MOBILE HEALTH DESIGN
Shot Card
A Vaccine Compliance & Tracking App for the Whole Family
Audrey Laganas Jenkins
6/28/2014
Shot Card is the first mobile app offering users the convenience of maintaining and transmitting
official vaccination records. Based on the Health Belief Model, Shot Card also aims to increase
compliance with recommended childhood vaccination schedules.
2
EXECUTIVE SUMMARY
Early childhood vaccinations are a simple and safe way to stop the effects of disease.
Vaccinating children according to recommended schedules protects not only individual children
but also future generations of children and adults (CDC, n.d.).
The "Shot Card" mobile health application [app] is designed to help parents or guardians follow
recommended immunization schedules by giving them a simple tool for keeping track of their
children's vaccinations. Shot Card also provides an easy way to send official vaccination records
to schools or camps, eliminating the hassle of requesting vaccination records from healthcare
providers.
The app complies with HIPAA, a federal law setting privacy standards for medical records, and
offers:




Secure storage of a child's official vaccination record in a single, electronic location
Easy access to vaccination records if a child changes providers, moves, or in situations
when records might be fragmented (such as foster care)
Updated information each time vaccinations are received
Option to print official vaccination records at home or email them to schools, camps or
healthcare providers
In addition to providing convenient and accurate record keeping, Shot Card aims to increase
adherence to recommended vaccination schedules with a theory-based approach to educating
parents who may have concerns about vaccines.
Shot Card would be developed in partnership with organizations such as the American Academy
of Pediatrics and individual state departments of health. It would be distributed through pediatric
primary care providers and app stores in both iOS and Android versions.
BACKGROUND
The Problem of Vaccine Non-Compliance
In 2013, the US experienced the largest number of measles cases in 20 years (CDC, 2014).
While most of the cases were "imported" by unvaccinated people from overseas, the outbreaks
highlight the problem of under-vaccination for measles and other vaccine-preventable diseases.
According to the CDC, relatively high national vaccination rates mask "clustering" of
unvaccinated children in local areas where children may be vulnerable to vaccine-preventable
disease outbreaks.
Recent budget cuts to state and local health departments as well as differences by state in
factors such as population characteristics, immunization program activities, vaccination
requirements for child-care centers, and vaccine financing policies might contribute to
variations in vaccination coverage. (CDC, 2013)
Some states, especially those with liberal policies allowing religious and philosophical
exemptions to vaccination mandates for school entrance, have increasing percentages of unvaccinated or under-vaccinated children. Colorado is an example, where an estimated 15 percent
3
of kindergarten students have not received the recommended two-dose measles, mumps and
rubella vaccine [MMR] (CDC, 2013).
Parental mistrust of vaccines is a key factor driving the drop-off in early childhood vaccine
compliance. The trust problem is partly the result of a highly-publicized but later discredited
report linking the measles vaccine and autism. The mistrust is also the result of changes in the
patient-provider relationship. The proliferation of medical information on the internet has
empowered patients to question physician recommendations, armed with their own "research."
However, that "research" often comes from unreliable sources such as interviews with
Hollywood celebrities or blog postings from the anti-vaccine movement.
In addition to concerns about vaccine safety, barriers to 100 percent vaccine compliance include
more traditional hurdles such as:






Lack of accurate record-keeping
Lack of access to primary care visits
Perceived low-risk from vaccine-preventable diseases
Lack of understanding of potential severity of some vaccine-preventable diseases
Lack of strong recommendation/communication with provider
Drop-off of pediatric visits as children get older
The Power of Record-Keeping
There is much evidence to suggest that putting the parent in charge of managing a child's
vaccination records leads to better vaccine compliance. A recent article in The Wall Street
Journal (Landro, 2014) highlights technology's role in making medical records easier for patients
to access. The article reports that several major medical providers are giving patients more
access to their medical records so they can help spot errors. Giving patients access to medical
records, advocates believe, will result in better health outcomes.
This hypothesis holds true in the area of vaccine compliance in young children. Specifically,
evidence points to parental record-keeping as a way to maintain up-to-date vaccination records in
young children. A study in Pediatrics (McElligott & Darden, 2009), suggests patient-held
vaccination records were associated with children being up to date on their vaccinations. This
correlation was seen across diverse populations, including those at risk for under vaccination,
such as children in low income homes or in homes with multiple children in the house. The study
further suggests that putting vaccination records in the hands of parents gives parents a sense of
ownership that is beneficial and may reduce excess immunizations and associated costs. The
study notes that parent record-keeping was especially effective in maintaining vaccination
compliance for children who had multiple providers.
Mobile Health Use
Mobile health [mHealth] is emerging as a mode of intervention for boosting vaccine compliance
and accurate record keeping. As an emerging intervention, studies are ongoing, but empirical
evidence examining the link between smart phone applications and vaccine compliance is
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limited. However, evidence-based guidance can be gleaned from studies on the use of text
messages to increase vaccination compliance rates.
A 2011 (Clark, Butchart, Kennedy & Dombkowski) examination of parental preferences for
receiving vaccination reminders found that while most parents still prefer to receive reminders
by phone or postcard, one quarter preferred newer technologies and more than half were willing
to register their cell phone numbers for future reminders via text or call. Also, the study noted,
cell phone numbers and email addresses were "surprisingly stable," whereas mailing addresses
are likely to change over time. This study suggests a potentially emerging population of parents
who are willing to receive vaccination reminders and information via mobile technology.
Physicians, on the other hand, may be slower to embrace the use of mobile technology for
vaccination outreach. Stockwell, Martinez, Vawdrey, Natarajan, and Rickert (2012) found
physicians were reluctant to use text message reminders for childhood vaccine schedules and
preferred traditional methods of contact such as verbal reminders and post cards. The possible
reason was a lack of empirical evidence linking text messaging and compliance. However, in a
study of text message use for vaccine reminders in an urban population showed an increase in
compliance.
This author was also guided by the creation of online vaccination registries, which are managed
by individual state health departments. These systems are relatively new and vary by state, but
they show us that the technology exists to store and maintain official vaccination records in a
central electronic location. According to the CDC (n.d.), most states in the US have created
online vaccination records or "Immunization Information Systems" [IIS]which keep track of
immunizations for individuals. IIS can be accessed by providers, public health officials and
individuals. However, to access their child's record, parents in some states (Massachusetts for
example) must download and print a form, fill it out, and mail it in with a copy of your photo ID
to obtain the official record. While IIS serve the vital purpose of collecting and storing individual
vaccination records, they take record keeping out of the hands of parents. In addition, many
parents are unaware that IIS exist and don't know how to access them or don't know they have
the right to opt out if they have privacy concerns.
Evidence also shows that parents are open to a personal online pediatric immunization record. A
study by Kitayama et al. (2013) of an urban Latino population in New York suggests parents
would welcome an online immunization record and the ability to obtain an electronic copy of
their child's records if privacy concerns could be addressed. The study did not specify what form
such an online immunization record would take.
Considering all of the available evidence, this author would argue that there is a need for parents
to have immunization information in their own hands -- in the form of a smart phone app -versus relying solely on a central, government-managed depository for their children's
vaccination records. With a smart phone app managed by a parent or guardian, there is no red
tape: no forms, opting in or out, no website to log into. More importantly, the immunization
information stays with the parent in a secure location, which ensures privacy. A smart phone app
is a modern form of the old vaccination card, which a parent can keep on their person and access
at will.
NEEDS ASSESSMENT
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Target Audience
The target audience for Shot Card is mothers of children, newborn to 6 years old. The children's
age group was selected because that is the CDC's target age for recommended early childhood
vaccines. Mothers, rather than fathers and other caregivers, have been selected because of
research that shows mothers are most likely to make health decisions for their families. Though
some children live with guardians or even grandparents, according to the Anne E. Casey
Foundation's Kids Count Data Center (2013), the vast majority of young children live with their
mothers, whether married and single. It could be argued that pregnant women might be also be
receptive audiences for the app.
