International Journal of Trend in Research and Development, Volume 4(5), ISSN: 2394-9333

www.ijtrd.com
Acceptability Testing of a Mobile Application to Improve
Immunization Status Monitoring and Compliance in
Selected Barangay Health Centers in Iligan City
1
Geraldine Ridad, 2Gabriel Joseph Esporsado, 3Abdulrauf Garangan, 4Art Brian Escabarte and 5Omar Khayyam Usman,
1,2,3,4
College of Nursing, Mindanao State University- Iligan Institute of Technology, Iligan City, Philippines
5
Amigu.co, Iligan City, Philippines

Abstract— With the availability of vaccines given freely by recommended infant or childhood vaccines, thus achieving the
the government for immunization, it is still a question as to goal of Fully Immunized Child (FIC) in the Philippines [3].
why the goal of 100% fully immunized child (FIC) status has
Globally, the immunization coverage for the six major
yet to be reached. Hence, an android application was created,
vaccine-preventable diseases has risen significantly but had
designed and developed to help increase the immunization rate
also stalled over the last decade. Philippines, having at least
specifically in Iligan City which only has 81.01% or 7,509 out
60% of the total number of children who did not receive
of 9269 total eligible population. This mobile application was
vaccination, has been one of the eight countries to have many
tested for its acceptability among nurses, midwives, and/or
unvaccinated children [4]. Studies show that various factors
Barangay Health workers in ten different Barangay Health
have caused barriers among the mothers from adhering to the
Centers in Iligan City. This was done in three phases; the
Expanded Program on Immunization. Among all other factors,
orientation phase, implementation phase, and evaluation phase.
barriers due to personal beliefs, social influence and
Results showed that the application was strongly beneficial geographical locations, lack of knowledge and awareness on
(Median=4) to them with an extreme ease of use EPI are the most prevalent [5].
(Median=6.75). They were also very satisfied (Median=1) with
On the other hand, technologies like smartphones have
its performance. The findings of this study have proved to be
paved their way to becoming very useful in the lives of the
promising in improving monitoring of immunization status and
many. Nowadays, smartphones became the defining
compliance. The android application is of great contribution
technology of the 21st century. It was estimated that by the
and has guaranteed a time-saving, cost-effective way in
year 2020, 80% of the total population especially adults
productivity and delivery of safe, quality care.
worldwide will have their own smartphones [6]. Thus,
Keywords— Immunization; Android Application; Fully smartphones having its easy accessibility and efficiency, have
Immunized Child. proven their use to many, even to improving health care
delivery system [7], [9], [14].
I. INTRODUCTION
Since EPI was established last 1976, significant changes
Every child has the right to have a fair chance in life. They
have resulted to the immunization status worldwide, and most
deserve a chance to live a long life, to feel safe and to be
importantly in the Philippines. But due to various factors,
protected against various diseases. However, in the year 2015,
Philippines cannot seem to achieve its 100% goal of Fully
an estimated 5.9 million children under 5 years of age died
Immunized Child all over the country. In fact, in Iligan City,
with a global under-five mortality of 42.5 per 1000 live births
only 81.01% or 7,509 out of 9,269 total eligible population
which is an estimate of 28 deaths per 1000 live births in the
have reached the Fully Immunized Child status in the end of
Philippines before they can even reach the age of five [2]. The
the year 2015 [8]. But with the advancement of technologies
causes of these deaths are said to be from several vaccine-
nowadays and with the use of smartphones and various mobile
preventable diseases, namely measles, tuberculosis,
applications, health care delivery system may just be
poliomyelitis, diphtheria, tetanus, and pertussis which has also
improved, thus, giving chances in improving and even
been reported to cause an estimate of 3 million deaths or
achieving the goal for the immunization status in the
disabilities each year. These, however, can be prevented
country[14].
through a complete and timely immunization [1].
