Date of Award

January 2016

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Kristina M. Talbert-Slagle


Background: Khushi Baby (KB) is a mobile health platform that tracks child immunizations using a mobile application and a Near Field Communication (NFC) necklace worn by the child. Quantitatively assessing intermediate indicators of the KB program’s progress is important, especially when considering the program’s scalability.

Objectives: This study seeks to quantitatively examine three key intermediate outcomes of the KB cluster Randomized Controlled Trial (cRCT), using group comparisons of mothers’ survey responses, that are indicative of whether the necklace is discussed, visible, and liked by users. Two data collection tools were compared in this study: the NFC sticker and the NFC necklace worn by the child. The dependent variables (number of people data collection tool was discussed with, positivity rating of data collection tool, and visibility of data collection tool to grandmothers/fathers) were assessed in relation to the independent variable of group membership.

Methods: Mothers were enrolled in the cRCT from August to December 2015, and the study period is to last 7 months. 208 mothers had been enrolled and 128 children had completed the DTP1-DTP3 vaccination series by the midline assessment (end of January 2016). Clustering was done on the village level, with 96 immunization camps randomly assigned to 3 arms: mothers given an NFC sticker placed on the immunization card (control group), mothers given an NFC necklace (group P), and mothers given an NFC necklace with voice calls reminding them to come to camp (group P+V). A Kruskal-Wallis H test was used to assess discussion level around the system. User satisfaction was analyzed using a chi-squared test, and visibility of the data collection tool to key relatives was modeled using logistic regression.

Results: Findings suggest that the necklace generates discussion and is well liked; however, the voice calls do not significantly amplify discussion or improve mothers’ perceptions of the necklace. Mothers discussed the data collection tool with significantly more people in P compared to control, and in P+V compared to control. In the follow-up surveys, 35.3% of mothers rated the necklace “very good” in P and 36.4% rated the necklace “very good” in P+V; these were both significantly greater than the 11.1% of control group mothers who rated the sticker “very good” (p = 0.005 and p = 0.008, respectively). P and P+V were significant predictors of the grandmother having seen the necklace, as per the mother (p < 0.001 for both). P was a significant predictor of the father having seen the data collection tool (p = 0.008).

Conclusion: Mothers reportedly like the necklace more than the sticker. The use of a culturally appropriate wearable as the data collection tool is amplifying discussion around the KB system, but little impact of the voice calls is evident as call deployment was inconsistent. Missing data limits the validity of the regression models used to assess visibility. There may be potential for the engaging quality of the KB necklace to improve health outcomes, if the necklaces are strategically used to encourage more mothers to bring their children to immunization camps.


This is an Open Access Thesis.