This informal CPD article ‘Why Children Miss Vaccinations, and How a Simple Text Message Can Help ’ was provided by Cima Care, who offer extensive training in vaccination and public health, advancing global health initiatives.
What the research says about keeping children on schedule, and why the answer is often simpler than expected
"Was that appointment last Tuesday, or next Tuesday?" "Has she had the second dose, or only the first?" "There is so much advice online that I no longer understand which of it to trust."
Most parents may recognise at least one of these thoughts. They are not signs of carelessness. They are the expected effect of managing a complicated schedule during the most active years of family life, often while tired, and usually while receiving advice from several directions at once. 1 Over the past decade, researchers have looked closely at what actually helps families keep children on schedule. Some of the findings are unexpected, and several lead towards solutions that are far simpler than might be considered. 2
The Difficulty Is Rarely a Lack of Willingness
Research from a leading child development research centre has described what happens when adults face complex or conflicting advice from several sources simultaneously. Under these conditions, and especially when combined with stress or hardship, people become less able to draw on the planning and self-regulation abilities they would usually rely on. Confidence falls and responding calmly to a child's essentials becomes more difficult. 3 This shifts how we think about missed appointments. A missed appointment is often not a decision at all. It is what happens when a demanding schedule meets crowded information circumstances.
The same body of work points to a practical conclusion: parenting is a learned skill, and like any learned skill, it improves with structured support rather than with exhortation. 4 Forgetting is not a failure of intention. It is what a crowded mind does under strain.
What Changes When Families Are Reminded
A 2025 systematic review examined whether digital tools can help more children receive their routine vaccines in low- and middle-income countries. The researchers searched studies published from January 2010 to August 2023. Of the 6,535 records screened, 27 studies involving 354,979 children in 17 countries were included.
Most of the studies, 19 out of 27, tested a simple form of technology: vaccine reminders sent by text message or delivered through a telephone call. These reminders were usually sent to parents or carers before a child's scheduled vaccination visit.
When the results were combined, children in reminder programmes had substantially higher odds of completing all recommended vaccines by their first birthday. They also had higher odds of receiving the third dose of the pentavalent vaccine. This five-in-one vaccine protects against diphtheria, tetanus, whooping cough, hepatitis B, and Haemophilus influenzae type b, a bacterium that can cause meningitis and other serious infections.
In the pooled analysis, reminder interventions were associated with a 2.61-fold higher likelihood of full vaccination by age 1 and a 2.32-fold higher likelihood of receiving the third pentavalent dose. The studies varied considerably in their settings and methods, so these figures should be understood as a strong overall pattern rather than a guarantee that every reminder system will achieve the same result.
The practical lesson though is simple: a timely text message or phone call can help a family remember, return, and complete a child's vaccination schedule. However, reminder systems must also be designed so they do not exclude families without reliable mobile phones, network access, or a means to keep phones charged. 5 The reminder adds nothing to the case for vaccination. It simply arrives in time.
Why Something as Simple as a Text Message Works
Roughly 29% of digital health programmes now rely on text messaging, and engagement with them tends to be higher than with conventional health education materials. 6 Reviews of text-message health programmes identify four consistent advantages: engagement is higher than with traditional methods; information can be collected in real time, allowing support to be tailored; the approach reaches families whether or not they have internet access; and running costs are low relative to the savings generated. 7
That last point about reach helps explain the wider pattern. A 2025 review noted that mobile phone access across low- and middle-income countries now exceeds 60%, including both personal and shared ownership, placing a simple text message within reach of most households even where other infrastructure remains limited. 8
The effect on vaccination itself has been measured directly. Analysis of mobile health programmes across Africa found that vaccination rates roughly doubled among children whose mothers used such services. 9 The same channels can be used for more than prompting attendance. Studies of mobile applications designed to involve patients directly in their own care have reported significant improvements in both understanding of safety matters and active participation in care. 18 The advantage here is therefore not sophistication. It is reach.