Therefore, with the increased demands and advancements
As defined by the World Health Organization (WHO),
in technologies like smartphones and its capacity to aid and
immunization is the process wherein a person is made immune
improve health care delivery, the researchers were dedicated to
or resistant to an infectious disease by the administration of a
create a solution to the decreased immunization status in the
vaccine. Vaccine, on the other hand, stimulates the body’s own
country, specifically in Iligan City where it has not achieved
immune system to protect the person against subsequent
the 100% status. The researchers specifically developed a
infection or disease. Given by the fact that children who are
mobile application with the intent of increasing the
not fully immunized are more vulnerable to common
immunization rate of the children in Iligan City.
childhood diseases, a program to improve immunization status
of each country was created. This program is called the Objectives:
Expanded Program on Immunization or EPI which is a
program established by the WHO in 1976 mainly to reduce  To determine the acceptability of the mobile
infant and child mortality that are commonly brought by the application as to ease of use, preferences, satisfaction
said vaccine-preventable diseases. The program also ensures rating, and perceived benefits and disadvantages.
the infants, children and even mothers an access to the

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 International Journal of Trend in Research and Development, Volume 4(5), ISSN: 2394-9333
www.ijtrd.com
 To determine the strengths and weaknesses of the status. In line with this, the researchers have designed, created
mobile application based on the perception of the and developed an android application. Its features are similar
respondents. to some of the existing apps which are primarily to improve
the storage of patient information and communicate data in a
II. RELATED STUDIES cost and space-effective means. But unlike the typical EHRs
In the area of technology and advancement, the effective and EMRs, patients can also have access to view their
use of smartphones cannot be denied that it has even become immunization data and status. Moreover, if the use of the app
the defining technology of the 21st century. An estimated 80% will be expanded, access by the health care workers will be a
of the total population, especially adults, will have their own lot easier and quicker, even if the data is from the father side of
smartphones by 2020 [6]. According to statistics, the number the country. The app is more centralized and has an added auto
of smartphone-users in 2016 will be an estimated 2.1 billion. SMS sending which will remind parents on immunization
By 2019, the numbers are expected to exceed the 5-billion dates 1 week before, 3 days, 1 day before and on the day of the
mark. However, the use of these smartphones has also immunization schedule to entice them to adhere to schedules.
established its utilization in the area of improving the health
III. RESEARCH METHOD AND THE MOBILE APPLICATION
care delivery system [7]. Mobile technologies are making a
breakout in health care systems since its gradual evolution A. Research Method
towards new models of care based on integrated care processes
The study had four phases: the planning and development
[9]. It offers ways to help improve access and quality of health
of the mobile application, orientation phase, implementation
care. It can connect clients and health-care providers in real-
phase, and the evaluation phase. The researchers created the
time, creating an access to each other and enables monitoring
mobile application based on the immunization forms used by
and management of health indicators [10]. Mobile
the DOH and the local government. Then after orientation, it
Applications will transform health care in 5 ways – improved
was implemented and tested for acceptability on 20
access to care, improved patient engagement, new provider
respondents from the ten different barangay health centers in
business models, reduced fraud and improved patient safety
Iligan City with the least compliance to immunization. The
[11].
respondents were chosen using a non-probability specifically
Mobile applications have been advantageous and have purposive or judgmental sampling. There were criteria in
greatly impacted the healthcare industry. It helps create choosing the respondents. They must be a licensed or certified
solutions to immunization challenges through its focused and nurse, midwife, and/or barangay health workers; must be an
biodirectional communication system. In Canada, as of 2015, android smartphone or tablet users with the mobile application
the Android app store reveals 225 existing mobile applications installed; must be recognized as an employee of the health
on immunization. Moreover, searching the Apple App Store center; and must pass the basic matrix skills for android with a
for such applications produced 98 results. The diversity of score of at least 20 points.
these applications ranges from provision of immunization
During the orientation phase, the respondents were taught
information, permission of vaccine tracking in both individuals
by the researchers how to utilize the mobile application using
and animals and even in assistance with the creation of
the observer’s guide. They were shown how the application
customized schedules and identification of vaccine clinics that
works. After several minutes of demonstration, they were then
serves as a source of education. For individuals, the use of
asked to perform a return demonstration on how to use the
mobile applications provides an avenue for better quality of
application. The respondents were graded using the basic
record keeping, assistance with the logistics of vaccination,
matrix skills derived from Component-Based Usability
and better means of communicating information. In systems,
Questionnaire (CBUQ) on how well they performed during
mobile applications provide the potential to improve the
their return demonstration [16]. The orientation phase lasted
quality of information residing in immunization information
for a week, with the researchers visiting individually each
systems and program evaluation, facilitate harmonization of
barangay health centers to give their full attention to the
immunization information between individuals, health care
knowledge of the respondents. Next was implementation
providers and public health as well as reduce vaccine
phase. The respondents were given the actual task of utilizing
hesitancy. As mobile technology continues to rapidly evolve
the mobile application on their own. They were given two
there will emerge new ways in which apps can enhance
weeks to experience using the mobile application by
immunization practice [12].
themselves, especially on Wednesdays or Immunization days.
