MoVeUP: Improving Pediatric COVID-19 Vaccine Uptake Using an mHealth Tool
Study Details
Study Description
Brief Summary
This study will determine the effectiveness of a vaccine communication mobile health app on parental decisions to vaccinate their children against coronavirus disease 2019 (COVID-19).
The hypothesis is that unvaccinated children of caregivers assigned to the Vaccine Uptake app will be more likely to achieve COVID-19 vaccine series completion than those children whose caregivers are assigned to the General Health app.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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N/A |
Detailed Description
This is a site-level block-randomized trial. The study population is Custodial parents/caregivers with ≥1 child eligible for COVID-19 vaccination who has not yet received the vaccine at the time of study enrollment.
The primary objective is to determine the effect of a parent-facing, vaccination decision-making mobile health (mHealth) tool on children's COVID-19 vaccine series completion. The endpoint of this objective is the proportion of children who complete COVID-19 vaccination, as verified in state, clinic, or participant-held records.
Secondary Objective 1 is to determine the effect of a parent-facing, vaccination decision-making mHealth tool on children's COVID-19 vaccine series initiation. The endpoint of this objective is the proportion of children who receive ≥1 dose of the COVID-19 vaccination series, as verified in state, clinic, or participant-held records
Secondary Objective 2 is to determine the effect of a parent-facing, vaccination decision-making mHealth tool on parental attitude toward pediatric COVID-19 vaccination. The endpoint of this objective is the change in enrolled parent/caregiver domain scores from baseline to week 16 on the modified World Health Organization (WHO) Strategic Advisory Group of Experts on Immunization (SAGE) Vaccine Hesitancy Scale adapted for the COVID-19 Vaccine.
Enrolling sites will recruit participants. These sites will collaborate with outpatient practices within Environmental influences on Child Health Outcomes (ECHO) Institutional Development Award (IDeA) States Pediatric Clinical Trials Network (ISPCTN) states that provide primary care services to children (<18 years old). Sites will serve a population base of at least 40% Medicaid/uninsured children, <60% non-Hispanic White children, or >40% of families residing in rural communities. Sites are encouraged, but not required, to have a high Spanish-speaking population.
Study interventions are a Vaccine Uptake App and General Health App. The Vaccine Uptake App will include 24-week (8 weeks with weekly push notifications; 2 monthly push notifications for 2 months [1 notification per month]; 8 weeks without) exposure to a mobile phone application (app) designed to improve parental knowledge, attitudes, and self-efficacy regarding pediatric COVID-19 vaccination. The app will address logistical and motivational barriers to pediatric COVID-19 vaccination. Participants will also receive eight weekly nudges and 1 monthly nudge for 2 months (cues to action) regarding vaccinating their child that will be sent to participants via push notifications to their mobile devices. Through branching logic, users will access content tailored to their COVID-19 vaccine knowledge and confidence gaps, locality, degree of rural-urban primary residence, primary language (English/Spanish), race/ethnicity, and child's age.
The General Health App will include 24-week (8 with weekly push notifications; 2 monthly push notifications for 2 months [1 notification per month]; 8 weeks without) exposure to a mobile phone app designed to provide information on general pediatric health and infection prevention and mitigation strategies based on recommendations from the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC). Eight weekly nudges regarding these topics will be sent to participants via push notifications to their mobile devices.
The study duration is 21 months (6 months study start-up; up to 6 months rolling enrollment; 6 months final participants' completion; 3 months analysis). Participant duration is 24 weeks.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Vaccine Uptake App 24-week (8 weeks with weekly push notifications; 2 monthly push notifications for 2 months [1 notification per month]; 8 weeks without) exposure to a mobile phone application (app) designed to improve parental knowledge, attitudes, and self-efficacy regarding pediatric COVID-19 vaccination. The app will address logistical and motivational barriers to pediatric COVID-19 vaccination. Participants will also receive eight weekly nudges and 1 monthly nudge for 2 months (cues to action) regarding vaccinating their child that will be sent to participants via push notifications to their mobile devices. Through branching logic, users will access content tailored to their COVID-19 vaccine knowledge and confidence gaps, locality, degree of rural-urban primary residence, primary language (English/Spanish), race/ethnicity, and child's age. |
Behavioral: COVID-19 Vaccine Uptake App
A mHealth mobile application (app) that will provide educational and logistical information about the COVID-19 vaccination for children. The target audience will be parents of unvaccinated children.
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| Active Comparator: General Health App 24-week (8 with weekly push notifications; 2 monthly push notifications for 2 months [1 notification per month]; 8 weeks without) exposure to a mobile phone app designed to provide information on general pediatric health and infection prevention and mitigation strategies based on recommendations from the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC). Eight weekly nudges and 1 monthly nudge for 2 months regarding these topics will be sent to participants via push notifications to their mobile devices. |
Other: General Health App
A mobile application (app) that will provide general pediatric health and infection prevention and mitigation strategies.
|
Outcome Measures
Primary Outcome Measures
- Proportion of children who complete COVID-19 vaccination, as verified in state, clinic, or participant-held records [Week 24]
Initiation and completion of the COVID-19 vaccine series during the 24-week intervention period. Vaccine series completion will be per ACIP guidance for the vaccine product. For children who receive a product that requires more than 2 doses for the primary series, receipt of up to 3 doses will be considered complete. Vaccine doses will be valid if given within 24-week study intervention. Additional doses for primary series completion will be valid if they are in accordance with ACIP-recommended interval minus a 4-day grace period. There will be no maximum interval between valid doses. An incorrect second vaccine product (i.e., mixed series) will be invalid. The statistical team will use a mixed model with the binomial distribution and the logit link to compare the two intervention groups and the proportions of children who complete COVID-19 vaccination, using a site random effect and controlling for clustering by caregiver.
