Acceptability of and Willingness to Pay for Using a Smartphone-based Vaccination Application in a Vietnamese Cohort

"With smartphone users accounting for the majority of mobile phone user populations in both the cities and rural areas of Vietnam,...smartphone-based applications might serve as an effective platform to educate and deliver important information about vaccination and immunization to a diverse population, especially those in areas that would be otherwise difficult to reach."

Previous studies have suggested that insufficient vaccination coverage and poor compliance to vaccine schedules, rather than the effectiveness of vaccines themselves, remain significant contributors to outbreaks of previously eliminated vaccine-preventable diseases (VPDs). Commonly cited explanations for inadequate coverage and lack of timely vaccination include missing vaccination appointments, being unaware of vaccination schedules, and intentional delaying of getting vaccinated - partly due to the dissemination of inadequate information regarding side effects of vaccination. It has been reported that the dissemination of inadequate information regarding adverse events following immunisation (AEFIs) by the media contributed to a decrease in over 30% in the coverage of hepatitis B vaccination in Vietnam in 2013. The country has started taking initiatives to tackle such problems, including the use of vaccination management smartphone applications ("apps"), which have been piloted to go beyond being a simple schedule reminder tool. This study hopes to contribute to efforts to evaluate the effectiveness, adoption, and feasibility of implementing mobile phone apps into vaccination management programmes in Vietnam.

A cross-sectional study was conducted between March and April 2016 in an urban vaccination clinic at the Hanoi Medical University in Vietnam. Convenience sampling was used to recruit 429 adult participants who had received vaccinations or whose children were vaccinated.

In this cohort, there was a high percentage of smartphone usage (90.1%), of whom 68.5% reported frequent usage. Among participants who used smartphone apps, only 5% were aware of existing vaccination management apps, of whom 57.9% had previously used them.

About 69.6% of participants believed the apps were necessary, 93.7% of them were also willing to use them, and 79.1% were willing to pay 92.7 thousand Vietnamese dong (VND) for them on average. Among those who were unwilling to use smartphone-based vaccination management apps or thought they were unnecessary, 44.4% felt that there was sufficient vaccination-related information available online, 32.2% praised the adequacy of vaccination schedule reminders from community workers, and 4.7% were accounted for not having access to a smartphone.

Participants who were older, unemployed, earned more household income, and had knowledge about functions and benefits of vaccination were less likely to use the vaccination apps. Participants who brought their children to get vaccinated at younger age and with higher level of education were willing to pay more for vaccination apps. People perceiving that vaccination information from hospital staff was more reliable compared to information from community health workers were less likely to pay for the apps. This finding suggests that increased visibility of the apps and promotion of their benefits among healthcare professionals in hospitals might help improve the adoption of such apps.

Thus, this study found high levels of acceptability of, willingness to use, and willingness to pay for smartphone-based vaccination management apps among Vietnamese parents whose children were vaccinated at an urban vaccination clinic. Despite high smartphone use, there was a gap in the awareness of such apps among Vietnamese adults. In addition to increased education about the benefits of the apps that differentiates them from available vaccination information available on the internet, stronger collaboration among application developers, funders, healthcare professionals, and community health workers might help maximise the apps' visibility, adoption, and effectiveness.

Even though they were not measured in this study, a better understanding of preferences for specific features of a smartphone-based vaccination management app might also provide useful insights into maximising the utility and acceptability of such apps. In addition, strategies to address the potential unmet needs associated with using the apps, such as financial burden, potential issues in data management, and confidentiality protection, as well as user integration into the existing healthcare infrastructures, might enable app developers to better differentiate the app's features from the available online resources and information provided by hospital staff.

In conclusion, the presence of inaccurate information about vaccines and immunisation on the internet supports the use of smartphone apps that go beyond the role of a schedule reminder to serve as a more curated tool for vaccination management, education, and communication with healthcare teams.