Currently submitted to: Online Journal of Public Health Informatics
Date Submitted: Jun 8, 2026
Open Peer Review Period: Jun 22, 2026 - Aug 17, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Digital Interventions in Immunization Programs: A Global Scoping Review of Tools, Outcomes, and Implementation Challenges
ABSTRACT
Background:
Digital health interventions (DHIs) are increasingly being integrated into immunization programs to address persistent challenges such as low vaccine coverage, poor schedule adherence, and rising vaccine hesitancy. However, the evidence on the effectiveness, implementation barriers, and stakeholder-specific outcomes of these interventions remains fragmented. This scoping review aimed to map the types of digital tools used in immunization programs globally, assess their impact on key outcomes coverage, adherence, knowledge, and hesitancy and identify common implementation barriers and enablers.
Objective:
This scoping review aimed to map the types of digital tools used in immunization programs globally, assess their impact on key outcomes coverage, adherence, knowledge, and hesitancy and identify common implementation barriers and enablers.
Methods:
Following the Arksey and O’Malley framework, refined by Levac et al., and guided by the Joanna Briggs Institute (JBI) and PRISMA-ScR guidelines, we conducted a comprehensive literature search across seven electronic databases and grey literature sources covering studies published from January 2005 to March 2025. Eligibility criteria included studies focusing on digital health interventions for immunization across all populations and settings, published in English, including randomized controlled trials, quasi-experimental, mixed-methods studies, and systematic reviews. Eligible studies included randomized controlled trials, quasi-experimental studies, mixed-methods designs, and systematic reviews. Study selection was conducted through title/abstract and full-text screening. Data were charted by digital tool type, stakeholder group, immunization domain, outcomes, and implementation context, using a standardized data charting form
Results:
Fifty-three studies met the inclusion criteria. SMS reminders were the most frequently used and consistently effective tools, especially in low- and middle-income countries (LMICs), showing improvements in vaccine uptake and schedule adherence. Electronic Immunization Registries (EIRs), AI chatbots, gamified applications, and decision aids demonstrated varied impact on data quality, knowledge, and vaccine confidence. Implementation success was supported by health system integration, localized messaging, and community trust, while barriers included low digital literacy, infrastructure gaps, and mistrust.
Conclusions:
Digital tools hold significant promise for enhancing immunization programs, particularly when tailored to local contexts and integrated into existing health systems. Further research should prioritize cost-effectiveness, equity, and long-term impact. These findings provide a comprehensive mapping of existing evidence to inform policy, practice, and future research in digital immunization strategies Clinical Trial: -
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