title: Vaccination adherence: Review and proposed model.
abstract: BACKGROUND
  The prevalence of childhood vaccine-preventable diseases can be significantly reduced through adherence to confirmed vaccination schedules. However, many barriers to vaccination compliance exist, including a lack of awareness regarding the importance of vaccines, missing due dates, and fear of complications from vaccinations. The aim of this study is to review the existing tools and publications regarding vaccination adherence, and to propose a design for a vaccination adherence application (app) for smartphones.
  
  
  METHODS
  Android and iOS apps designed for vaccination reminders have been reviewed to examine six elements: educational factor; customizing features; reminder tools; peer education facilitations; feedback, and the language of apps' interface and content. The literature from PubMed has been reviewed for studies addressing reminder systems or tools including apps.
  
  
  RESULTS
  The study has revealed insufficient (n=6) technology-based interventions for increasing childhood vaccination rates by reminding parents in comparison to the fast growth in technology, out of which are two publications discussed mobile apps. Ten apps have been found in apps stores; only one out of them was designed for the Saudi vaccination schedule in Arabic language with some weaknesses. The study proposed a design for a vaccination reminder app that includes a number of features in order to overcome the limitations discussed in the studied reminders, apps, and systems. The design supports the Arabic language and the Saudi vaccination schedule; parental education including peer education; a variety of reminder methods, and the capability to track vaccinations and refer to the app as a personal health record.
  
  
  CONCLUSIONS
  The study discussed a design for a vaccination reminder app that satisfies the specific requirements for better compliance to children's immunization schedules based on reviewing the existing apps and publications. The proposed design includes element to educate parents and answer their concerns about vaccines. It involves their peers and can encourage the exchange of experiences and overcome vaccine fears. In addition, it could form a convenient child personal health record.
authors.affiliation: Biomedical Technology Department, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh 11433, Saudi Arabia. Electronic address: asmabahussin@ksu.edu.sa.
authors.forename: Asma A
authors.initials: AA
authors.lastname: Abahussin
authors.affiliation: Health Informatics, Research Chair of Health Informatics and Health Promotion, College of Medicine, King Saud University, Riyadh, P.O. Box 63709, Riyadh 11526, Saudi Arabia. Electronic address: albarrak@ksu.edu.sa.
authors.forename: Ahmed I
authors.initials: AI
authors.lastname: Albarrak
mesh_terms: D003141:Communicable Diseases / Q000453:epidemiology*; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D006801:Humans; D055118:Medication Adherence; D063731:Mobile Applications; D017010:Reminder Systems; D000068997:Smartphone; D014611:Vaccination / Q000706:statistics & numerical data*
keywords: Adherence; Application; Child; Design; Reminder; Vaccine