gongbao/content/2011/content_1927200.htm webcite]
• [7]Fu XL, Jia Y, Huang RN, Li K, Su LY: The cross sectional study for Township based childhood immunization program in Chengdu City. J preventative Med Inf 2002, 18:15-18. (in Chinese)
• [8]Zheng RZ, Chen L: An analysis of the affecting factors of missed or overdue immunization of local resident children in Tieshangang Township. Jilin Medical Journal 2011, 32:699-700. (in Chinese)
• [9]Mechael P, Batavia H, Kaonga N, Searle S, Kwan A, Goldberger A, Fu L, Ossman J: Barriers and Gaps Affecting mHealth in Low and Middle Income Countries: Policy White Paper. [http://crcrth670-f11-sullivan.wikispaces.umb.edu/file/view/mHealth_EARTH+Institute_Low+Mid+Income+Co's_Barriers_WhitePaper_Columbia+U+'10.pdf webcite]
• [10]Carter MC, Burley VJ, Nykajaer C, Cade JE: Adherence to a smart phone application for weight loss compared to website and paper diary: pilot randomized controlled trial. J Med Internet Res 2013, 15:e32.
• [11]Whittaker R, Maddison R, McRobbie H, Bullen C, Denny S, Dorey E, Ellis-Pegler M, van Rooyen J, Rodgers A: A multimedia mobile phone-based youth smoking cessation intervention: findings from content development and piloting studies. J Med Internet Res 2008, 10:e49.
• [12]Free C, Phillips G, Galli L, Watson L, Felix L, Edwards P, Patel V, Haines A: The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: a systematic review. PLoS Med 2013, 10:e1001362.
• [13]Kaewkungwal J, Singhasivanon P, Khamsiriwatchara A, Sawang S, Meankaew P, Wechsart A: Application of smart phone in “Better Border Healthcare Program”: a module for mother and child care. BMC Med Inform Decis Mak 2010, 10:69. BioMed Central Full Text
• [14]Stockwell MS, Fiks AG: Utilizing health information technology to improve vaccine communication and coverage. Hum Vaccin Immunother 2013, 9:1802-1811.
• [15]Sichuan Provincial People’s Government: Overview of Sichuan. [http://www.sc.gov.cn/10462/10778/10876/2013/3/27/10253724.shtml webcite]
• [16]Dazhou City’s government [http://www.dazhou.gov.cn/ webcite]
• [17]Moore RT: blockTools: Blocking, Assignment, and Diagnosing Interference in Randomized Experiments. R package version 0.5-7. [http://rtm.wustl.edu/software.blockTools.htm webcite]
• [18]Hayes RJ, Bennett S: Simple sample size calculation for cluster-randomized trials. Int J Epidemiol 1999, 28:319-326.
• [19]Nielsen J, Mack RL: Usability Inspection Methods. New York: John Wiley & Sons; 1994.
• [20]Graham MJ, Kubose TK, Jordan D, Zhang J, Johnson TR, Patel VL: Heuristic evaluation of infusion pumps: implications for patient safety in intensive care units. Int J Med Inform 2004, 73:771-779.
• [21]Choi J, Bakken S: Web-based education for low-literate parents in Neonatal Intensive Care Unit: Development of a website and heuristic evaluation and usability testing. Int J Med Inform 2010, 79:565-575.
• [22]Bastien JM: Usability testing: a review of some methodological and technical aspects of the method. Int J Med Inform 2010, 79:e18-e23.
• [23]Nielsen J: Usability Engineering. San Francisco: Morgan Kaufmann Publishers; 1993.
• [24]Davis FD: Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Quarterly 1989, 13:319-340.