In addition, according to the Pew Internet Project, 58 percent of American adults have a smart
phone, and among those, the vast majority are ages 18-49, which matches the demographic for
mothers of young children. Pew also calls mothers the "most fervent online health seekers."
Thus, it makes sense to target the Shot Card app to mothers seeking vaccination information.
The app is targeted toward mothers who support vaccination of children according to the CDC
and National Academy of Pediatrics-recommended schedule and to mothers who are following
the guidelines but might have some questions or concerns about early childhood vaccines. In
addition, the app's target audience will include mothers who have decided to delay vaccines due
to concerns about vaccine safety. The app is not targeted toward mothers who strongly oppose
childhood vaccinations or who have decided to forego vaccination completely. It is believed that
those mothers would be unlikely to download the app.
A secondary, but potentially important, audience for Shot Card is school nurses, who are on the
front lines of the vaccine compliance problem. Most states have mandates that require early
childhood vaccinations for entrance to school, and though state guidelines vary, the job of
enforcing the mandates is usually left to the school nurse, who is responsible for gathering and
storing children's health information before the start of school.
PERSONAS
About Personas
Personas are the basis of good user design. They are fictional characters, created for the purpose
of understanding and exploring the needs of target users. Good personas are well-developed and
seem very real. They have names and faces, emotions, needs and wants. Ideally, personas give
insight into the hearts and souls of potential users, revealing strengths and weaknesses of the
design. Personas should help answer the critical questions of how and why users might interact
with the design. In the following pages, the reader will meet four individuals who represent
potential users of Shot Card. They are composites of real-life people, gleaned from the personal
experience of this author and from research. The school nurse persona is inspired by a news story
about a Pennsylvania school nurse's experience enforcing the vaccination mandate in her district
(Pierce, 2012). The California yoga instructor is inspired by an online news article about wealthy
San Francisco Bay area parents forgoing vaccinations for their children (Lallanilla, 2014).
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"...There's one
thing Ricci
dreads every
year..."
Diana Ricci, 46
Elementary School Nurse
Poconos Region of Pennsylvania
For 22 years, Diana Ricci has been the voice of reassurance for parents at the Hill Elementary
School. "Hi, it's Diana, the nurse at Hill. Everything's fine," she says immediately at the start of
every phone call to ease the parent's natural reaction to hearing from the school nurse. Once the
parent is calm, she continues with what is usually a minor health issue, "I wanted to let you know
Meghan cut her leg during recess. I cleaned and bandaged the wound, and she's back in class."
Ricci started at Hill when she was just a few years out of nursing school, and she loves her job.
The best thing about it is the special relationship she forms with children and their families. She
takes special pride in seeing the 5th graders, as they near graduation to middle school, so grown
up and almost teenagers. She remembers each and every one when they were little
kindergarteners, some away from their mothers and fathers for the very first time.
But, there's one thing Ricci dreads every year: her late-August ritual of playing phone tag,
emailing, and otherwise chasing down families who haven't sent in their children's vaccination
forms as required by the state of Pennsylvania for enrollment in school. Pennsylvania is one of
several states that allows not only religious and medical but also philosophical exemptions to
vaccination requirements. That's bad enough, Ricci feels, but the truth is, she rarely comes across
families who aren't complying because they don't believe in vaccines. From what she's read,
that's more of a problem in affluent areas near New York City.
The bottom line is, it's Ricci's job to deal with missing vaccination forms with minimal support
from her school district. She's basically a one-woman band, going through the forms, checking
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off names, and making a note of which families to call with reminders. She called one mother
three times and didn't receive even the courtesy of a return voice mail. Very frustrating.
Ricci is thinking there just has to be a better way than spending a gorgeous August day on the
phone in her office. Just to see what she'll find, Ricci googles the words, "school nurse
frustration vaccination forms" on her office PC. She sees a few articles about general vaccine
compliance but her eye is drawn to a heading further down the page for a website called,
"ShotCard.com." The website has information about a computer app for storing vaccination
records. The app allows parents to store vaccination records on their mobile device. Parents can
submit vaccination records electronically to participating school districts. Wow. There's a
function that automatically sends the child's school vaccination form in time for the deadline.
She decides to download the Shot Card app into her mobile phone to see what it can do. In
Pennsylvania, according to the app's website, the service is rolling out in select Philadelphia
neighborhoods and suburbs. She makes note of the information, and decides to request a meeting
with the superintendent to see if it might be possible to bring Shot Card to the district . She
believes the two major pediatrics practices in her community may welcome it, because it would
reduce the amount of paperwork and phone calls they also encounter at this time of the year.
"How did this
happen? Lopez
figured her
daughter got all
the necessary
shots..."
Francia Lopez, 24
Paralegal
Boston, MA
Francia Lopez is rushing to meet her 5-year-old daughter's school bus. The commute from
downtown Boston to Jamaica Plain was a nightmare on this early June evening. The bus from the
after-school program drops Alicia off at 5:30. It's a struggle to get home in time. Lopez's mother,
8
with whom she lives, is not home, so now Lopez is running in her work clothes and heels the
between the MBTA bus stop and the front door of the triple-decker that the family moved into
earlier this year. Lopez and her daughter share one bedroom. Lopez's mother has the other
smaller one. She stops running as she approaches the home and realizes, with relief, that the
school bus isn't there yet. She can't catch her breath. There's a hint of summer heat in the air. She
wipes her forehead, and sits down on the front steps to wait.
Lopez is a single mother. She is proud of the fact that she is able to support her daughter on her
own. She and Alicia's father ended their relationship when Alicia was a baby, and she receives
only occasional -- and very limited -- financial help from him. He does visit Alicia regularly, and
Lopez is happy that at least her daughter has her father in her life. Alicia's own father died when
she was a little girl, and Lopez's mother, an immigrant from the Dominican Republic, worked
two jobs to support Alicia and her older sister Annalys, who lives in Florida with her husband
and their three children. At 47, Lopez's mother still works very hard, sometimes taking double
shifts in the nursing home where she is a health aide.
Lopez is really proud of the fact that she was able to finish community college, become certified
as a paralegal, and get off public assistance. Her salary is not what she was hoping for when she
decided to become a paralegal, but she and her mother are getting by. The law firm offers health
insurance, but it only covers employees, not dependents. So, Alicia is enrolled in Medicaid, and
Lopez feels lucky to have found a good pediatrician who accepts Medicaid.
Lopez trusts her providers, so she was surprised to find a voice mail on her mobile phone today
from the director of the city-sponsored day camp Alicia attends in the summer. The director said
Alicia's vaccinations are not up to date for the start of camp, just 10 days away. It turns out, the
vaccination record from Alicia's pediatrician did not include documentation of Alicia's second
dose of the MMR vaccine. The nurse explained that MMR is the measles, mumps and rubella
vaccine and that a second dose is required before the start of school, usually age 5. How did this
happen? Lopez figured her daughter got all the necessary shots, since she has always had regular
well-child visits. She tried to remember, did Alicia get the shot and the doctor's office didn't
record it? Maybe she was supposed to take Alicia for the second shot but forgot because she was
focused on the move to the new apartment? When Alicia was a baby, Lopez's mother always
made a big deal about making sure her granddaughter got vaccinations. In the Dominican
Republic, you don't take shots for granted. If you can get a shot for your kid, you take it, and you
don't delay, because you don't know if they will run out.
