Immunization and Technology among Newcomers: A Needs Assessment Survey for a Vaccine-Tracking App

"Mobile technology has the potential to empower individuals to manage their own health information."

CANImmunize is a free, bilingual, pan-Canadian digital application (app) that allows individuals to manage their own and their families' vaccination records. To inform how a vaccine tracking app such as this one might be tailored to meet the unique needs of newcomers, who need to navigate complex vaccination catch-up schedules upon arrival in their new home countries, this study sought to determine commonly spoken languages, technology use, and current methods of vaccine tracking among recent newcomers to Canada.

The researchers explain that refugee newcomers in particular often arrive with illegible, incomplete, or no proof of vaccination from their home countries. Without complete and comprehensive knowledge of vaccination coverage among this population, public health units in host countries face economic and care challenges related to over- or under-vaccination. In addition, without reminders or instructions from healthcare providers, vaccination series doses may be missed and never fully completed. As refugees make frequent use of mobile devices to stay connected with friends and family and to help navigate their host countries, there exists the opportunity to leverage mobile devices as tools to support public navigation of complex health systems and promote bi-directional communication between the public and health providers.

In that context, CANImmunize was launched in 2014. The app contains all 26 Canadian provincial and territorial adult and paediatric vaccination schedules with information on vaccination in each jurisdiction. The app permits multi-record vaccination tracking that allows parents or guardians to manage a digital record for dependents along with their own records and includes a recall-reminder system that notifies the account holder of upcoming and overdue vaccinations. To date, over 211,000 users have downloaded CANImmunize.

In a city with a large immigrant population (Ottawa), 50 out of 52 participants approached at a health clinic specifically providing immunisation services to Government Assisted Refugees, privately sponsored refugees, and refugee claimants completed a 17-question paper survey. The largest proportion (42%) were between 25-34 years of age. Twenty-seven (54%) of the participants were parents, of whom 23 reported having two or more children. The most common region of origin of participants was Sub-Saharan Africa (Eritrea, Ethiopia, Zimbabwe, Burundi, Burkina Faso, Democratic Republic of Congo; 35%), followed by the Middle East (Lebanon, Syria, Iraq; 32%). The most common language spoken was Arabic. Thirty-one (62%) participants indicated they had previously tracked their vaccinations on paper cards in their home countries, whereas 18 (36%) reported not tracking their vaccinations at all.

Although a high percentage (92%) of the study participants owned smartphones, few were active users of health apps. When asked if they would use an app to learn about vaccinations in Canada, participants indicated their interest in using such a tool, particularly if it were translated into their primary language of communication.

The researchers suggest future directions for study, including:

• determining what vaccine information newcomers require and how this information and the format in which it is presented might differ from the general population;
• examining the value of a translated version of the CANImmunize app as a tool to encourage vaccine tracking, promote awareness about vaccines in Canada, and improve on-time vaccination rates;
• evaluating the effectiveness of public health messaging toward this population and adverse event reporting;
• examining the impact of the app on healthcare providers; and
• exploring eventual integration of the app into public health vaccination databases.