Use of Apps to Promote Childhood Vaccination: Systematic Review

"...there is demand and engagement with apps supporting childhood vaccinations; however, further investigation is required."

Multiple private and public organisations have investigated mobile health (mHealth) to support the uptake of vaccinations, including vaccination information websites and mobile apps, hereafter referred to as apps. These apps have various functions designed to support healthcare providers, caregivers, and, in some cases, children to access vaccine-related information and recommended immunisation schedules, to store vaccination records, and to receive appointment reminders. This systematic review aimed to assess the effectiveness of apps supporting childhood vaccinations in improving vaccination uptake, knowledge, and decision making, as well as the usability and user perceptions of these apps.

The search, which took place on October 23 2019, was limited to studies conducted during or after 2008, when the first smartphone was launched. A total of 28 studies evaluating 25 apps met the inclusion criteria and were included in the analysis; 39% (11/28) of the studies took place in deprived areas and/or developing countries.

The characteristics of the 25 apps investigated in the included studies are shown in Table 2 of the paper. The apps were primarily delivered via a smartphone or tablet, with 4 apps using multimodal delivery methods. The primary functionality of the apps described in the included studies varied; however, most had multiple functions, with the most common features being education, reminders, and record keeping. These were primarily for the use of parents or healthcare providers; only the iCHRcloud app facilitated the sharing of vaccination record information between parents and physicians. No apps had been designed for the use of school staff, and no apps had the functionality to share information between schools and parents. (This could be an avenue for further investigation.)

Overall, 9 studies assessed vaccination uptake, of which 4 reported a significant improvement in vaccination coverage after versus before the implementation of the app. Similarly, 4 studies reported significant improvements in the knowledge or learning compared with a control group or after versus before the intervention (P≤.05).

The implications of the vaccination apps on decision making and evaluation of the risk-benefit of vaccinations were investigated in 8 studies. Seven of the 8 studies reporting this outcome indicated a positive impact of the apps on vaccination beliefs and intent to vaccinate; the remaining study was unable to report improvements because of no vaccine hesitancy in participants at baseline. Half of the studies (4/8) indicated significant improvements (P≤.05) in the intent to vaccinate children, positive attitudes toward vaccination, and/or confidence in their vaccination decision after interaction with the app versus before or compared with a control group.

Patient perceptions, usability, and acceptability were generally positive. For example, a study reporting on the qualitative experiences of service providers and mothers with the mTika app revealed that the app was perceived as helpful, easily understood by mothers, user-friendly, time-efficient, and helpful in reducing the workload of vaccination service providers.

The quality of the included studies was found to be moderate to poor, likely because of the early phase nature of many of the apps and their respective studies. Only 5 studies were randomised. In several studies, many aspects of the methodology were unclear.

In short, this study found little evidence to support the use of childhood vaccination apps to improve vaccination uptake, knowledge, or decision making. The researchers stress that larger, more robust studies of are needed, and the methodology of studies must be reported more comprehensively to enable accurate assessment of the effectiveness of childhood vaccination apps and the risk of bias of studies.

That said, "the positive user perceptions, usability, and acceptability reported present a compelling opportunity to build on the successes of current apps and learn from their shortcomings. Individual studies included in this review reported the potential benefit of these apps on an individual, community, and nationwide level, highlighting the breadth of engagement that can be harnessed with the use of mobile apps..."