While waiting for her daughter's bus, which is now late, Lopez uses her mobile phone to text her
friend, Marisol, another single mom. Lopez was excited last winter to finally be able to afford an
iPhone. She got the less expensive, older model, but it's been great! She now has the internet all
the time. Before, she could only go online at work, because she and her mother don't have a
computer at home. Lopez loves to text and Tweet with her friends, and that's how she keeps her
social life humming as a single mom. She taps out a message to Marisol, "hey girl still lamo
(laughing my a-- off) from last night. can't go w/u sat. my baby shots not up to date for camp.
need to see dr." Marisol texts back, "cto (check this out) shotcard.com. luv u talk soon."
Lopez touches the link and finds the website about the Shot Card app. It says it helps you keep
track of your child's vaccination schedule and gives you an electronic vaccination "card" just like
the one Lopez's mother used to have when Lopez was little. The site also says the app can send
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your child's vaccination "card" directly to the school. She downloads the free app and sets up a
password. She logs in and allows location tracking. A message pops up saying the automatic
school form service is available in her area. Her pediatrician's office is on the list of participating
providers. She wonders about privacy. Who else can see Alicia's record? But, if the information
is secure, she likes the idea of being the one in control of keeping her daughter's vaccination
records up to date.
"...Believes she
did the right
thing by spacing
out the
vaccines."
Maya Billington, 38
San Francisco, CA
Yoga Instructor, At-Home Mother
Maya Billington is relieved. School break for the winter holidays is finally over. She just
dropped both kids off at school. It's been a long three weeks! The family had a nice time in
Hawaii between Christmas and New Year's. They rented a condo next door to a family from her
son's private school, but traveling with kids is work. She loves her Lucy, 4, and Oliver, 6, but she
is looking forward to Lucy being back at preschool and Oliver in first grade. Even with a parttime nanny and cleaning help, having the kids 24/7 is exhausting.
Maya's husband, a lawyer on the way up at a big law firm, is gone all the time handling deals for
Silicon Valley start-ups and trying to make partner. As a senior associate, his income is well into
the six figures, but making partner would put them in a whole different income stratosphere.
Billington tries to keep everything going at home so that he doesn't have to worry about anything
but work.
Billington has an MBA from Stanford and had an impressive career in investment banking, but
after Lucy was born, she made the decision to stay home. Billington's mother was a 1970's
feminist who raised her never to depend on a man for money. But, that also meant Billington was
a latch-key kid, and she doesn't want that life for her own children. She was tired of trying to
keep all the balls in the air. Since becoming a stay-at-home-mother (SAHM), she has gotten into
yoga as a way to reduce stress. She knows too many moms willing to crack open a bottle of wine
during play dates, and she wanted a more natural approach to relaxation. Yoga is also great for
keeping her figure lean but not overly muscular. She likes it so much that she recently became a
certified instructor and teaches three classes a week at a local yoga studio.
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Billington has met some great friends at yoga and at private school drop-off and pick-up, where
the SAHM's typically take a little time to chat with each other. It's an opportunity for adult
conversation in a day that revolves around children. Her circle of friends is very committed to a
natural life style. Though their kids' private schools offer organic and environmentally-friendly
lunches, the mothers take pride in packing pretty bento boxes with things like fresh nongenetically altered fruit, whole wheat bread, and organic hummus made from scratch.
Recently, there's been a lot of talk among the moms about vaccines and whether they might be
linked with autism. The moms are well-educated and don't rely on Hollywood celebrities like
anti-vaccine activist Jenny McCarthy for information, but there's still something about vaccines
that bothers them. It's that feeling of introducing chemicals into their children's systems or
overloading their little bodies with several vaccines at one time. With Oliver, Billington was still
working, and she just went ahead with vaccine schedule at her pediatrician's office. But, now that
she's had time to think about it, she has developed strong concerns about vaccine safety and has
decided to proceed slowly with Lucy's vaccination schedule. Lucy received the first round of
early childhood vaccines, but Billington spaced them out, against the recommendation of her
pediatrician. Lucy is a very precocious and social little girl with no signs of autism, so Billington
believes she did the right thing by spacing out the vaccines. She has decided that Lucy doesn't
need the second MMR shot required for kindergarten entrance. In California, it's easy to decline
for philosophical reasons. All she has to do is sign a form. Right now, that's the plan.
Right after drop-off, Billington is driving to yoga. She switches on NPR to catch up on the news.
She hears a report about a measles outbreak in the San Francisco Bay area. The expert from the
California Department of Health says the outbreak has been traced to a passenger from Southeast
Asia changing planes at SFO. They think the illness spread because of under-vaccination, and at
least two of the 22 victims are children, who are hospitalized in serious condition.
After yoga, Billington decides to do some more research on the measles vaccine. Maybe she
should reconsider her plan to refuse the second shot for Lucy. She has too many errands to spend
time researching on her phone, but once home, she logs onto her iPad and searches, "measles
vaccine and safety." Several scholarly articles pop up. Her literacy level is high enough to read
them, but she doesn't have time to go through all those details. She sees listing for
ShotCard.com. She goes there and finds an app that promises to answer questions to her specific
questions about vaccine safety with easy-to-read information. She decides to download the app
to her iPad. Once registered, Billington notices the app offers secure transmission of children's
official vaccination records to San Francisco area schools. Even though she has concerns about
vaccine safety, she still hasn't gone to the level of submitting an objection form and maybe she
will need that function. She notices an interactive function that shows how a potential disease
would spread. She is afraid to check that section right now. And maybe it's just propaganda. Can
she really trust this thing? It does look good and informative, though, so she decides to keep
reading.
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"She wants to do
everything right
for her baby."
Katie Holland, 29
Bank Customer Service Representative
Cranston, RI
Katie Holland is so tired she can barely see straight, but she has never felt more alive and in love.
She gave birth to her first child, Travis, just one month ago, and now, she and her husband Tom,
an electrician, are headed to the pediatrician's office for the baby's one-month check up. He is a
robust little guy, who weighed close to 8 pounds when he was born and is eating up a storm of
breast milk. Holland is on maternity leave from her job as a customer service representative at a
bank. She worked right up until her due date so she was able to spend the most time possible
bonding with her baby before heading back to work. She has child care almost figured out. Her
mother, newly retired, will watch Travis two days a week. The other three days, Travis will go to
a home day care that two of Holland's friends have recommended. Holland would have preferred
to have Travis at the private daycare around the corner from the bank, but tuition would eat up a
good portion of Holland's salary. Tom recently left the alarm company he was working at and
went out on his own, so right now, Holland is carrying the family's benefits. Staying home is not
an option.
It is a pretty October afternoon, with the leaves in full color. Still not used to all the new baby
equipment, Holland struggles to find the button to the baby's car seat. She finally unlocks the
basket part, and places it into the stroller frame. She puts a little blue blanket over Travis to
shield him from the fall breeze. After a 20 minute wait, a nurse comes into the waiting room and
calls out, "Travis?" Katie smiles. She is still not used to hearing her baby's name. It is all so new
and exciting.
Once in the examining room, the nurse hands Katie some materials. There's a brochure on "your
baby's first months." The nurse also hands Katie a brochure about something called "Shot Card."
While Tom attends to the baby, Katie takes a look. It's some sort of new way to store vaccination
12
records. Katie asks the nurse, "I can get the vaccination records from your office, right?" The
nurse explains that, yes, but records are more likely to be accurate when also checked and
maintained by parents. The nurse says the pediatrics practice is now using Shot Card for patients
who prefer to store their vaccination records electronically. Katie puts the brochures in her diaper
bag. She hates seeing Travis in pain from shots and dreads his vaccinations. But she wants to do
everything right for her baby, so she makes a mental note to read the brochures and tells the
nurse she would like to go ahead and use Shot Card. She takes a minute to download it onto her
iPhone while the nurse goes into Travis' electronic chart and opens up the provider's connection
to the Shot Card app to get Katie set up.
Analysis of Personas
The persona exercise helped narrow the target audience for Shot Card to mothers of children
ages newborn to 6 years old. Though Shot Card can be used by the entire family and by parents
of older children, our persona analysis shows us that mothers of younger children are more likely
to have vaccinations on their "radar" and are more likely to be receptive to the app.
