Background: Pediatric to adult health service (AHS) transition is an inevitable but challenging time for many adolescents and young adults (AYAs) with a chronic illness. As the responsibility of illness management begins to shift from parents to the AYA themselves, many AYAs fail to transition in a timely manner which has important health consequences. Mobile apps have the potential to assist AYAs in self-managing their condition during this vulnerable time, but empirical data on app uptake as well as efficacy with respect to transition outcomes and illness control are lacking. Objective: This pragmatic, single arm pilot trial aimed to evaluate AYA usage of a mobile app called ‘TransitionMate’ (TMApp) which was purpose-built to support chronic illness self-management for youth undergoing transition. Secondary aims were to assess AHS attendance and changes in illness control over the first 12 months post-transition. Upon demonstration of TMApp feasibility (≥70% of participants using TMApp at least once a month), a randomized controlled trial was planned to test efficacy of the app in relation to transition and illness control outcomes. Methods: AYAs aged 16-19 years who were transitioning out of two major pediatric hospitals in Sydney, Australia were recruited. Just prior to transition, participants’ demographic and clinical details were collected and TMApp was installed on their mobile devices. Participants were contacted by telephone at six and 12 months for information on self-reported usage, app usefulness and other feedback. Quantitative cohort-level usage data, including the number of times specific app features were accessed, was tracked via mobile analytics. At 12 months, electronic medical records (eMR) from participants’ designated AHS were accessed for data on AHS attendances, measures of illness control and unplanned hospitalizations. Results: 73 AYAs (30 male; median age 18 years) were recruited, with one withdrawing participation in the first month. Participants were primarily from three chronic illness subgroups: diabetes mellitus (n=23); inflammatory bowel disease (n=19); and cystic fibrosis (n=9). 50% of participants reported using TMApp at one month post-transition. Self-reported usage rates subsequently fell to 25% and 11% at six and 12 months, respectively. Mobile analytics data broadly corroborated self-reported usage. Eight participants who continued to use TMApp until 12 months gave a median usefulness rating of 8/10. Over two-thirds (68%) of participants successfully transitioned to their designated AHS by 12 months. Among the successful transitioners who had illness control data available on eMR, over 80% maintained a stable/improved illness status at six and 12 months. Conclusions: Results showed that TMApp was not used regularly enough by AYAs to demonstrate feasibility and justify progression to a randomized controlled trial. Despite low app uptake, over two-thirds of participants successfully transitioned suggesting that TMApp had minimal influence on transition outcomes. Clinical Trial: Australian New Zealand Clinical Trials Registry ACTRN12620000074998; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377349&isReview=true.

Background: The global, nearly universal penetration of mobile phones has offered novel opportunities for delivering health services and communicating health-related information to individuals. A low-cost system that facilitates autonomous communication with individuals via mobile phones holds potential for expanding the reach of health messaging and service delivery in settings with human resource and infrastructure limitations. Objective: We sought to design a flexible, low-code system using open-source software that could be adapted to different contexts and technical environments and accommodate a wide range of automation needs. We report on key details of the mobile phone-based appointment reminder and incentive system (mParis), document its use, review implementation challenges and adaptations to address these challenges in the context of a quasi-randomized trial of mobile phone-based reminders and incentives as means of increasing the timeliness of routine childhood vaccinations in Tanzania, and outline other use cases that highlight the versatility of the system. Methods: The mParis instance described in this manuscript, which is hosted in Tanzania, sent automated, individualized vaccination reminders to the mobile phones of mothers of young children. Process workflows, based on the national childhood vaccination schedule of Tanzania, were programmed into mParis. Reminders for vaccinations due at ages 6, 10, and 14 weeks were sent 7 days and 1 day prior to and 14 days after each vaccination due date. A subset of messages included financial incentive offers to mothers for the timely vaccination of their children. We report on implementation outcomes, challenges, and adaptations to address these challenges. Results: Between August and December 2017, 412 pregnant women were enrolled into the trial. After mothers reported the birth of their children, individualized vaccination reminder messages were sent for vaccination due dates between January and July 2018. From March 2018, messages contained financial incentive offers. Of 1,397 messages sent, 1,122 SMS (80.3%) were recorded as delivered, 249 (18.8%) as expired and resent, 23 (1.6%) as failed, and 3 (0.2%) as sent but lacking delivery confirmation. 633 messages (45.3%) contained tiered incentive offers. Of 173 women who received at least one message, 67 (38.7%) were sent reminders only; 106 women (61.3%) were sent at least one incentivized message. Numerous challenges were encountered during the system’s implementation, despite its deliberate design to accommodate basic problems such as intermittent internet access and power failures. Continuous adaptation to increase the resilience of the system, complemented by limited backstops, resulted in a successful deployment. Conclusions: mParis’ open-source nature, auditability, and ability to autonomously execute algorithms in a low-resource setting with frequent infrastructure challenges suggest favorable prospects to automate health communication in a wide range of settings. mParis’ use in multiple other health-related research studies demonstrates its versatility and ability to accommodate challenges that may be encountered in diverse other contexts. Clinical Trial: ClinicalTrials.gov: NCT03252288

Vaccination is a cost-effective strategy for reducing morbidity and mortality among children under 5 years old. To be fully protected from diseases such as tuberculosis, diphtheria, pertussis, and polio, children must receive all recommended vaccinations in a timely manner. In many countries, including Tanzania, high overall vaccination rates mask substantial regional variation in vaccination coverage and low rates of vaccination timeliness. This study evaluates the efficacy of mobile phone-based (mHealth) reminders and incentives for improving vaccination timeliness in the first year of life.