Digital Health Information Interventions for Immunisation Demand Generation: A Guide for Selecting Appropriate Tools and Technologies

"Digital health information interventions have the potential to make new connections with engaging content, accessible tools and rapid communication to improve vaccine demand for quality services in priority communities."

Demand generation strategies and interventions are based on the application of behavioural science to develop, design, and implement tailored, evidence-based, measurable interventions to build trust and bridge the knowledge-practice gap to increase uptake of immunisation services. Digitally-delivered approaches may help enhance opportunities and reduce barriers to immunisation demand by engaging and supporting communities and health workers, improving quality and caregiver experiences, and increasing the accessibility of immunisation services. Developed by HealthEnabled as part of Gavi, the Vaccine Alliance's Digital Health Information Strategy, this guide presents a stepwise approach and considerations for selecting and planning for digital technologies and tools to improve demand for immunisation. It draws on evidence and early experiences with tools and technologies that have been applied in Gavi-supported countries.

Immunisation demand generation interventions are intended to increase caregiver access and uptake of immunisation services for their children, promote positive opinions and attitudes about immunisation services and providers, and ultimately improve immunisation coverage, timeliness, and completeness. With these outcomes in mind, the guide examines digital solutions for immunisation demand that are:

• Supported with strong evidence and can be adopted with confidence: caregiver mobile phone reminders; conditional cash transfers; and social and behaviour change (SBC) mobile messages.
• Promising: health worker eLearning and remote training; and health worker job aids, alerts, and reminders.
• Emerging/new: call centres, hotlines, or automated information menus; social media engagement; service experience feedback; supportive supervision, coaching, and peer support; and adverse events following immunisation (AEFI) reporting, monitoring and support.
• Less likely to show success: vaccination-themed video games; unique project-specific apps; centrally-curated push messages; text-based SMS (short messaging service); and digital as a stand-alone intervention.

Having looked at the tools, the guide illustrates how digital tools can support immunisation uptake and demand and offers a roadmap for digital demand intervention planning and selection, as well as key considerations for design, development, and implementation. Working with the United Nations Children's Fund (UNICEF) Journey to Health and Immunisation framework, the guide explores steps in the journey and relevant digital solutions:

• Step 1: Knowledge, awareness, and beliefs
• Step 2: Intent
• Step 3: Cost and preparation
• Step 4: Point of service
• Step 5: Experience of care
• Step 6: After service

Some suggested approaches for decision-makers and programmes considering the use of digital technologies to improve immunisation demand include, in brief:

• Plan for scale.
• Engage the government from the beginning.
• Co-create with the intended audience.
• Work with local creative content developers.
• Negotiate with mobile network operators.
• Consider the source of data on digital access.
• Develop a marketing promotion strategy.
• Take advantage of opportunities for repeat exposure.
• Provide a link to physical services.

In conclusion: "When supported by careful planning, formative research and meaningful user engagement, digital technologies and tools can be useful components of an immunisation demand strategy to meet identified needs and opportunities so that no child is left behind with immunisation."