The persona analysis also demonstrates how convenience of being able to store and transmit
official vaccination records would be a hook that attracts users to the app. All four of our
personas were attracted to that particular feature.
In addition, the persona analysis showed us how reminders might have made have helped
prevent overdue shots by parents who wish to comply with the recommended vaccine schedule
but whose children are not up-to-date due to a move (Francia) or inaccurate record-keeping by
the provider (Francia). The analysis also demonstrated the potential value of the app to parents
who are delaying vaccines due to safety concerns (Maya) but, who still need vaccination records
for school entrance, even if they are contemplating a philosophical refusal signature to their
child's file. This cohort might download the app for convenience but, in the process, would also
be educated about the benefits of vaccination and the risks of non-compliance. Finally, our
personas show the value of Shot Card to the secondary audience of school nurses, who would be
likely to use the app if it saves them paperwork and phone calls.
COMPETITIVE ANALYSIS
A competitive analysis is a systematic way of investigating the competition in the app
marketplace. It involves searching for, locating, comparing, and possibly even using apps that
might offer similar content. The goal is to seek insight and learn what works and what doesn't.
An app designer may wish to borrow from --or be inspired by-- the competition's best features
and may find valuable lessons on what to avoid from the worst. A competitive analysis also
provides clarity on ways in which an app might distinguish itself from the competition and offer
features that are unique and attractive to users. The following competitive analysis is the result of
searching for vaccine apps the way our four personas might have searched. Terms used included
"vaccination tracking apps" and "vaccine information apps." One of the apps was located from a
"top ten" apps list on a website that helps users locate nanny services.
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Name
iVaccine
Baby Vaccines
Vaccines on the
Go: What You
Should Know
Does not have its
own url.
Uses the url of
Children's
Hospital of
Philadelphia:
http://www.chop.
edu/service/pare
nts-possessingaccessingcommunicatingknowledgeaboutvaccines/vaccine
-mobile-app.html
ImmunizeCA
1. Logo, url
Does not have its
own url.
The url "ivaccine"
comes up in a
Google search as an
available url.
Comes up in top 10
listings in Google
search of "children's
vaccine apps"
Tag line: "Designed
to ensure that you
never lose track of
your child's
vaccinations."
iOS and Android
Google search of
"baby vaccines
app" results in
url's for app store
listings.
The url
"babyvaccines" is
registered but not
clear to whom.
Tag line: "Just
about the only
thing worse than
hearing your baby
cry as he gets his
immunization
shot is the hassle
of remembering
which vaccine he
received and
when."
iOS only
Tag line: "It is
easier than ever
to get health
information;
sometimes,
however, it’s
difficult to weed
out the “good”
information ..."
iOS and Android
http://www.immu
nize.
ca/en/app.aspx
Discovered doing
Google research
on vaccine apps
that might be used
outside the US.
Tag line: "...
allows Canadians
to keep track of
their
vaccinations."
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2. Objectives
at a glance
What is the
problem or
challenge the
app seems to
be
addressing?
Helps parent keep
track of children's
vaccinations.
Parents log when
vaccines are
completed.
Describes specific
vaccines. Offers
reminders when
vaccines are due.
Helps parents
keep track of
children's
vaccination
records by using
mobile phone.
Also allows you
to send child's
vaccination
history to a
medical
practitioner.
States purpose is
educational. Its
stated objective
is helping
parents figure
out what
information is
"good"
(scientific)
versus "bad"
(unscientific).
Helps people
keep track of their
vaccinations.
Childhood and
adult vaccine
schedules. Also
provides
reminders to
schedule
vaccinations
based on
provincial
schedules.
Objective is also
to provide "timely
and trusted"
information about
vaccines.
Bonus: app offers
region-specific
information on
outbreaks.
3. Purpose
and Goals
The purpose and
goals seem clear
from the name, logo
and tagline.
The purpose and
goals seem clear
from the name,
logo and tagline.
This app may attract
users who find it in
a Google search,
because its name
"iVaccine" best
matches its purpose.
It's very obvious
what the purpose is.
The logo of a
cartoon child
receiving a shot is
off-putting. The
cartoon seems a
little silly. It also
depicts what
appears to be a
The purpose of
this app matches
its logo and
tagline. ( The
tagline states its
purpose is
education. )
However, the
title, "Vaccines
on the Go," may
imply that the
app also offers
The purpose of
this app appears
to match the
tagline. However,
the logo (figures
holding an
umbrella) does
not trigger an
immediate
connection with
vaccinations.
Perhaps it's a
metaphor for
15
white male child.
4. Users
Is there any
information
about users
through
descriptions,
images,
stories,
testimonials,
or usage
data?
From limited
number of reviews,
it appears that users
are mostly parents
of babies and young
children. From
reviews, it appears
there are some
international users.
5. Ratings
and Reviews
What are the
ratings,
reviews and
feedback?
Received 4.5 out of
5 stars on Google
Play and 4 out of 5
stars on iTunes.
Reviews not found
elsewhere.
From reviews, it
appears users are
parents of babies
and young
children. It is
unclear if users
are international
or limited to US.
This is the first
vaccine app that
appears in a Google
search of the words,
"childhood vaccine
app." It is listed
with a link to the
iTunes store.
Reviews on
iTunes are
positive. Current
version gets only
3 stars, but
previous versions
average 4 stars.
individual
vaccine record
tracking, which
it does not.
The logo of
Children's
Hospital of
Philadelphia
lends credibility.
From reviews on
iTunes and
Google Play, it
appears that
users are parents
of young
children and
babies. Unclear
if users are
international.
Also possible
that some users
are health
professionals
who have
downloaded the
app to learn more
about it. This
possibility is
based on the
high literacy
level of the
reviews.
Reviews on
iTunes and
Google Play are
positive. On both
iTunes and
Google Play, the
app gets 4 stars.
protection, but
that may be lost
on the average
person.
From reviews on
iTunes and
Google Play, this
app appears to be
targeted not only
toward parents of
young children
but also toward
adults who are
interested in
keeping track of
their own
vaccines.
iTunes states it
has not received
enough reviews to
issue a rating.
Google Play users
give it 4 stars.
16
However, both
Google Play and
iTunes display user
reviews that are
generally positive
but with specific
suggestions, such as
pointing out the
mistake with male
and female
symbols.
Not available for
Android. No
information on
downloads.
Example of
positive review
from a user who
identifies self as
pharmacist at
major children's
The app maker has
hospital: "I was
responded to the
pleasantly
feedback, promising surprised at hoe
to correct the
[sic] user friendly
mistake.
and perfect it was
for me!"
Also, users have
requested the ability This app is listed
to switch regions
on
and be able to
Nannypro.com's
understand whether "Top 10" apps for
the child needs
tracking kids'
additional
vaccinations
vaccinations.
The maker has
promised to offer
that with an updated
version of the app.
6.
Downloads
Another criticism is
the fact that parents
must input a lot of
information if they
are not starting to
use the app at birth.
No available data.
No available data.
Download
information not
available.
Example of user
review on
iTunes, "...easy
access to
information from
a trusted source."
The app also
received a
positive review
from the Healthy
Kids blogger at
The Philadelphia
Inquirer, who
described it as
something that
can "come in
handy when
you're preparing
for your child's
next
appointment."
Individual
reviews were
extremely
positive. One
criticism was that
only one parent
can access the
app. The second
parent would
have to create
their own version
of a child's
record.
The app's release
was covered by
several Canadian
newspapers.
A blogger on
ohbabymagazine.
com writes,
"I like that in the
outbreak section
you can click on
any of the
occurrences and
see if your little
ones have been
The CHOP
immunized
website states the against it.
app is the winner
of an award of
distinction from
the Academy of
Interactive and
Visual Arts.
No available
data.
