A Smartphone App to Increase Pre-Transplant Vaccine Rates: Assessing Feasibility, Acceptability, and Effectiveness (Preprint)
Authors: Feldman Amy G , Beaty Brenda L. , Moore Susan L , Bull Sheana , Wilson Kumanan , Atkinson Katherine M. , Bell Cameron , Denize Kathryn M. , Kempe Allison 
Published: December 2024

BACKGROUND

Background: Vaccine preventable infections result in significant morbidity, mortality and costs in pediatric transplant recipients. Despite intensive medical care in the pre-transplant period, less than 20% of children are up to date for age-appropriate vaccines at the time of transplant. Mobile health apps have the potential to improve pre-transplant vaccine rates.

OBJECTIVE

Objectives: To perform Phase 2 beta-testing of the smartphone app, Immunize PediatricTransplant, to determine 1) if it was effective in achieving up to date vaccine status by the time of transplant in a cohort of children awaiting transplant and 2) if the app was feasible and acceptable to parent and transplant provider users.

METHODS

Methods: We recruited 25 dyads of parents and providers of a child awaiting liver, kidney, or heart transplant at Children’s Hospital Colorado, Lurie Children’s Hospital, and the Children’s Hospital of Philadelphia. Parents and providers filled out an Entry Questionnaire before app use to gather baseline information. A research team member entered the child’s vaccine records into the app. The parent and provider downloaded and used the app until transplant to view vaccine records, read vaccine education, communicate with team members, and receive overdue vaccine reminders. After transplant (or on 4/1/2024, the conclusion of the study), the parent and provider filled out an Exit Questionnaire to explore feasibility and acceptability of the app. The child’s vaccine records were reviewed to determine if the child was up to date on vaccines at transplant.

RESULTS

Results: Twenty-five parent/provider dyads were enrolled; 56% (14/25) of a child awaiting liver, 28% (7/25) kidney, and 16% (4/25) heart transplant. At the conclusion of the study, 96% (24/25) of the children were up to date on vaccines. Of the 36 parents and providers who filled out an Exit Questionnaire, 97% (35/36) agreed/strongly agreed that they felt knowledgeable about pre-transplant vaccine use and 86% (31/36) agreed/strongly agreed that communication around vaccines was good after using the app. Ninety-one percent (20/22) of parents and 79 percent (11/14) of providers recommended the app to future parents and providers of transplant candidates. Parents and providers suggested that in the future the app connect directly to the electronic medical record or state vaccine registries to obtain vaccine data.

CONCLUSIONS

Conclusions: The overwhelming majority of children whose parents and providers used the Immunize PediatricTransplant app were up to date on vaccines at the time of transplant. The majority of app users felt the app was feasible and acceptable. In future iterations of the app and subsequent clinical trials, we will explore whether application programming interfaces might be used to extract vaccine data from the electronic medical record. If implemented broadly, this app has the potential to improve pre-transplant vaccine rates, resulting in fewer post-transplant infections and improved post-transplant outcomes.

CLINICALTRIAL

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