Acceptability, Barriers and Facilitators of Mobile Text Message Reminder System Implementation in Improving Child Vaccination: A Qualitative Study in Northwest Ethiopia

Abstract

Background Mobile phone text message-based mHealth interventions have shown promise in improving health service delivery. Despite the promising findings at a small scale and few contexts, implementing new technologies as part of changes to health care services is inherently challenging. Though there is a potential to introduce mHealth initiatives to health systems of developing countries, existing evidence on the barriers and facilitators of implementation in different contexts is not adequate. Therefore, this study aimed to explore the acceptability, barriers and facilitators of implementing mobile text message reminder system for child vaccination in Ethiopia. Methods This study applied a phenomenological study design. The study was conducted in north-west, Ethiopia between July 28 and August 19, 2020. A total of 23 participants were purposively selected for the in-depth and key informant interviews. We used an interview guide to collect data and audio-records of interviews were transcribed verbatim. Coding was done to identify patterns and thematic analysis was conducted using ATLAS ti7 software. Results The findings indicated that mothers were receptive to mobile text message reminders for their child’s vaccination. Low mobile phone ownership, access to mobile network, access to electricity and illiteracy among the target population were identified as barriers that would affect implementation. Confidentiality and security-related issues are not barriers to implementation of text message reminders for child vaccination service. Facilitators for implementation include stakeholder collaboration, providing orientation/training to users, and willingness to pay by clients. Conclusion In this study, using mobile phone text message reminders for child vaccination services are acceptable by clients. Barriers identified were related to inadequate ICT infrastructure and other technical issues. Addressing the potential barriers and leveraging the existing opportunities could optimize the implementation in resource-limited settings. Before actual implementation, program implementers should also consider providing orientation to users on the proposed mHealth program.

Understanding barriers of receiving short message service appointment reminders across African regions: a systematic review

“…Of these, illiteracy was one of the barriers to SMS-based appointment reminders, as reported by six studies 17 19 21 23–25. In this systematic review, patients’ inability to use mobile phones or text message reminders, poor awareness and knowledge of the disease, being unable to respond with SMS message information, having no or low-level education, being unable to read and write the SMS message and being unable to understand and comprehend SMS messages were grouped as illiteracy.…”

“…Five out of nine studies (55.6%) were done by RCT 17–21. Two out of nine studies (22.2%) were done with a cross-sectional study design,22 23 whereas the remaining two studies (22.2%) were done by qualitative methods24 and a mixed method25 of study design accounted for one in each study design. Four out of nine studies (44.4%) were done in Nigeria19 20 and Ethiopia22 24 accounted for two studies in each country.…”

“…Two out of nine studies (22.2%) were done with a cross-sectional study design,22 23 whereas the remaining two studies (22.2%) were done by qualitative methods24 and a mixed method25 of study design accounted for one in each study design. Four out of nine studies (44.4%) were done in Nigeria19 20 and Ethiopia22 24 accounted for two studies in each country. The remaining five out of nine studies (55.6%) were done in Burkina Faso,17 Mozambique,18 Tanzania,23 South Africa25 and Cote d’Ivoire21 with one in each country.…”

“…According to the publication year, five out of nine (55.6%) studies were published in 2019 19–22 25. Two out of nine studies (22.2%) were published in 2021,23 24 and the remaining two out of nine studies (22.2%) were published in 2018,18 and 202017 accounting for one for each year (table 2).…”

“…Inadequate ICT infrastructure17 24 including poor access to electricity and network; unfamiliarity with text messages,21 25 including unclear language, impersonal nature and negative, meaningless and uninterpretable SMS messages; and being a rural resident19 23 were the third most common barriers, occurring two times out of the nine included studies (18.18%). Unfamiliarised (with) SMS messages in this systematic review means the negative and impersonal nature of messages, SMS messages that are inadequate to add insights, and uninterpretable messages.…”