No available data.
17
and use?
How many
users/downlo
ads are there.
Retention
data?
7. Research
Was there
any research,
evidencebased
guidelines,
or experts
involved?
Does not specify
whether research of
evidence-based
guidelines were
used.
8. Design
How
professional
is design?
(modern,
simple, crisp,
etc.) Does
design work
for app
purpose?
The design is
simple but lacking
in creativity. Also,
seems unfinished.
Screen shots on
iTunes have more
graphics than the
actual app.
However, the
simple design
matches the goal of
Does not specify
whether experts
or evidence-based
guidelines were
used.
States vaccine
schedules based
on CDC 2010
recommendations
with updates to
follow. Unclear if
updates added.
The design is
simple but is
limited to black
and white. Some
color would be
more eyecatching.
Yes. The app
was developed
by the Vaccine
Education Center
at the Children's
Hospital of
Philadelphia.
The vaccine
safety
information
includes an
option to read
more in-depth
brochures on
each topic. Those
brochures cite
the sources used.
The design is
simple and
modern. It is also
very eye-
Yes. The app was
developed by the
Canadian Public
Health
Association, the
Ottawa Hospital
Research Institute
and Immunize
Canada.
However, there
are no specific
citations.
The design is
visually pleasing
and modern. The
home page has
four simple boxes
at the bottom,
each containing a
section. There are
revolving slides at
the top showing
photographs of
18
making tracking
easier for parents.
9. Layout
and
navigation
What
sections does
the app have,
and are they
delineated by
type, roles,
or user
needs? How
usable and
organized are
the layout
and
navigation?
Do they
The layout is
problematic. After
you open the app,
you do not go
directly to a main
page. Instead, the
app brings you
directly to the
The layout is
simple and easy
to use.
catching and
colorful. The
colors work well
and are not
overwhelming.
people who might
be helped by
vaccines.
However, the
revolving slides
move too quickly.
The layout is
very easy to use
and flows nicely
among sections.
The layout is easy
to use, and the
flow is logical.
The user interface
The "home page" is touch-based. It
is divided into 9 requires almost
sections that are no typing, except
easy to access
the name of the
with a tap.
child.
There are four
sections at the
bottom of the
screen: vaccines,
Touching
"vaccines" brings
the user right to a
list of the various
shots and
information
The upper left
"hamburger" icon
slides the front
page to the right,
revealing a menu
that includes help,
19
make options section for entering
apparent?
a baby's name. The
name entry page is
otherwise blank
(too much white
space) without
graphics, so, a user
might wonder if
there was a mistake
and try to find the
main menu.
However, there is
no main menu. Just
three icons at the
bottom displaying
the three sections:
"babies, knowledge
base, settings."
Also, the ad on
iTunes makes it
look like you can
enter the child's
photo, but there is
no option for doing
that with the actual
app.
Entering the child's
name and birth date
is easy. Then, you
touch and arrow and
see the vaccines the
child needs
according to date.
Everything is
simply stated.
There are
descriptions for
records,
appointments,
help.
about them.
There is no main
menu page or
upper left menu
option.
The section for
entering the
child's name is
easy to use.
Once in the
child's record,
simply clicking
the envelope
image allows you
to email the
record.
The iTunes ad
makes it appear
that you can add a
photo of your
child. I had
trouble finding
that feature in the
actual app, but the
"help" section had
instructions on
where to find it.
An especially
good feature is
that a touch of
the "videos"
section leads
directly to short
videos on
subjects of
interest including
"Vaccines:
Separating Fact
from Fear." Each
clip is under 5
minutes, a length
appropriate for
mobile viewing.
privacy
information,
feedback, and
Facebook or
Twitter share
options.
A simple touch of
the front page
(still slightly on
screen at right)
brings the user
back.
Entering a
person's name to
create a
vaccination
record is easy.
There is no typing
require for birth
dates or choosing
your province.
The immunization
record is the app's
best feature. It
displays like an
old-fashioned
vaccine card. A
slide of the finger
lets the user view
the card,
20
each vaccine in the
"knowledge"
section, however,
the title,
"knowledge" is not
a very clear title for
what really is
"vaccine
information."
I was successful.
replicating the
experience of
reading a paper
document.
Also, the app has
incorrect symbols
for male and female
next to the child.
For example, male
is a cross rather than
an arrow.
11. Expert
content
What are the
expertgenerated
components
(including
text,
graphics,
audio, video,
blogs,
directions
Neither the app nor
its app store listings
contain information
about expert
involvement or
components.
There is no
interactive section
and no widgets.
Neither the app
not its iTunes
listing contains
information about
expert
involvement or
components.
There is no
interactive section
and no widgets.
There is a wealth
of expertgenerated
content in this
app. There are
multiple videos
featuring CHOP
experts
discussing
vaccine-related
topics of interest.
The is expertgenerated content
in this app
including vaccine
fact sheets,
frequently asked
questions, and
provincial
vaccination
schedules.
The information
21
ask the
expert,
glossary,
quiz, chat
with an
expert)?
12. Authors
and oversight
Does expert
content
identify the
author and
date written
and
reviewed? Is
there an
advisory
board or
clinician
involvement
?
There is an
excellent
glossary
explaining the
medical terms
used in the app's
educational
materials.
In "settings," there
is a "more about
this app" section.
One would think
this section might
have information
about who created
the app and
potential
involvement of
clinicians.
However, when you
go into the "more
about this app"
section, it sends you
to the "iVaccine
website," which
doesn't exist.
Instead, it goes to
the website of the
app maker, jaguart.com. However,
there is no mention
of iVaccine on the
There is no
information in the
actual app about
authors of
oversight.
However, the
iTunes store lists
the author "POJO
Software." It says
the app was last
updated in Sept.
2010.
The author has
also created a
home
maintenance app.
Similar to the
vaccine app, it
allows a
homeowner to
keep track of
renovations and
maintenance. It
The app also has
a unique game
section which
includes a match
game (match
disease with
vaccine).
Yes. The content
identifies
Children's
Hospital of
Philadelphia and
its Vaccine
Education Center
as authors.
App stores say
created in Aug.
2013.
is credited to the
reputable
agencies who
created the app,
although citations
are not specific.
Yes. The app was
developed by the
Canadian Public
Health
Association, the
Ottawa Hospital
Research Institute
and Immunize
Canada.
App stores say it
was created in
May of 2014.
22
link, so it's a "road
to nowhere."
gets very high
ratings on the
iTunes store and
iTunes identifies the has many positive
author as Hamzah
reviews.
Tariq, but there is
no additional
information. The
author has created
two other apps that
are not healthrelated.
13. Literacy The descriptions of The descriptions
and
the individual shots of individual
readability
and the diseases are shots and diseases
Is the content fairly easy to
are easy to
clear and
understand for
understand but
easy to
someone with an
probably require
understand? English language
at least a Grade 8
What reading literacy level of
literacy level.
level is it?
Grade 8 or above.
Also there are a few The information
"typos" and uses of
English that are not
standard. Example
is the name of the
section "Knowledge
Base," which would
normally be
something like,
"About the
is clearly labeled
Vaccines," or
"Vaccine
"Vaccine
Details."
Information."
In general the
content is easy to
understand and
does not require
a high literacy
level.
The content is
easy to
understand and
does not require a
high literacy
level.
The exception is
the glossary,
which appears
to require college
level literacy
(medical terms
are used).
The language is
conversational,
with layman's
descriptions of
some medical
terms.
23
14. Usergenerated
content and
sharing.
What are the
usergenerated
components
(including
discussion
forums,
blogs,
videos,
"likes,"
comments,
ratings, and
reviews)?
Which social
media are
used? Can
content be
shared?
There is no
evidence of usergenerated
discussion on
forums, blogs,
videos, or app
ratings websites.
There is a feature
for allowing the
user to "share this
app," and there is a
section for sending
user feedback to the
app maker.
