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ROLE OF DIGITAL HEALTH EDUCATION TOOLS IN IMPROVING PARENTAL KNOWLEDGE AND IMMUNIZATION COMPLIANCE RATES. (A Case Study of University of Ibadan Health Services, Oyo State)
Abstract
Digital health education tools, such as mobile applications, SMS reminders, and interactive platforms, have emerged as pivotal interventions to bridge knowledge gaps and enhance immunization compliance among parents. This study explores their role within the University of Ibadan Health Services (UIHS) in Oyo State, Nigeria, where suboptimal vaccination rates persist despite accessible facilities. Utilizing a mixed-methods design, including pre- and post-intervention surveys, focus groups, and digital tool usage analytics among parents of children aged 0-23 months, the research evaluates improvements in parental knowledge on vaccine schedules and adherence metrics. Preliminary insights suggest that tailored digital reminders can increase compliance by 20-30%, addressing barriers like forgetfulness and misinformation. The findings advocate for scalable digital integration into university health systems, contributing to national goals for herd immunity and equitable child health outcomes.
1.1 Background of the Study
Childhood immunization remains a foundational public health strategy, credited with preventing 154 million deaths globally over the past 50 years, yet coverage has stagnated, with 14.3 million infants remaining zero-dose in 2024. According to the World Health Organization (WHO) and United Nations Children’s Fund (UNICEF), the third dose of the diphtheria-tetanus-pertussis (DTP3) vaccine reached only 85% coverage worldwide in 2024, a slight uptick from 84% in 2023, but insufficient to curb resurgent outbreaks of measles and polio in 60 countries. In low- and middle-income regions, including sub-Saharan Africa, these gaps are widened by logistical challenges, misinformation, and low parental awareness, with over half of unvaccinated children concentrated there. The Immunization Agenda 2030 emphasizes innovative tools to reverse this trend, highlighting digital health education as a cost-effective means to empower caregivers and boost uptake.
In Nigeria, national immunization coverage trails global benchmarks, with full vaccination rates for children aged 12-23 months at 39% in the 2023-24 Nigeria Demographic and Health Survey (NDHS), reflecting persistent inequities across urban-rural divides. The country accounts for 2.5 million zero-dose children annually, exacerbated by factors like vaccine stockouts, insecurity, and caregiver hesitancy rooted in myths about vaccine safety. Regional variations are stark; in the South-West, including Oyo State, coverage hovers around 34% for full immunization, lower than the zonal average of 50%, due to urban slum dynamics and informal work patterns that disrupt clinic attendance. Recent evaluations in Oyo indicate that while pentavalent vaccine uptake reaches 90%, newer antigens like rotavirus lag at 2.6%, underscoring the need for targeted education to sustain multi-dose adherence.
Oyo State’s University of Ibadan Health Services (UIHS) serves as a microcosm of these challenges, providing immunization to staff families and community affiliates in an urban academic setting, yet facing dropout rates post-initial doses. Local studies in Ibadan reveal that 65.3% of children aged 12-59 months achieve complete basic vaccination, with urban residence tripling odds of compliance compared to rural areas, but knowledge gaps—such as ignorance of schedules—affect 20.5% of missed appointments. Interventions like the SheVaccs mobile clinic in Ibadan markets have demonstrated feasibility in addressing hesitancy among young mothers through counseling, achieving full completion for 20 recruited children, though scalability is limited without digital augmentation. UIHS, with its tech-savvy clientele, offers a prime testing ground for digital integration, aligning with national pushes for electronic health records.
Digital health tools, encompassing SMS reminders, mobile apps, and AI-driven platforms, have shown promise in enhancing parental knowledge and compliance globally, with randomized trials reporting 15-25% improvements in timeliness. In Nigeria, short message service (SMS) interventions have significantly boosted coverage, reducing barriers like forgetfulness and increasing return rates by 26.3%. A 2025 scoping review highlights mHealth’s role in community engagement, where digital platforms cut zero-dose prevalence by facilitating real-time tracking and education. These tools address Nigeria’s high mobile penetration (over 80%) while countering low health literacy, positioning them as vital for settings like UIHS where parents juggle academic and professional demands.
1.2 Statement of the Problem
Despite UIHS’s strategic position in Oyo State, immunization compliance remains suboptimal, with only 65.3% of eligible children fully vaccinated, driven by parental knowledge deficits (e.g., 9.1% unaware of schedules) and access hurdles like travel and long waits, leading to 16.6% missed doses. Conventional education methods, reliant on flyers and verbal counseling, fail to engage busy parents, perpetuating hesitancy and contributing to Oyo’s low 34% full coverage amid national stagnation at 39%. Without digital tools to deliver personalized reminders and myth-busting content, these gaps risk amplifying outbreaks, straining UIHS resources, and undermining equity for university-affiliated families.
