Background
Timely completion and uptake of the childhood vaccination is key to reducing the high morbidity and mortality of vaccine-preventable diseases (VPDs) among infants globally. Maintaining reductions in mortality from VPD relies on continued immunisation uptake that is reliant on parental decision-making and subsequent attendance at health facilities.1 However, many children still miss scheduled vaccines in the extended programme of immunisation or are being vaccinated after the recommended ages.1 2
Adherence to childhood vaccination schedules is a function of various factors including the information gaps both from the service supply and demand sides.3 The immunisation programme is also challenged with a lack of effective methods to track vaccination schedules.4 Immunisation programmes usually involve the use of the child health card as a tool for reminding caregivers of children of the dates of their next vaccination.3 However, it was observed that the majority of the mothers who missed their vaccination appointment were due to forgetfulness and difficulty in tracking vaccination schedules indicating a need to identify more innovative approaches. This necessitates the establishment of an appropriate and uninterrupted vaccine delivery strategy with more focus on demand-side interventions.5–7
To date, there is a continuous growth of mobile network coverage and unprecedented penetration of mobile devices globally.8 By the end of 2018, 5.1 billion people around the world subscribed to mobile services, accounting for 67% of the global population.9 In the same year, mobile subscribers in Ethiopia reached 44%.10 A study conducted on mobile phone access in Gondar city among pregnant women reported that 76.7% of mothers owned a mobile phone. Among those women who had mobile phones, 90% were able to read text messages using their mobile phones.11 With these advancements, leveraging mobile health (mHealth) applications in the health sector is becoming popular.8
mHealth is the use of mobile phone technology to deliver healthcare.12 According to the WHO, mHealth has the ability to transform the delivery of healthcare and bring a paradigm shift in healthcare delivery processes all over the world.13 mHealth is now extensively used in healthcare and there is a growing global trend in harnessing this technology for behaviour change, disease surveillance, prevention and control of various health problems and enhancing attendance for health services. Hence, the field of mHealth has been proposed as a potential solution to many of the challenges that developing countries face.13–21
mHealth applications and programmes make use of several aspects of mobile technology such as text messaging, voice and video services.12 The WHO reported that short message service (SMS) is the the most common mobile phone features used for appointment reminders.13 It is widely applicable appointment reminder intervention to improve healthcare-seeking behaviours considering participant characteristics such as forgetfulness and lack of knowledge.22–24 Mobile phone-based text messaging demonstrates strong potential as a tool for healthcare improvement for several reasons; applicability on almost every model of mobile phone, relatively low cost and widely applicable to a variety of health behaviours and conditions.25 26
Implementing new technologies is inherently challenging. According to the non-adoption, abandonment, scale-up, spread and sustainability framework, the condition, the technology, the value proposition, the adopter system (comprising professional staff and clients), the organisational infrastructure, the context and the interaction between all these domains determine effective implementation of new technological innovations.27 Evidence also indicated that mHealth initiative success is based on the accessibility, acceptance, effective adaptation to local contexts and strong stakeholder collaboration.28–30 It is also important to take into account the diverse environment with cultural and contextual differences to adopt new technological interventions.31–37
Among the various factors contributing for the successful implementation of mHealth interventions, end-users perception and value propositions to the new system are crucial worth considering before actual implementation.27 35 38 39 According to the theory of reasoned action, the adoption of new intervention is dependent on the behavioural intention of users. Effective technology use is also the result of an intention in making the behaviour, and this intention is influenced by the perceived ease of use and perceived usefulness including user’s preference.37 39 40
The programme theory for this study is that clients will use the proposed SMS-based mHealth intervention if they have intention to use the system, the system is designed based on their preference and they believe that it will provide positive results.37 Hence, investigating the user’s intention and preference is crucial to design and implement more effective mHealth interventions in developing countries including Ethiopia.28 31 41–47 Therefore, this study aimed to assess the intention and preference of mothers to use mobile phone text message reminders for child vaccination in northwest Ethiopia.