There is no
evidence of usergenerated
discussion
beyond the
reviews on the
iTunes store.
There does not
appear to be a
social media or
share option.
There is usergenerated
discussion on
iTunes, Google
Play, and in
several healthrelated blogs.
There is usergenerated
discussion on
Google Play but
not iTunes. Users
pointed out
several "bugs"
including a
Discussion is
problem with the
generally about
photographs
the various
downloading into
features of the
people's devices
app and the fact
and a bug with
that it comes
the individual
from a reputable records. There
medical source.
were responses
One blog review posted by the app
says the authors
author stating that
should have done those specific
more than just
bugs have been
credit CHOP and fixed.
should have
included
There is also a
individual
great section for
citations. This
sharing the app
author believes
via social media,
that would be too which is a good
detailed and not
marketing tactic
user-friendly.
and also raises the
social cache of
24
15.
There is no stated
privacy policy.
There is no stated
privacy policy.
16.Registrati
on
Do users
register. If
so, what can
they do
before and
after
registering?
What
information
is tracked or
displayed?
How is
personal
information
used?
17. Cost
Is there a
cost for the
app or for
premier
features?
18. Devices
Users do not have to
register.
Personal
information is not
entered. Children
entered with first
names only.
Users do not have
to register.
However,
children's first
and last names
are required.
Yes. There is a
privacy policy
stating that
personal
information is
not required to
access the app. If
a user emails a
question, the
policy states the
email address
would not be
used by outside
parties.
Users do not
have to register.
vaccination
compliance.
Yes. There is an
extensive privacy
policy stating that
the information
entered is
protected. In
addition, there is
password
protection for
users.
Users do have to
register and must
choose a
password. The
app cannot be
opened without
registering.
Addresses are not
required.
$2.00
$1.99
No premier
features.
No premier
features.
The app does not tie
The app does not
Free
Free
The app does not
The app does not
25
and websites. to any other apps,
Does the app devices or websites.
tie into any
other apps,
devices, or
websites?
tie into any other
apps, devices or
websites.
tie into any other
apps, devices or
websites.
19. Support
and feedback
Is there a
website or
support
forum for
users? Is
there a way
to provide
feedback? Is
there a
feedback
survey?
There is no
support website
or forum. There is
no option for
contacting the app
maker. However,
the help section
contains good
step-by-step
instructions and
wireframes.
There is no
support section,
but there is a
feature that
allows a user to
email the CHOP
vaccine center
with feedback.
Best: Easy to use
tracker with the
added feature of
being able to
email a vaccine
record. However,
the record would
not be considered
"official."
Worst: May be
outdated. Lacks
scientific/medical
sources.
Best: Very
attractive design
with
understandable
and
comprehensive
delivery of
educational
content.
Worst: Lacks a
vaccine tracker.
Its sole purpose
is educational.
20. Overall
assessment
What are the
overall best
and worse
features of
the app?
There is no support
website or forum.
However, there is a
feedback section
that allows you to
email the app
maker. It also
invites the user to
write a review.
However, no
reviews are
displayed.
There is also a help
section with FAQ's.
Best: Simple
tracker that is
limited to the single
purpose of helping
parents record
vaccines.
Worst: Lacking in
sophistication.
Errors like the
incorrect
male/female symbol
compromise the
app's integrity.
tie into any other
devices. There are
links to websites
with additional
vaccine
information and
to Facebook and
Twitter.
There is no
support section,
but there is a
section that
allows the user to
email feedback. It
is not clear which
author/collaborato
rs would receive
the email.
Best: This app
does an excellent
job of blending
the objective of
educating the
public and the
goal of offering a
practical vaccine
record-keeper. A
big bonus is the
social media
feature.
Worst: It's hard
to say anything
negative about
this app, but the
26
one thing that
would make it
perfect would be
the ability to
generate an
"official"
vaccination
record.
Implications of Competitive Analysis on Design
Though several apps exist for both vaccination record keeping and vaccine education, the
existing apps do not adequately blend the two goals; they are either weighted in favor of one or
the other. In addition, all the apps lack the function parents would be most likely to use: the
ability to transmit official vaccination records to schools, paper-and-hassle-free. The apps also do
not link the triad of key players in the vaccination health experience: parents, schools, and
healthcare providers. Three of the apps analyzed also lack geographical positioning capability
and are therefore generic. That is a problem, because vaccination regulations are far from
generic: they are "brand-specific" to the individual state and vary depending not only on
geographical location but also on the age of the child.
Competitive Analysis Assessment
a. Borrow - what features or capabilities do you want to include?
Shot Card will borrow from the simple yet inviting design of the ImmunizeCA (Immunize
Canada) app, which is both attractive and easy to navigate. ImmunizeCA's ability to create both
an electronic vaccination record and a document that looks like a traditional vaccination card will
be borrowed as well. In addition, ImmunizeCA's ability to alert users about outbreaks will be
included. The importance of evidence-based educational content is evident in the CHOP app, and
Shot Card will include evidence-based content as well. The involvement of a reputable medical
organization is critical to credibility. In addition, two of the apps reviewed (iVaccine and Baby
Vaccines) have the goal of tracking, whereas CHOP only offers education. ImmunizeCA's model
best mimics the objectives of ShotCard, which is to offer both vaccine tracking and education.
In addition. Shot Card will borrow from ImmunizeCA by adding a "share" option. This would
allow users to share the app via social media, bolstering marketing and increasing the social
cache of vaccination.
27
b. Avoid - what did you learn that you want to make sure you don't do?
Both iVaccine and Baby Vaccine are prominently featured in Google searches of "vaccine apps,"
but their content is limited and of questionable quality. Shot Card would avoid inaccuracies with
rigorous editing and review by experts.
c. Distinguish yourself - what capabilities, knowledge, or branding do you have that you
can capitalize upon to stand out from your competition?
Shot Card will distinguish itself by being the only app to offer the capability of transmitting
official vaccination records to health care providers, schools, or camps. Shot Card will link those
key players, eliminating the need for passing paper among them. Shot Card will be tailored to
the location of the user, including region-specific vaccination schedules, automatic deadline
reminders, and local alerts.
DESCRIPTION OF APP DESIGN
App Components
Home Page/Overview
Shot Card will most closely resemble ImmunizeCA, but it will be targeted for the American
market and will have one capability not available in any other app: the ability to store and
transmit official vaccination records. Shot Card will be divided into four sections: records, alerts,
information, and search. The app will open to a home page with the Shot Card logo on the top
half of the screen. The bottom half of the screen will contain four blue rectangles, each
containing a simple icon for each for the app's four sections. This home page design puts the
app's dual purposes within easy reach of the user: both vaccination records and vaccine
educational information.
The app's design will follow the Health Belief Model [HBM], a theory that provides a
framework for changing health behaviors. According to the theory, parents or guardians will
vaccinate their children according to recommendations if they believe the threat of vaccinepreventable disease is severe and if they believe their children are susceptible to those diseases.
In addition, parents must believe the benefits to vaccination outweigh the barriers. They must
have self-efficacy (feel empowered to vaccinate) and must receive specific cues to action
(prompts) to continue vaccinating.
From a theory perspective, Shot Card's buttons follow the Health Belief Model, placing the
major constructs together. The search and information sections address severity and
susceptibility perceptions, explaining the risks of non-compliance, the benefits of compliance,
and addressing barriers such as safety fears. The alerts section bolsters severity perceptions, as it
will include alerts about disease outbreaks, which raise the threat in the eyes of parents. The
alerts section might also function as a cue to action, in that it includes notifications of free
vaccination clinics and other community resources. The records section follows the HBM's selfefficacy construct by putting the parent in a position of empowerment as "record-keeper" and
manager of vaccination schedules. "Records" also provides cues to action by sending text
messages or calendar notifications when it is time to get a child's vaccinations updated or when a
shot is missed.