Better Records Mean Fewer Children Overlooked
Reminders address one half of the problem. The other half is knowing which children are due and which have been missed. Where electronic immunisation records have replaced paper registers, accuracy improves, information becomes available sooner, errors fall, and individual children can be followed through the full schedule rather than counted only in totals. 10
The practical benefits extend to the clinic itself. In Tanzania, an electronic immunisation registry saved health workers about 70 hours each year and reduced annual costs by an estimated US$10,000 per health facility. In Vietnam, use of the registry was associated with a 20% increase in the on-time delivery of three routine vaccines. These examples show how digital immunisation records can reduce administrative burden while helping health workers identify children who are due or overdue for vaccination. 11 Time returned to a health worker is more time available for families.
What Digital Support Cannot Do on Its Own
It would be misleading to describe mobile-health tools as successful in every setting. Reviews consistently find that mobile health tools can fail or reach fewer people when mobile networks or digital platforms are unreliable, when families lack access to mobile phones, when health records are incomplete, or when health workers have not received sufficient training. Introducing a new digital system can also add to the workload of already stretched health workers.
The review also warns that mobile-health programmes may increase inequality if the people most in need of care, particularly poorer women and women in rural areas, are least likely to own or control a mobile phone. Language, literacy, social norms, distance from health facilities and vaccine shortages can further limit the value of digital reminders.
When these practical barriers are addressed, mobile phones can help health workers send reminders, collect information, track service schedules, and share health messages. Across the studies reviewed, these interventions were often associated with improved use of maternal and child health services and, in several studies, with improved childhood immunisation coverage or more timely vaccination. However, results varied across settings, and the authors call for larger, more robust studies before drawing broad conclusions. 12
On the question of training, a recent systematic review found that simulation using virtual reality improved clinical competency among nursing students, indicating one means by which staff preparedness can be developed alongside the introduction of a new system. 19 Technology is not the only intervention, but along with the system around it, they are.
Children overdue for vaccination
What Else Is Known to Help Families
Three further findings sit outside the digital question but bear directly on whether children complete their schedules. The first concerns time. A global analysis found that countries with paid parental leave policies tend to record higher childhood vaccination coverage for the straightforward reason that parents have more opportunity to attend appointments. 13
The second concerns conversation. Structured frameworks for discussion between parents and health professionals have been shown to address uncertainty about vaccination and to support informed decision-making. 14
The third concerns involvement. A review of patient engagement across health services found that people who take an active part in their own care are more likely to follow the instructions they receive, with fewer complications, fewer medication errors and fewer avoidable appointments. 20 The quality of that exchange is not only a matter of personality. It is a method that can be taught.
The Wider Picture
Beyond the individual family, the same data now serves broader purposes. Analysis of large health datasets, including through artificial intelligence, is being used to anticipate disease outbreaks, identify emerging transmission patterns, and shorten the time between detection and response. 15
Within clinical care, reviews of artificial intelligence in decision support report that, where such systems are implemented carefully, they can assist in detecting errors, in identifying patients at higher risk, and in managing medicines more safely. 21 & 22 Digital platforms are also used to coordinate vaccine distribution, allowing stock and delivery to be tracked as they move, which reduces waste and improves the reliability of supply to communities. 16
Digital tools have also changed how safety concerns are identified after a vaccine or medicine is already in routine use. In Nigeria, the introduction of a smartphone-based reporting system increased both the number and the quality of reports of unexpected or harmful reactions, which is the process through which such concerns are detected and investigated. 23 This form of monitoring has strengthened internationally. Between 2020 and 2022, the proportion of countries reporting immunisation safety data jointly through their national immunisation programme and their medicines regulator rose from 19% to 27%, and in 2022, 92 of 215 countries and territories met a newly introduced standard for case-based vaccine safety monitoring. 24 For a parent, this is the part of the system that is rarely visible: the arrangements by which a vaccine already in everyday use continues to be observed.
