title: Application of mobile technology for improving expanded program on immunization among highland minority and stateless populations in northern Thailand border.
abstract: BACKGROUND
  Studies of undervaccinated children of minority/stateless populations have highlighted significant barriers at individual, community, and state levels. These include geography-related difficulties, poverty, and social norms/beliefs.
  
  
  OBJECTIVE
  The objective of this study was to assess project outcomes regarding immunization coverage, as well as maternal attitudes and practices toward immunization.
  
  
  METHODS
  The "StatelessVac" project was conducted in Thailand-Myanmar-Laos border areas using cell phone-based mechanisms to increase immunization coverage by incorporating phone-to-phone information sharing for both identification and prevention. With limitation of the study among vulnerable populations in low-resource settings, the pre/post assessments without comparison group were conducted. Immunization coverage was collected from routine monthly reports while behavior-change outcomes were from repeat surveys.
  
  
  RESULTS
  This study revealed potential benefits of the initiative for case identification; immunization coverage showed an improved trend. Prevention strategies were successfully integrated into the routine health care workflows of immunization activities at point-of-care. A behavior-change-communication package contributes significantly in raising both concern and awareness in relation to child care.
  
  
  CONCLUSIONS
  The mobile technology has proven to be an effective mechanism in improving a children's immunization program among these hard-to-reach populations. Part of the intervention has now been revised for use at health centers across the country.
authors.affiliation: Center of Excellence for Biomedical and Public Health Informatics (BIOPHICS), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. jaranitk@biophics.org.
authors.forename: Jaranit
authors.identifier: http://orcid.org/0000-0001-7916-8460
authors.initials: J
authors.lastname: Kaewkungwal
authors.forename: Tawatchai
authors.identifier: http://orcid.org/0000-0003-4205-7980
authors.initials: T
authors.lastname: Apidechkul
authors.forename: Kasemsak
authors.identifier: http://orcid.org/0000-0003-0042-9889
authors.initials: K
authors.lastname: Jandee
authors.forename: Amnat
authors.identifier: http://orcid.org/0000-0001-9715-6658
authors.initials: A
authors.lastname: Khamsiriwatchara
authors.forename: Saranath
authors.identifier: http://orcid.org/0000-0001-8455-2344
authors.initials: S
authors.lastname: Lawpoolsri
authors.forename: Surasak
authors.identifier: http://orcid.org/0000-0002-2523-4650
authors.initials: S
authors.lastname: Sawang
authors.forename: Aumnuyphan
authors.identifier: http://orcid.org/0000-0002-2349-9954
authors.initials: A
authors.lastname: Sangvichean
authors.forename: Peerawat
authors.identifier: http://orcid.org/0000-0002-5239-1416
authors.initials: P
authors.lastname: Wansatid
authors.forename: Sarinya
authors.identifier: http://orcid.org/0000-0001-8588-0876
authors.initials: S
authors.lastname: Krongrungroj
keywords: EPI; behavioral change communication; expanded program on immunization; hill tribes; mobile technology; stateless