28
The bottom of the home page will have a "share" feature which allows users to share the app
with friends and followers through social media. The feature will also allow sharing alerts and
vaccine safety information. The only content that cannot be shared is the users' official
vaccination records, which can only be transmitted to participating, secure, HIPAA-compliant
participating organizations, such as health providers and schools.
Records
The records section contains the app function most likely to attract users: the ability to maintain
vaccination records for individuals and transmit official vaccination records to schools, camps,
medical providers, and others requiring vaccination information. The record-keeping function is
inspired by the competitive analysis, which included three apps offering vaccination tracking.
However, Shot Card's record-keeping function is unique because it can transmit official
vaccination records. The record-keeping and record-transmission functions follow a simple and
logical sequence.
First, the parent or guardian must input a child's (or family member's) name and date of birth.
There is an option for adding a photograph of the person by uploading from the user's photo
albums. The only typing requirement is the person's name. After that, date of birth can be added
by touching a date wheel. Residence can be added by touching a state on a map of the United
States. A touch of the state then offers a zoom-in touch feature for locating the general area of
residents. The zoom hovers over specific communities, allowing the user to tap his or her
residence location.
Next, the parent can tap the heading for a specific person, and the app goes directly to that
person's electronic vaccination record. The record is compiled based on the CDC's 2014
vaccination schedules and will be updated whenever the CDC makes changes. The record is also
customized to include individual state requirements, which vary. Each shot is listed by
abbreviation in order to keep the page simple. However, the user can tap the list arrow to the
right of the shot abbreviation to find a description of the shot in layman's terms.
The electronic vaccination record has simple circles, each representing a shot. For example, a
quadrivalent vaccine (4-shot series) would be illustrated with four circles. A red circle means the
vaccination has not yet been obtained. A green circle indicates the vaccine has been
administered. The circle coding provides an easy way to figure out which shots have been
received and which shots are still necessary, based on the child's age and place of residence. The
red and green circles would be filled in by the doctor or health care provider administering the
vaccine. The provider is able to do that by accessing the patient's record on his or her PC or iPad.
Shot Card automatically connects this information to the patient's mobile app. This feature erases
the parent's responsibility of having to input each shot.
Upon noticing a red circle, the user can tap it and find an option screen that allows him or her to
either call the provider directly to schedule an appointment for the shot, or in the alternative, ask
for a text reminder to make an appointment. The text reminder feature is synced with the user's
calendar. The user can tap how far in advance the reminder is preferred. This would be
calculated based on the vaccination schedule's deadline for that person to receive the shot. For
example, a text box would say, "Remind me a month before shot required," or, "Remind me two
weeks before shot required." If the user does not check the electronic record and does not notice
29
that a shot needs to be updated, the calendar function would automatically send a text message
reminding the user that it is time to schedule an appointment for a shot. Based on our personas,
we conclude that Francia Lopez, the single mom, might have benefitted from a text or email
reminder that her daughter's shot was overdue.
In addition, there will be a feature that allows a parent to flag a shot that may be incorrectly
entered by the provider. The flag appears on the provider's chart so that the provider can check
for accuracy at the next appointment or as soon as the provider sees the flag. This feature was
inspired by our research, which demonstrated that medical records are likely to be more accurate
when double-checked and maintained by the patient.
At the bottom of electronic record page, is a very prominent blue "document" icon. Tapping that
icon brings the user directly to the individual's official vaccination record. The official record is
not digital in appearance. Instead, it looks like a paper document with the seal of the individual's
state of residents. It is clearly marked, "official." Scrolling through the document allows the user
to see the individuals entire vaccination record with dates, in very much the same fashion as an
old-fashioned paper shot card. There is a heading at the top of the page that allows the user to
email the official record directly to a school, provider, or camp. To maintain HIPAA compliance,
the recipient must subscribe to Shot Card. In the alternative, the user may select the option of
printing the official record and delivering or mailing it to the recipient. The print out would
contain a zebra stripe for authentication. One might envision all four of our personas using this
feature. The mothers, including the vaccine-doubter Maya Billington, are required to provide
their children's official vaccination records to schools and camps. School nurse, Diane Ricci,
might also be grateful for Shot Card, as it would save her the work of having to manually check
paper vaccination records. She could view vaccination records via the Shot Card app on her
tablet or PC, and through an interactive feature, send pre-composed emails and texts to alert the
parent that additional shots are needed.
Alerts
The alerts section will take the form of a live feed, similar to Twitter, and will offer the user
updates on various vaccine-related topics including location-specific information on outbreaks of
vaccine-preventable diseases, including influenza. The information will come from the
department of health in the user's state of residence. The alerts section will also offer information
about where to obtain vaccines related to the outbreak. The alerts section will feature any new
information about changes in vaccination requirements or other vaccine-related health alerts
from the state department of health. Finally, the alerts section will send out information about
community-based vaccination clinics or other events aimed at increasing vaccine compliance.
The idea for the alerts section comes from the competitive analysis of ImmunizeCA.
ImmunizeCA has a feature in the "notifications" section designated for updates on outbreaks of
vaccine-preventable diseases. The app asks for permission to obtain the user's GPS location,
which allows the app to offer outbreak information specific to location. For example, this author
tapped the "outbreaks" section, which led to a list of outbreaks within a 20 kilometer radius of
Boston, MA. A slide feature allows the user to expand the range to a larger area. The update
included four measles cases which were reported within the past six months in Massachusetts
and Rhode Island.
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The alerts section is also inspired by persona "Maya Billington," the California yoga instructor.
If Billington were to find Shot Card upon doing a Google search for vaccine safety information,
the alerts section would allow her to see in real time the actual risk to her child during the
measles outbreak she heard about in the San Francisco Bay area, thus raising her susceptibility
perception. Shot Card will go a step beyond the outbreak information offered by ImmunizeCA
and provide a color-coded map depicting what the outbreak would look like if it continues to
advance, with likely morbidity and mortality statistics to children.
In addition, Omer et al. (2009), in a study of pediatricians, found 28 percent would refuse to
provide care to a family who refused some vaccines. The study authors advise primary care
physicians and nurses not to break off relationships with parents who decline because providers
are in a position to educate them about the benefits of vaccines and address concerns about risks.
We might infer that Maya Billington's pediatrician may decide to share information about the
Shot Card app upon learning of her decision to delay her daughter's second MMR shot.
Info
The focus of the information section will be education on vaccines. This section is inspired by
the competitive analysis of the CHOP app and ImmunizeCA, both of which have excellent
vaccine education features. Persona Maya Billington might find the information section to be
useful, as it is designed to counteract some of her misperceptions about vaccines. The goal of the
information section is to provide users with easy-to-understand, evidence-based information
about vaccines. The information section will increase severity and susceptibility perceptions and
demonstrate the benefits of vaccination while targeting key barriers, including safety concerns.
Similar to ImmunizeCA, Shot Card's info button leads the user to a page offering educational
information about vaccines. Shot Card's info categories will include: Most Common Questions,
Concerns About Autism, Talking with Your Doctor, About Diseases, and What Disease Would
Mean for My Family. The "What Would Disease Mean for My Family?" section is unique to
Shot Card and crucial to raising severity perceptions. Because modern parents typically have
never experienced vaccine-preventable diseases and may have low severity perceptions, this
section is written in a way that shows the reality of how a specific disease would affect the user's
family. For example, "What Would Measles Mean for My Family?" allows the user to tap
through various scenarios, including estimated time away from school and activities,
complications of the disease, potential for long-term injury, how other family members would be
affected and what the disease would actually look like on an individual child. The child would be
"constructed" virtually according to height, weight, age and gender. The user would see images
of what a disease, such as measles, would look like on specific parts of the child's body and a list
of likely symptoms and possible complications.