Key Takeaways
- Missed vaccination appointments frequently reflect a crowded schedule and conflicting information rather than an unwillingness to vaccinate. 3
- Across 27 studies covering 354,979 children in 17 countries, children in programmes using communication technology were about 2.6 times more likely to complete their first-year schedule. 5
- Text messaging reaches families without internet access, engages them more effectively than conventional materials, and costs comparatively little to operate. 6 &7
- Vaccination rates roughly doubled among children whose mothers used mobile health services in a cross-Africa analysis. 9
- In Tanzania, an electronic immunisation registry saved health workers about 70 hours each year and reduced annual costs by an estimated US$10,000 per health facility. In Vietnam, use of the registry was associated with a 20% increase in the on-time delivery of three routine vaccines. 11
- These tools depend on reliable networks, trained staff, clear policies, and data privacy protections. 12
- Paid parental leave and structured parent-clinician conversations are both associated with better vaccination outcomes. 13 & 14
- Digital reporting has also strengthened how concerns about medicine and vaccine safety are detected, and joint national reporting of immunisation safety data rose from 19% to 27% of countries between 2020 and 2022. 23 & 24
Looking Forward
Much of what helps children receive every recommended vaccine dose does not depend on a new vaccine or sophisticated technology. It depends on having accurate, up-to-date immunisation records and using them well: knowing which vaccine a child has received, which dose is due next, and which children have become overdue.
For a parent, this may be as simple as receiving a reminder by text message, telephone call, letter or another agreed method before a vaccination appointment is due. For a health service, it means more than counting doses given. A well-functioning immunisation information system brings together each child's vaccination history, forecasts future doses, identifies children who are due or overdue, and helps staff follow up before a child is missed. The practical goal is not merely to record vaccinations after they occur but to use reliable records to support on-time vaccination and help every child complete the recommended schedule. 17
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REFERENCES
1- Kaufman J, Tuckerman J, Bonner C, Durrheim DN, Costa D, Trevena L, et al. Parent-level barriers to uptake of childhood vaccination: a global overview of systematic reviews. BMJ Global Health [Internet]. 2021 Sept [cited 2026 Aug 11];6(9):e006860. Available from: https://gh.bmj.com/content/6/9/e006860
2- Mengistu M, Farheen A, Bryant DM, Kothari A, Zecevic AA, Ezezika O. Strategies for improving childhood routine immunization coverage: a global systematic review & meta-analyses. Discover Public Health. 2026 Apr 20;23(1).
3- Raver C, Blair C, Bunge S, Pavetti L, Babcock E, Bowne J, et al. Building Core Capabilities for Life FUNDING SUPPORT [Internet]. Available from: https://developingchild.harvard.edu/wp-content/uploads/2024/10/Building-Core-Capabilities-for-Life.pdf
4- Raising Parents [Internet]. Unicef.org. 2025 [cited 2025 Jun 2]. Available from: https://www.unicef.org/parenting/raising-parents
5- Zarekar M, Al-Shehabi H, Dörner R, Weishaar H, Lennemann T, El Bcheraoui C, Bernasconi A. The impact of information and communication technology on immunisation and immunisation programmes in low-income and middle-income countries: a systematic review and meta-analysis. EBioMedicine. 2025 Jan 1;111.
6- Whitehead L, Robinson S, Arabiat D, Jenkins M, Morelius E. The report of access and engagement with digital health interventions among children and young people: systematic review. JMIR pediatrics and parenting. 2024 Jan 17;7:e44199.
7- Suffoletto B. Deceptively Simple yet Profoundly Impactful: Text Messaging Interventions to Support Health. Journal of Medical Internet Research. 2024 Aug 27;26:e58726.
8- Onigbogi O, Ojo OY, Kinnunen UM, Saranto K. Mobile health interventions on vaccination coverage among children under 5 years of age in Low and Middle-Income countries; a scoping review. Frontiers in Public Health. 2025 Jan 28;13.
