Peer-reviewed article
Child Vaccination Status and Behavioral and Social Drivers of Vaccination Among Their Caregivers in the Philippines: Cross-Sectional Survey Study Comparison of Household, Mobile, and Online Modes.
Bonner KE, Hipol M, Sy D, Royono R, Johnson D et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study surveyed caregivers of young children in the Philippines about vaccination status and the behavioral and social factors that influence whether children receive vaccines. Researchers compared three survey methods—household visits, mobile phone messaging, and online surveys—to understand which approach works best for collecting vaccination data. Vaccination rates were high across all survey methods (85-92% for DPT vaccine), but cost per response varied dramatically, with online surveys being cheapest and household visits most expensive. The main barriers caregivers reported were difficulty affording vaccination, despite strong overall support for vaccines.
Key points
- DPT vaccination coverage was 91.8% (household), 90.3% (mobile), and 85% (online) among surveyed children
- Over 85% of caregivers across all survey methods believed vaccines are very important, very safe, and supported by family
- More than 30% of mobile and online survey respondents reported difficulty paying for vaccination
- Cost per response was US$29.38 (household), US$6.93 (mobile), and US$2.61 (online)
- Online and mobile respondents were more likely to be male and have completed high school compared to household respondents
Limitations
The study used different sampling approaches for each survey method, which may affect representativeness and comparability of results. The online survey had notably lower vaccination coverage (85%) and fewer respondents (398), limiting confidence in that method's estimates.
Abstract
Background The World Health Organization recommends that countries routinely collect data on the behavioral and social drivers (BeSD) of vaccination to inform public health interventions that increase vaccine uptake. There is a need to identify data collection methods that can rapidly and inexpensively collect representative data, particularly in low- and middle-income countries. Objective This study aimed to understand BeSD drivers of vaccination in the Philippines and assess the trade-offs between survey methods. We compared responses to household, mobile, and online surveys in terms of demographics, vaccination status, responses to BeSD questions, and cost. Methods We conducted concurrent household, mobile (SMS text messaging and interactive voice response), and online surveys among caregivers of children 2 years of age and below in Regions V and XII of the Philippines, with sampling differing by survey method. We assessed, for each survey method, (1) respondent demographics (sex, age, region, and socioeconomic status) and (2) the weighted proportion of responses from caregivers of children who received at least one dose of diphtheria-pertussis-tetanus (DPT)-containing vaccine. We estimated the weighted proportion of each BeSD survey response option and calculated the financial cost (monetary outlays) per survey response from an implementer's perspective by summing the costs incurred in each survey method and dividing by the number of responses received. Results We surveyed a total of 1201 household respondents, 2153 mobile respondents, and 398 online respondents from January to March 2025. We found that online and mobile survey respondents were more likely to be male and have completed high school than household survey respondents. The weighted proportion of respondents indicating that their child had received at least one dose of DPT vaccine was 91.8% (n=1090; 95% CI 90%-93.3%) for the household survey, 90.3% (n=1853) for the mobile survey, and 85% (n=346) for the online survey. With regard to vaccine demand, more than 85% of respondents in each survey method indicated that vaccines are very important, very safe, supported by family, and that they knew where to bring a child for vaccination. More than 30% of mobile and online survey respondents indicated that it was not easy to pay for vaccination. The financial cost to conduct the survey per survey response was US $2.61 for the online survey, US $6.93 for the mobile survey, and US $29.38 for the household survey. Conclusions In the Philippines, household, mobile, and online survey methods reached caregivers of children who were unvaccinated against DPT, and these proportions were similar across survey methods. BeSD responses indicated high vaccine demand and challenges in caregivers' cost to access vaccination. Determining the most appropriate survey method depends on trade-offs between representativeness and costs. However, areas with strong connectivity and high mobile device ownership can consider mobile and online methods as a lower-cost alternative to rapidly collect BeSD data.