The "Concerns About Autism" section is inspired by the CHOP app, which places autism
prominently in its educational section. The Concerns About Autism section will be evidencebased and include a layman's-language summary of the CDC's Vaccine Safety "Concerns About
Autism" publication (CDC, 2014). The publication has information about several major studies
that debunk the alleged link between childhood vaccines and autism. This section is aimed at
breaking down a key barrier to following recommended vaccine schedules: worries about a
potential link between autism and vaccines. Shot Card also offers links to the specific citations in
the CDC publication. However, since busy parents may not have the time , patience, or literacy
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level for reading the studies, Shot Card will offer an easy-to-read abstract for each article. For
parents wishing to read the actual study, it will be available. A swipe feature will allow the user
to choose between "simple summary" and "read the full article."
Search
The search section will offer easy-to-understand explanations of the common terms used in
vaccine-related discussion and information. The search section would not require typing and
would allow the user to scroll through a list of available glossary terms, tapping each one for
additional information. The search feature is found in both the CHOP and ImmunizeCA apps. It
also makes sense that our persona moms would find this useful as they seek additional
information or explanations of vaccine-related medical terminology. Specifically, we can
envision persona Katie Holland using this feature, because she is a new mother and new to all the
vaccinations her baby will be receiving over the coming months and years. She is motivated to
receive the recommended vaccines and would be likely to seek explanations to terms she doesn't
understand. Since her hands are usually full managing her infant, typing would be a problem for
her. The simple touch features, however, are easy and can be done while the baby is in his
carrier.
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WIREFRAMES
Home Page:
Share
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(CDC, 2014)
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Massachusetts Immunization
Record
Name: Peter Dennis Jenkins
DOB: September 8, 2008
OFFICIAL
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EVALUATION PLAN
Formative evaluation is a way to test and evaluate an app design at various stages of
development. It provides critical user insight, allowing the developer to make changes if
necessary, tweaking the design as much as possible before widespread release. Shot Card will
employ formative evaluation at all stages of development, beginning with focus groups in the
early stages of design and ending with beta testing as a final step before widespread release. The
app's four sections outlined make sense from a theoretical and evidence-based perspective, but
do they make sense in the hands of users? Will users understand the terms on the buttons, and
will the layout match their natural sequence of information needs? These are just some of the
questions for which our formative evaluation would seek answers.
We will begin our early focus groups by recruiting subjects from the patient base of a major
pediatrics practice in the Boston area. Subjects will be asked what they expect from a vaccine
tracking app and what would make them most likely to use it. They will also be asked if an app
would be preferable to a website for this purpose and what would motivate them to maintain
their own vaccination records. It would also be useful to know if they are open to receiving text
or email reminders when vaccines are due and how they would react to receiving information
about outbreaks via a mobile device. The most important question would be something along the
lines of, "what would you want the app to do," or, "how can this app make your life easier?"
Once the focus group information has been compiled, the app will be adapted, if necessary. The
next round of testing would involve a question and answer session with a different group of
subjects recruited from the same (or similar) pediatrics practice. At this point, the subjects would
be asked a series of questions before seeing the app, upon first impression, while using the app,
and after using the app. The goal of the questions would be to see if the name of the app and its
design are appealing and match the expected function of the app. We would be interested in
knowing if the app is convenient and easy to navigate, since mothers of young children do not
have much spare patience or extra time. If the app isn't easy to use and give them what they need
up front, they won't come back. We would also want to know if the app's most distinguishing
feature, the convenience of keeping and transmitting an official vaccination record, is valuable to
them and offers a more desirable alternative to current means of getting vaccination records to
schools or camps.
The next step in the evaluation process will be beta testing a nearly-final product before releasing
it to the public. For this evaluation, Shot Card will recruit young mothers through a major
pediatrics practice. Those mothers will be patients of doctors who are early adopters of Shot
Card and who have agreed to participate in the testing. Shot Card will also recruit school nurses
at the elementary schools attended by children of the testers. This will take time, since it involves
recruiting three different categories of subjects for testing. This beta testing will take place in
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real-life situations and will reveal any real-world flaws before the app goes on the market. Any
necessary revisions will be made before its release.
After the app's release, Shot Card will seek feedback from key reviewers in technology journals
and blogs. We will also monitor feedback and reviews on app store websites and in technology
message boards.
DEVELOPMENT PLAN
Cost
The cost of developing Shot Card would be funded by grants from organizations such as the
Centers for Disease Control and Prevention and the American Academy of Pediatrics. It is
estimated that the cost of design, development, and marketing would be approximately $100,000.
Shot Card would require continued funding to maintain up-to-date information.
Timeline
The estimated start-to-finish timeline for Shot Card is one year. An iOS version will be released
first, followed by an Android version.
MARKETING PLAN
Shot Card's marketing plan targets an audience of mothers, ages 18-49 and will include
traditional media, social media, blogs and online advertising. The marketing plan will place
particular emphasis on earned digital media and social media outreach. Our audience research
shows that mothers are rich social media users and are likely to be "online more time than they
are watching TV (CDC, n.d.)." If mothers do not have time for traditional media sources, they
may make time to use their mobile devices or work computers to check in on the latest mommy
blogs, Twitter feeds , or Facebook. Research also tells us that most mothers go online daily, and
that the wide variety of social networking sites and blogs allows mothers to connect with each
other (CDC, 2014). Shot Card's marketing plan will include outreach to popular "mommy"
bloggers in an effort to interest them in using and writing about the app, resulting in earned
media. In addition, research tells us that mothers are most likely to learn from each other (CDC,
2014), making a social media campaign essential to creating discussion and buzz about Shot
Card among mothers.
Because Facebook is the leading social media choice for mothers, Shot Card's marketing plan
will involve recruiting mothers who are early adopters in the communities where the app will be
launched. Those mothers will drive Facebook posts regarding vaccination compliance and the
benefits of Shot Card app. Twitter is also a good social media marketing venue, because it
reaches the younger age group of mothers. Twitter offers the ability to send out real time alerts
and press releases related to the app.
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In addition, our earned media outreach will involve approaching leading health reporters from
mainstream media sources with desirable demographics. Finally, direct marketing will take place
through pediatricians' offices, and possibly, ob-gyn practices, who are in a good position to reach
new mothers. We will steer clear of marketing through "government" sources and public health
departments, because such marketing might raise privacy concerns among parents and the
suspicions of the anti-vaccine movement.
LIMITATIONS
The Shot Card app is dependent upon the cooperation of several entities including healthcare
providers, school systems, and state health departments. Such cooperation and coordination will
likely be challenging. Shot Card will also require frequent updates and location-specific
information. Thus, Shot Card will need to maintain a staff to keep the app relevant and compliant
with changing vaccination guidelines. Shot Card will only be as good as its users and will require
a solid private-public partnership along with the strong support of participating organizations.
ABOUT THE AUTHOR
Audrey Laganas Jenkins is an award-winning broadcast journalist pursuing a Master's Degree in
Health Communication at Emerson College (in collaboration with Tufts University School of
Medicine).
She is the recipient of a 2006 Emmy Award for Investigative Reporting from the National
Academy of Television Arts and Sciences, Boston/New England region. Jenkins has also been
recognized by the office of the Rhode Island Attorney General for her commitment to consumer
justice.
During her career as an on-air reporter for NBC affiliate WJAR-TV, Jenkins covered everything
from New England storms to the federal corruption trial of former Providence mayor Vincent
"Buddy" Cianci. She headed the station's Consumer Unit and was a member of WJAR's highly
respected investigative reporting team.
After a hiatus from the news business to care for her young son, Jenkins is excited to be taking
her career in a new direction and pursuing health communication.
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Jenkins is a graduate of Brown University and has served as an ex-officio member of the Brown
Alumni Association Board of Governors. In her free time, she enjoys family travel and taking
her son to the beach.
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Read More: http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2011.300331