Secondary Outcome Measures
- Proportion of children who receive ≥1 dose of the COVID-19 vaccination series, as verified in state, clinic, or participant-held records [Week 24]
For each vaccine-eligible child, this secondary endpoint will be defined as whether or not the child initiates the COVID-19 vaccine series during the 16 weeks of study participation. Vaccine series initiation will be receipt of at least 1 valid dose of any COVID-19 vaccine product. Vaccine doses for series initiation will only be valid for study purposes if given within the 16 weeks of study participation. The statistical team will use a mixed model with the binomial distribution and the logit link to compare the two intervention groups with respect to the proportions of children who initiate COVID-19 vaccination, using site as a random effect and controlling for clustering by caregiver.
- Change in enrolled parent/caregiver domain scores from baseline to immediately post-intervention on the modified WHO SAGE Vaccine Hesitancy Scale adapted for the COVID-19 Vaccine [16 weeks]
The study team will evaluate parental attitude toward pediatric COVID-19 vaccination by using the vaccine hesitancy questionnaire that includes ten statements with ordinal responses using a 5-point Likert scale. At baseline and week 16, the study statisticians will generate summary statistics for each of the 10 questions for the two intervention groups. Similarly, the change in responses from baseline to end of study will be determined for each intervention group. The study statisticians will use the general linear mixed model to evaluate the intervention effect on responses to each measure at baseline and end of study, and they will use this model to evaluate the change in each measure by using site as a random effect. Within each intervention arm and for each statement, the study statisticians will use the Wilcoxon signed rank test to determine if the change in response from baseline to end of study is significantly different from zero.
Eligibility Criteria
Criteria
Parent/Caregiver Inclusion Criteria:
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Age of majority, as defined by the state of residency
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Access to a mobile device that can store and run the study app for 24 weeks. Devices that can run the app include mobile phones and tablets running Android or iOS operating systems
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Able to speak and read in English or Spanish
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Be a parent/caregiver with primary medical decision-making and legal authority to consent to vaccination decisions for at least one child who meets the child inclusion criteria
Child Inclusion Criteria:
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Age 6 months to less than age of majority, as defined by the child's state of residence
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Has not received any doses of COVID-19 vaccine based on parent/caregiver report
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Eligible to receive COVID-19 vaccine
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Patient at a participating clinic
Parent/Caregiver Exclusion Criteria:
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Has only a child or children with known contraindication to all COVID-19 vaccines
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Has only a child or children whose other parent/caregiver is already a current or past participant in the study
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Has a child or children enrolled in any other COVID-19 vaccine study of any kind
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Past or present participation in a COVID-19 vaccine or behavioral trial
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Has a cognitive impairment that limits their ability to engage with the app content and/or make medical decisions regarding vaccination, based on the site investigator's assessment and local human subjects research policies
Child Exclusion Criteria:
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Not a patient of a participating clinic
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Prior receipt of least one dose of COVID-19 vaccine
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Receiving or scheduled to receive COVID-19 vaccination at the time of parental consent
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Known medical contraindication to all COVID-19 vaccines
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Ineligible to receive COVID-19 vaccine
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Prior or current participation in a COVID-19 vaccine study of any kind
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Arkansas Children's Research Institute | Little Rock | Arkansas | United States | 72202 |
| 2 | Nemours Children's Health | Wilmington | Delaware | United States | 19803 |
| 3 | Kapiolani Medical Center for Women and Children | Honolulu | Hawaii | United States | 96813 |
| 4 | University of Kansas Medical Center | Kansas City | Kansas | United States | 66160 |
| 5 | Norton Children's Research Institute | Louisville | Kentucky | United States | 40202 |
| 6 | Our Lady of the Lake Regional Medical Center | Baton Rouge | Louisiana | United States | 70808 |
| 7 | University of Mississippi Medical Center | Jackson | Mississippi | United States | 39216 |
| 8 | University of Nebraska Medical Center | Omaha | Nebraska | United States | 68198 |
| 9 | Dartmouth Hitchcock Clinic | Lebanon | New Hampshire | United States | 03756 |
| 10 | University of New Mexico Health Sciences Center | Albuquerque | New Mexico | United States | 87102 |
| 11 | University of Oklahoma Health Sciences Center | Oklahoma City | Oklahoma | United States | 73104 |
| 12 | Rhode Island Hospital | Providence | Rhode Island | United States | 02903 |
| 13 | Medical University of South Carolina | Charleston | South Carolina | United States | 29425 |
| 14 | Avera Research Institute | Sioux Falls | South Dakota | United States | 57108 |
| 15 | West Virginia University | Morgantown | West Virginia | United States | 26506 |
Sponsors and Collaborators
- IDeA States Pediatric Clinical Trials Network
- National Institutes of Health (NIH)
- University of Nebraska
- University of Montana
Investigators
- Principal Investigator: Russell J. McCulloh, MD, University of Nebraska
- Principal Investigator: Ellen Kerns, PhD, University of Nebraska
- Principal Investigator: Paul Darden, MD, University of Arkansas
- Study Director: Jeannette E Lee, PhD, University of Arkansas
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 273761
- U24OD024957