Is the intention to vaccinate enough? Systematic variation in the value of timely vaccinations and preferences for monetary vs non-monetary incentives among pregnant women in southern Tanzania

Ostermann, Jan; Hair, Nicole L; Moses, Sara; Ngadaya, Esther; Mfinanga, Sayoki; Brown, Derek S.; Baumgartner, Joy Noel; Vasudevan, Lavanya

doi:10.1016/j.jvacx.2023.100266

Cited by 2 publications

(3 citation statements)

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“…The study seeks to contribute evidence to the literature in 3 key ways. First, although many studies have evaluated mobile phone-based reminders for promoting childhood vaccinations [10], evidence is lacking [9] for more complex community-based digital health interventions that target multifaceted barriers to vaccinations, such as those identified in our prior research [4,6,7]. Second, few community-based digital health interventions for promoting childhood vaccination have been evaluated using rigorous randomized controlled study designs, especially in sub-Saharan African countries and in rural areas [11][12][13][14][15].…”

Section: Objectivesmentioning

confidence: 99%

“…Conditional incentive offers will be specific to each child's vaccination schedule. In our prior work [7,8], we identified a set of incentives (eg, pharmacy vouchers and birth certificates) that are likely to be acceptable to mothers. The specific incentives, their value, conditionality, and the timing of disbursement will be determined in discussion with local key informants.…”

Section: Incentive Offersmentioning

confidence: 99%

“…In general, rural mothers reported more vaccine-related knowledge gaps and concerns than urban mothers [6]. Despite challenges, vaccination intention was high among mothers, and conditional incentives were identified as a potential nudge to increase vaccination timeliness [7,8]. In addition, a community health worker (CHW)-delivered knowledge intervention was piloted and determined to be feasible to implement in rural areas.…”

Section: Introductionmentioning

confidence: 99%

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Leveraging Community Health Workers and a Responsive Digital Health System to Improve Vaccination Coverage and Timeliness in Resource-Limited Settings: Protocol for a Cluster Randomized Type 1 Effectiveness-Implementation Hybrid Study

Vasudevan,

Ostermann,

Thielman

et al. 2024

JMIR Res Protoc

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Background Tanzania is 1 of 20 countries where the majority of unvaccinated and undervaccinated children reside. Prior research identified substantial rural-urban disparities in the coverage and timeliness of childhood vaccinations in Tanzania, with children in rural settings being more likely to receive delayed or no vaccinations. Further research is necessary to identify effective and scalable interventions that can bridge rural-urban gaps in childhood vaccination while accounting for multifaceted barriers to vaccination. Objective This protocol describes a type 1 effectiveness-implementation hybrid study to evaluate Chanjo Kwa Wakati (timely vaccination in Kiswahili), a community-based digital health intervention to improve vaccination timeliness. The intervention combines human resources (community health workers), low-cost digital strategies (electronic communication, digital case management, and task automation), a vaccination knowledge intervention, and insights from behavioral economics (reminders and incentives) to promote timely childhood vaccinations. Methods The study will be conducted in 2 predominantly rural regions in Tanzania with large numbers of unvaccinated or undervaccinated children: Shinyanga and Mwanza. Forty rural health facilities and their catchment areas (clusters) will be randomized to an early or delayed onset study arm. From each cluster, 3 cohorts of mother-child dyads (1 retrospective cohort and 2 prospective cohorts) will be enrolled in the study. The timeliness and coverage of all vaccinations recommended during the first year of life will be observed for 1200 children (n=600, 50% intervention group children and n=600, 50% nonintervention group children). The primary effectiveness outcome will be the timeliness of the third dose of the pentavalent vaccine (Penta3). Quantitative surveys, vaccination records, study logs, fidelity checklists, and qualitative interviews with mothers and key informants will inform the 5 constructs of the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework. The results will be used to develop an implementation blueprint to guide future adaptations and scale-up of Chanjo Kwa Wakati. Results The study was funded in August 2022. Data collection is expected to last from February 2024 to July 2027. Conclusions This study will address the lack of rigorous evidence on the effectiveness of community-based digital health interventions for promoting vaccination coverage and timeliness among children from sub-Saharan Africa and identify potential implementation strategies to facilitate the deployment of vaccination promotion interventions in low- and middle-income countries. Trial Registration ClinicalTrials.gov NCT06024317; https://www.clinicaltrials.gov/study/NCT06024317 International Registered Report Identifier (IRRID) PRR1-10.2196/52523

