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Currently submitted to: JMIR mHealth and uHealth

Date Submitted: May 21, 2020
(closed for review but you can still tweet)

Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.

Social and behaviour change communication interventions delivered face-to-face and by mobile phone to strengthen vaccination uptake and improve child health in rural India: A randomised pilot study for a cluster randomised controlled trial

  • Mira Johri; 
  • Dinesh Chandra; 
  • Georges Karna Koné; 
  • Marie-Pierre Sylvestre; 
  • Alok K. Mathur; 
  • Sam Harper; 
  • Arijit Nandi; 

ABSTRACT

Background:

In resource-poor settings, lack of awareness and low demand for services constitute important barriers to expanding coverage of effective interventions. In India, childhood immunisation is a priority health strategy with suboptimal uptake.

Objective:

To assess study feasibility and key implementation outcomes for the Tika Vaani model, a new approach to educate and empower beneficiaries to improve immunisation and child health.

Methods:

Cluster-randomised pilot trial with a 1:1 allocation ratio conducted in rural Uttar Pradesh, India from January to September, 2018. Villages were randomly assigned to either the intervention or control group. In each participating village, surveyors conducted a complete enumeration to identify all eligible households and requested participation in person prior to randomisation. Interventions were designed through formative research using a social marketing approach and delivered over a three-month period using strategies adapted to disadvantaged populations: (1) mHealth: entertaining educational audio capsules (edutainment) and voice immunisation reminders via mobile phone; (2) face-to-face: community mobilisation activities, including three small group meetings offered to each participant. The control group received usual services. The main outcomes were prespecified criteria for feasibility of the main study (recruitment, randomisation, retention, contamination, and adoption). Secondary endpoints tested equity of coverage and changes in intermediate outcomes. Statistical methods included descriptive statistics to assess feasibility, penalized maximum logistic regression and ordered logistic regression to assess coverage, and generalised estimating equations models to assess changes in intermediate outcomes.

Results:

All villages consented to participate. Gaps in administrative data hampered recruitment; 14% (79/565) of recorded households were non-resident. Only 1% (8/565) did not consent. 387 (184 intervention; 203 control) households with children ages 0 to 12 months in 26 (13 intervention: 13 control) villages were included and randomised. The end line survey occurred during flood season; 18% of (68/387) households were absent. Contamination was below 1%. Participation in one or more interventions was 94% (173/184) (82% (144/184) for the face-to-face strategy and 67% (124/184) for the mHealth strategy). Determinants including place of residence, mobile phone access, education and female empowerment shaped intervention use; factors operated differently for face-to-face and mHealth strategies. For 11 of 13 intermediate outcomes, regression results showed significantly higher basic health knowledge among the intervention group, supporting hypothesised causal mechanisms.

Conclusions:

A future trial of a new intervention model to improve immunisation uptake and child health is feasible. The interventions demonstrate the potential to strengthen delivery of immunization and universal primary health care. Social and behaviour change communication via mobile phone proved viable and contributed to standardisation and scalability. Face-to-face interactions remain necessary to achieve equity and reach, suggesting the need for ongoing health system strengthening to accompany introduction of communications technologies. Clinical Trial: ISRCTN.com ISRCTN44840759; https://doi.org/10.1186/ISRCTN44840759


 Citation

Please cite as:

Johri M, Chandra D, Koné GK, Sylvestre M, Mathur AK, Harper S, Nandi A

Social and behaviour change communication interventions delivered face-to-face and by mobile phone to strengthen vaccination uptake and improve child health in rural India: A randomised pilot study for a cluster randomised controlled trial

JMIR Preprints. 21/05/2020:20356

URL: https://preprints.jmir.org/preprint/20356

Per the author's request the PDF is not available.