Peer-reviewed article
Can a visual self-learning tool improve immunisation awareness? Evidence from a quasi-experimental pilot study in Madhya Pradesh, India
Priyanka Das, Santosh Kumar Shukla, Mehak Bhatia, Nitin Kothari, Harkabir Singh Jandu et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study tested a visual tool called the Routine Immunisation Wheel to improve caregivers' and health workers' knowledge about vaccination schedules in Madhya Pradesh, India. The tool was compared between an intervention district and a control district with 384 caregivers in each group and over 60 health workers. Caregivers in the intervention district showed significant improvements in their knowledge about immunisation schedules, benefits, and session site awareness from baseline to endline, and also scored higher than the control district at endline. Health workers adopted the tool completely and used it for patient counselling.
Key points
- Immunisation schedule knowledge improved from 35.6% at baseline to 53.7% at endline in the intervention district (p < 0.05)
- Knowledge of immunisation benefits increased from 62.5% to 87.4% in the intervention district (p < 0.05)
- Session site awareness rose from 89.8% to 95.1% in the intervention district (p < 0.05)
- All three knowledge areas were significantly higher in the intervention district compared to the control district at endline (p < 0.05)
- 100% of Auxiliary Nurse Midwives adopted the tool for due listing and counselling
Limitations
This was a pilot study in one Indian state with a quasi-experimental design lacking random assignment, which limits generalisability to other settings. The document does not provide information on long-term sustainability, cost-effectiveness, or whether the knowledge improvements translated into actual changes in immunisation coverage rates.
Abstract
INTRODUCTION: Immunisation coverage in low- and middle-income countries continues to face challenges due to persistent gaps in vaccination schedule knowledge among caregivers and health workers. The Routine Immunisation Wheel was developed as a low-cost visual tool to complement existing systems like Mother Child Protection (MCP) cards and community healthcare worker visits in Madhya Pradesh, India. This pilot study evaluates the tool’s effectiveness on improving knowledge and awareness among caregivers and frontline workers (FLWs), as well as its potential for scaling within routine immunisation programs. METHODOLOGY: Using a mixed-methods approach, we conducted a quasi-experimental pilot comparing intervention and control districts with 384 caregivers per arm and more than 60 FLWs (vaccinators/Auxiliary Nurse Midwife (ANMs), mobilizers Accredited Social Health Activists (ASHAs) and Anganwadi Workers (AWWs). Statistical analysis included descriptive statistics for demographics, mean scores with 95% confidence intervals for knowledge domains, independent samples t-tests for group comparisons, chi-square tests for proportions, and thematic analysis of qualitative feedback. RESULTS: At endline, caregiver knowledge scores in the intervention district were higher than at baseline for immunisation schedule (mean: 53.7% vs. 35.6%, p < 0.05), immunisation benefits (mean: 87.4% vs. 62.5%, p < 0.05), and session site awareness (95.1% vs. 89.8%, p < 0.05). When compared with the control district at endline, the intervention district had, on average, higher scores for immunisation schedule knowledge, immunisation benefits and session site awareness (all p < 0.05). The tool demonstrated high utility among health workers, with 100% adoption by ANMs for due listing and counselling. CONCLUSION: The routine immunisation wheel effectively addresses critical knowledge gaps in routine immunisation through its dual functionality as both caregiver reminder and healthcare worker job aid. These results highlight its potential for integration into broader immunisation strategies, especially in low-literacy, resource-limited settings.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- The Routine Immunisation Wheel, a low-cost visual tool to improve knowledge of vaccination schedules, benefits, and session sites among caregivers and frontline health workers
- Population
- 384 caregivers per arm and more than 60 frontline health workers (ANMs, ASHAs, Anganwadi Workers, mobilizers) in Madhya Pradesh, India
Key finding
Intervention district caregiver knowledge on immunisation schedule increased from 35.6% to 53.7% (p < 0.05)
Das et al. · OpenAlex · 19 Nov 2025