CPHA Canvax

Alberta Health

Project Title: Helping Healthcare providers address the drop in childhood immunization coverage between age 12 and 18 months:  A pilot test of text message reminders and identification of children at high risk
Funding Recipient: Alberta Ministry of Health
Project Contact: Celine O’Brien – Director, Immunization and Communicable Disease Control Operations (celine.obrien@gov.ab.ca)
Project Period: June 5th, 2018 – March 31st, 2021

About the Project 

This project will pilot test a text message reminder/recall intervention at the time of a child’s 18-month immunization appointment. The intervention will be delivered in two communities: Edmonton-Northgate (serving an ethnically diverse clientele, enabling to test the effectiveness of texts in client’s language of choice), and Lethbridge (set in an area of low coverage due to surrounding non-immunizing communities). Text messages will be sent to parents in as many as 10 possible languages of choice, and will include information on the importance of immunization in general and the vaccine to be administered.


Assess the feasibility of using text messages to send immunization key messages and to remind parents of their children’s 18-month immunizations.


  • Short Term: Development/feasibility testing of a system that improves ease and decreases HCP workload for sending immunization appointment reminders and key messages; improves convenience to parents for remembering immunization appointments and improves knowledge of vaccines being administered; decreases missed appointments and increases 18-month immunization coverage in intervention sites post-intervention.
  • Medium Term: Guide decision-making by the Ministry and AHS partners in determining whether it is feasible to implement the text messaging tool at the population level.
  • Long Term: Ensuring adequate measurement and evaluation during provincial scale-up, this project will be able to provide valid data on effectiveness in order for other P/Ts to determine whether to adopt/adapt this tool. Additionally, Alberta (and other jurisdictions) can explore the benefit of this approach for other immunizations, such as the pre-school vaccines and influenza vaccines.

The challenge that the project addresses

It is a well-recognized phenomenon that uptake of infant immunizations exhibits a precipitous drop at the time of the 18-month vaccine doses. This trend has been observed by public health agencies and researchers across North America, including Alberta, where coverage for the 18-month vaccines are routinely 10-15% below those administered at 12 months. This drop is often the difference between reaching/approaching herd immunity for a vaccine-preventable disease and having coverage low enough to put the population at risk for a disease outbreak. Health care providers (HCPs) are also known to expend much time and energy on follow-up to recall children who have missed their 18-month vaccines. There is evidence, including previous work by the Alberta Ministry of Health, to suggest that forgetfulness by parents regarding the 18-month appointment contributes to this problem. This is not surprising, given the 6-month gap between the 12 and 18-month immunization appointments and the fact that mothers in Canada often return to work when the child is 12-months of age. However, there has been little testing of possible interventions to assist HCPs in addressing this significant problem, and limited understanding of which families are most at risk and thus in most need of intervention. One intervention to address forgetfulness that has shown promise in other contexts is text message reminders. This approach has been used for other populations and vaccines, but never used in Alberta, nor to target 18-month vaccine uptake specifically.

About Alberta Ministry of Health

In Alberta, the Ministry of Health provides leadership in disease control and prevention, wellness strategy development and health surveillance. The Alberta Ministry of Health is responsible for developing policies and high-level program guidelines for the provincial immunization program.  The Alberta Ministry of Health provides budgetary support for immunization programs by procuring all vaccines used in the publicly funded immunization program. Childhood (and other) vaccines are provided without charge to Alberta Health Services (AHS) for administration to Albertans in accordance with the policies set out in the Alberta Immunization Policy. The Alberta Ministry of Health has also developed a 10-year immunization strategy (2007 to 2017) which provides a common and collective guide to streamline efforts and facilitate collaborative action including engaging Albertans and stimulating demand for immunization. 


Last Reviewed: October 16, 2018