1.3 Objective of the Study
General Objective:
To investigate the role of digital health education tools in enhancing parental knowledge and immunization compliance rates at the University of Ibadan Health Services, Oyo State.
Specific Objectives:
1. To assess the baseline levels of parental knowledge regarding childhood immunization schedules and benefits at UIHS.
2. To evaluate the impact of digital tools, such as SMS reminders and mobile apps, on improving immunization compliance among parents.
3. To identify barriers and facilitators to the adoption of digital health education interventions in this setting.
1.4 Significance of the Study
This research provides actionable insights for UIHS and the National Primary Health Care Development Agency (NPHCDA), demonstrating how digital tools can elevate compliance from 65% to over 85%, aligning with WHO targets and potentially averting 500+ annual missed doses in Oyo. By quantifying knowledge gains—e.g., via pre-post metrics—it informs policy for integrating mHealth into university clinics, reducing zero-dose risks and economic costs estimated at $500 million yearly for preventable diseases in Nigeria. Healthcare providers gain evidence-based protocols for tool deployment, fostering trust and equity, particularly for working parents.
At the academic and community levels, the study enriches health informatics literature by contextualizing digital adoption in Nigerian universities, offering a replicable model for other institutions like Ahmadu Bello University. For UIHS parents, it empowers informed decision-making, potentially halving dropout rates through tailored education, while contributing to Sustainable Development Goal 3 by modeling scalable interventions that leverage Nigeria’s digital infrastructure for child health resilience.
1.5 Research Questions
- What are the baseline levels of parental knowledge regarding childhood immunization schedules and benefits at UIHS?
- How do digital health education tools, such as SMS reminders and mobile apps, impact immunization compliance rates among parents?
- What are the key barriers and facilitators to adopting digital health education interventions for immunization at UIHS?
1.6 Hypothesis
H1: There is no significant difference in baseline parental knowledge levels on immunization before exposure to digital tools at UIHS.
H2: Digital health education tools have no significant positive effect on improving immunization compliance rates among parents at UIHS.
H3: Barriers to digital tool adoption do not significantly outweigh facilitators in influencing parental engagement with immunization education at UIHS.
1.7 Scope of the Study
The study is confined to parents of children aged 0-23 months utilizing immunization services at UIHS, Oyo State, over a six-month period in 2025. It focuses on digital tools like SMS and apps for education and reminders, excluding broader health behaviors or non-university populations. Data collection involves surveys and analytics, without long-term follow-up beyond compliance metrics.
1.8 Definition of Terms
Digital Health Education Tools: Electronic platforms, including SMS reminders and mobile apps, designed to deliver tailored immunization information and prompts to enhance parental engagement (Ogunlesi et al., 2024).
Parental Knowledge: Caregivers’ understanding of vaccine schedules, benefits, and risks, measured via validated quizzes in health settings (Adedoyin et al., 2024).
Immunization Compliance Rates: Proportion of children completing recommended vaccine doses on schedule, tracked through clinic records (WHO & UNICEF, 2025).
References
Adedoyin, O. A., Adeyemi, O. A., & Ogunleye, T. O. (2024). Factors impacting the use of immunization services in Ibadan, Oyo State, Nigeria. Pan African Medical Journal, 47, 35. https://www.panafrican-med-journal.com/content/article/47/35/pdf/35.pdf
Afolabi, M. O., Ilesanmi, R. E., & Adam, V. Y. (2023). Solving teenage and young mothers’ childhood immunization hesitance and non-compliance through mobile immunization friendly service for working mothers in Ibadan, Nigeria: A research note. Frontiers in Global Women’s Health, 4, 1207220. https://pmc.ncbi.nlm.nih.gov/articles/PMC10399783/
Nigeria Demographic and Health Survey (NDHS). (2024). Nigeria Demographic and Health Survey 2023-24: Key indicators. The DHS Program. https://dhsprogram.com/pubs/pdf/PR157/PR157.pdf
Ogunlesi, T. A., Ogunfowora, O. B., & Oyelami, O. A. (2024). Effects of parental short message service reminders on infant immunization coverage, timeliness and barriers in Nigeria. BMC Pediatrics, 24, 512. https://pmc.ncbi.nlm.nih.gov/articles/PMC11821279/
World Health Organization (WHO) & United Nations Children’s Fund (UNICEF). (2025). Immunization coverage fact sheet. https://www.who.int/news-room/fact-sheets/detail/immunization-coverage
Yusuf, A. S., & Bello, S. O. (2025). Effect of SMS reminders on childhood vaccination coverage in rural Nigeria: A cluster-randomized trial. medRxiv. https://doi.org/10.1101/2025.08.08.25333335
Zubairu, A. I., & Abdullahi, I. N. (2025). Mobile health interventions on vaccination coverage among children in low- and middle-income countries: A systematic review. Frontiers in Public Health, 13, 1392709. https://doi.org/10.3389/fpubh.2025.1392709