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Section: Objectivesmentioning

confidence: 99%

Section: Incentive Offersmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Leveraging Community Health Workers and a Responsive Digital Health System to Improve Vaccination Coverage and Timeliness in Resource-Limited Settings: Protocol for a Cluster Randomized Type 1 Effectiveness-Implementation Hybrid Study

Vasudevan,

Ostermann,

Thielman

et al. 2024

JMIR Res Protoc

Self Cite

View full text Add to dashboard Cite

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Leveraging Community Health Workers and a Responsive Digital Health System to Improve Vaccination Coverage and Timeliness in Resource-Limited Settings: Protocol for a Cluster Randomized Type 1 Effectiveness-Implementation Hybrid Study (Preprint)

Vasudevan,

Ostermann,

Thielman

et al. 2023

Preprint

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BACKGROUND Tanzania is one of 20 countries where the majority of un- and under-vaccinated children reside. Prior research identified substantial rural-urban disparities in coverage and timeliness of childhood vaccinations in Tanzania, with children in rural settings being more likely to receive delayed or no vaccinations. Further research is necessary to identify effective, scalable interventions that can bridge rural-urban gaps in childhood vaccination while accounting for multifaceted barriers to vaccination. OBJECTIVE This protocol describes a type 1 effectiveness-implementation hybrid study to evaluate Chanjo Kwa Wakati (“Timely Vaccination” in Kiswahili), a community-based, digital health intervention to improve vaccination timeliness. The intervention combines human resources (community health workers), low-cost digital strategies (digital case management, task automation), a vaccination knowledge intervention, and insights from behavioral economics (reminders, incentives) for promoting timely childhood vaccinations. METHODS The study will be conducted in two predominantly rural regions in Tanzania with large numbers of un- or under-vaccinated children: Shinyanga and Mwanza. Forty rural health facilities and their catchment areas (“clusters”) will be randomized to an early or delayed onset study arm. From each cluster, three cohorts of mother-child dyads, one retrospective cohort and two prospective cohorts, will be enrolled into the study. The timeliness and coverage of all vaccines recommended during the first year of life, will be observed for 1200 children (600 intervention children and 600 non-intervention children). The primary effectiveness outcome will be the timeliness of the third dose of the pentavalent vaccine (Penta3). Quantitative surveys, vaccination records, study logs, fidelity checklists, and qualitative interviews with mothers and key informants will be used to inform the five constructs of the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Results will be used to develop an implementation blueprint to guide future adaptations and scale-up of Chanjo Kwa Wakati. RESULTS The study was funded in August 2022. Data collection is expected to last from February 2024 to July 2027. CONCLUSIONS This study will address the lack of rigorous evidence on the effectiveness of community-based digital health interventions for promoting vaccination coverage and timeliness among children from sub-Saharan Africa and identify potential implementation strategies to facilitate the deployment of vaccination promotion interventions in low- and middle-income country settings. CLINICALTRIAL The trial was registered at clinicaltrials.gov on September 6, 2023 (NCT06024317).

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Is the intention to vaccinate enough? Systematic variation in the value of timely vaccinations and preferences for monetary vs non-monetary incentives among pregnant women in southern Tanzania

Cited by 2 publications

References 50 publications

Leveraging Community Health Workers and a Responsive Digital Health System to Improve Vaccination Coverage and Timeliness in Resource-Limited Settings: Protocol for a Cluster Randomized Type 1 Effectiveness-Implementation Hybrid Study

Leveraging Community Health Workers and a Responsive Digital Health System to Improve Vaccination Coverage and Timeliness in Resource-Limited Settings: Protocol for a Cluster Randomized Type 1 Effectiveness-Implementation Hybrid Study

Leveraging Community Health Workers and a Responsive Digital Health System to Improve Vaccination Coverage and Timeliness in Resource-Limited Settings: Protocol for a Cluster Randomized Type 1 Effectiveness-Implementation Hybrid Study (Preprint)

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