9- Gilano G, Sako S, Molla B, Dekker A, Fijten R. The effect of mHealth on childhood vaccination in Africa: A systematic review and meta-analysis. Plos one. 2024 Feb 21;19(2):e0294442.
10- Dolan SB, Carnahan E, Shearer JC, Beylerian EN, Thompson J, Gilbert SS, Werner L, Ryman TK. Redefining vaccination coverage and timeliness measures using electronic immunization registry data in low-and middle-income countries. Vaccine. 2019 Mar 22;37(13):1859-67.
11- Closing gaps in vaccine coverage with electronic immunization registries [Internet]. PATHtweets. 2024 [cited 2026 Aug 11]. Available from: https://www.path.org/our-impact/case-studies/electronic-immunization-registries/
12- Venkataramanan R, Subramanian SV, Alajlani M, Arvanitis TN. Effect of mobile health interventions in increasing utilization of Maternal and Child Health care services in developing countries: A scoping review. DIGITAL HEALTH. 2022 Jan;8:205520762211432.
13- Daku M, Raub A, Heymann J. Maternal leave policies and vaccination coverage: a global analysis. Social science & medicine. 2012 Jan 1;74(2):120-4.
14- Leask J, Kinnersley P, Jackson C, Cheater F, Bedford H, Rowles G. Communicating with parents about vaccination: a framework for health professionals. BMC pediatrics. 2012 Dec;12:1-1.
15- Cho G, Park JR, Choi Y, Ahn H, Lee H. Detection of COVID-19 epidemic outbreak using machine learning. Frontiers in Public Health. 2023 Dec 18;11:1252357.
16- Digital technologies will support the supply chains for COVID-19 vaccines and medical goods [Internet]. blogs.worldbank.org. Available from: https://blogs.worldbank.org/transport/digital-technologies-will-support-supply-chains-covid-19-vaccines-and-medical-goods
17- CDC. Leverage Immunization Information System (IIS) Functionality [Internet]. IQIP. 2024 Oct [cited 2026 Aug 11]. Available from: https://www.cdc.gov/iqip/hcp/strategies/leverage-immunization.html
18- Lee NJ, Ahn S, Lee M. The effects of a mobile application for patient participation to improve patient safety. Health Expectations. 2022 Aug;25(4):1601-18.
19- Cho MK, Kim MY. Enhancing nursing competency through virtual reality simulation among nursing students: a systematic review and meta-analysis. Frontiers in Medicine. 2024 May 7;11:1351300.
20- Marzban S, Najafi M, Agolli A, Ashrafi E. Impact of patient engagement on healthcare quality: a scoping review. Journal of patient experience. 2022 Sep;9:23743735221125439.
21- Choudhury A, Asan O. Role of artificial intelligence in patient safety outcomes: systematic literature review. JMIR Med Inform. 2020 Jul 24; 8 (7): e18599. doi: 10.2196/18599.
22- Ratwani RM, Bates DW, Classen DC. Patient safety and artificial intelligence in clinical care. InJAMA Health Forum 2024 Feb 2 (Vol. 5, No. 2, pp. e235514-e235514). American Medical Association.
23- Elemuwa UG, Bitrus F, Oreagba IA, Osakwe AI, Abiodun AS, Onu K, Abubakar A, Faniyi AE, Etuk V, Yuah D, Momodu R. Trends in Adverse Event Reporting Before and After the Introduction of the Med Safety App in Nigeria. Pharmaceutical Medicine. 2024 May 6:1-9.
24- Blau EF. Progress in Immunization Safety Monitoring — Worldwide, 2020–2022. MMWR Morbidity and Mortality Weekly Report [Internet]. 2023;72. Available from: https://www.cdc.gov/mmwr/volumes/72/wr/mm7249a2.htm