In the Philippines, the Department of Health has been After two weeks of implementation, the respondents were
implementing their new program called the iClinicSys. This is given the structured questionnaires to evaluate the application.
a system which caters several functions of any health centers Structured questionnaires were developed to collect data in
or units in the country. iClinicSys is a data saving system order to evaluate user’s satisfaction to the android application.
which generates standardized patient records and reporting The questionnaire was composed of different sections namely
requirement both at the local and the national level. It has the generalizations and the android application experience;
several systematic features such as the Field Health Services modified from study of Davis [17]. The generalized section
Program, Unified Disease Registries, Watching Over Mother consisted of demographic profile of respondents in terms of
Babies, Philippine Health Information Exchange, and so on. gender, age, civil status, educational attainment and length of
This system requires the use of a computer, laptop, or service in the selected barangay health centers. Following the
smartphones and as well as an internet connection [13]. general section was android application experience wherein
barangay health workers’ responses were evaluated in
The new electronic age has paved the way as the world correlation with the benefits and disadvantages, ease of
looks for better means to provide quality healthcare, shifting documentations, satisfaction and their preference in using the
towards Electronic Health Records and Electronic Medical mobile app.
Records. This will also help break the barriers that prevent
reaching the goal of 100% Fully Immunized Child (FIC)

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 International Journal of Trend in Research and Development, Volume 4(5), ISSN: 2394-9333
www.ijtrd.com
B. The Mobile Application and interested to see what lies ahead for this advancement. The
innovation has confirmed beneficial to the community’s
The mobile application the researcher created allows and
management of immunization and its status.
provides electronic form of documentation of clients under the
Expanded Program on Immunization. It allows the users to For the strengths of the application, the respondents think
input new patient’s data, edit and view the data, and monitor that through its utilization, more time can be saved and data
the immunization status of the client. It is also added with a saving and access is easier. In contrast, it can’t be used offline
special feature which sends an automatic notification to or without internet connection and electricity, making the
parents or guardians of the client regarding the immunization application usage limited only to certain barangays.
schedule, status of the client, and health promoting messages
Table 1: Acceptability Testing
related to immunization. This application saves data collected
to a cloud-based database. The app operates on mobile devices Median/
with Android Operating System. It is compatible with Android Parameter Remarks
Percentage
4.4 Kitkat and higher versions. The researchers of the study
Ease of Use 6.75 Extremely likely to use the app
believed that android OS has more users than that of the other
operating systems. According to statistics released by the User
1 Very Satisfied
Gartner last February 2017, 81.7% of smartphone users are Satisfaction
android OS users, while only 17.9% comprised the users of an Perceived Users have agreed strongly that
4
Apple iOS [15]. The application requires connection to internet Benefits the app is of great benefit
in order to save data to the cloud-based database. After Seldom, users experience
installation on the device, the app can be used immediately unavailability of the system
Perceived
without any further configuration. The mobile application has 3 and also the network, system
Disadvantages
three user types; the admin, healthworker, and patient or client. downtime or crashtime, and
However, to ensure confidentiality and security of data only some missing files.
the admin or the healthworker has the power to edit or change 95% for
any data on the system, while the patient user type can only app 5% for
Preference 95% preferred the app
view his or her data on the system. A user’s manual or paper-
observer’s guide was also created to help the user understand based
the mobile application. It explains in general terms the system
and the purpose for which it is intended. The user’s manual CONCLUSION
consists of five sections: General Information, Application The findings of this study have proved to be promising to
Summary, Getting Started, Using the Application, and the health sector. It has guaranteed a time-saving, cost-
Frequently Asked Questions. effective way in productivity and delivery of safe, quality care.
The android application is of great contribution to information
management, report facilitation and data management of
nurse’s immunization documentation.
Acknowledgment
The authors would like to thank the College of Nursing of
Mindanao State University- Iligan Institute of Technology, and
the health workers of the 10 barangays of Iligan City for their
support in the preparation and completion of the study.
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