Health Workers’ Perspectives on Missed Childhood Immunisation Appointments and SMS Reminder Implementation in Primary Healthcare Centres in, Abuja, Nigeria

Abstract

Context: Childhood immunisation remains an effective public health intervention for preventing vaccine-preventable diseases. Missed appointments undermine vaccine uptake. Short Message Service (SMS) reminders have demonstrated effectiveness in improving childhood immunisation uptake and timeliness. Evidence on implementation barriers from frontline health workers remains limited. This study explored health workers' perspectives on factors associated with missed childhood immunisation appointments, the feasibility and implementation of SMS-based reminder in Abuja, Nigeria.

Materials and Methods: This qualitative design used key informant interviews. Twenty-eight different categories of health workers were purposively recruited from 14 primary healthcare facilities until thematic saturation was achieved. The interview guide explored immunisation attendance patterns, reasons for missed appointments, health system barriers, existing defaulter-tracking practices, and perceptions of SMS-based immunisation reminders. Interview transcripts were analysed using Braun and Clarke's six-step thematic analysis framework (2006) to identify recurring themes and patterns.

Results: Seven themes emerged: household constraints; mobility and continuity of care; clinic-organisation barriers; defaulter-tracking; acceptability of mobile reminders; operational barriers and community engagement and service responsiveness. Health workers viewed SMS reminders favourably but highlighted literacy, network coverage, electricity access and mobile phone ownership as implementation challenges. Participants with previous exposure to automated reminder systems expressed greater confidence in digital reminder interventions.

Conclusion: Missed childhood immunisation appointments arise from a complex interplay of caregiver, health system, and programme-level factors rather than a single cause. While health workers view SMS reminders as feasible and acceptable, long-term sustainability remains a key challenge for successful implementation. These findings support implementing a locally sustainable, funded, multi-channel follow-up system.