In Pakistan, data showed a significant drop-off between infants’ first dose of diptheria-tetanus-pertussis (DTP1) and the third dose (DTP3).

Upon investigating the problem, researchers noticed a common challenge for many of the mothers: the physical ‘reminder’ card that they received after the first dose of the vaccine was difficult to interpret.

The standard card presented mothers with two challenges:

  • It was too small, 9cm by 8.5cm when folded. The information appeared crowded and disorderly.
  • The next immunization date—the most critical piece of information—was handwritten by the staff at the clinic, often in cramped and irregular letters. Less literate mothers in particular had trouble reading it.

In a randomized controlled trial, the research team adjusted the card’s design to simplify the information and make it easier for the mothers to understand. Some mothers in the trial received cards that were:

  • Bigger: The card was larger, 15.5 cm by 11.5cm when folded.
  • Eyecatching: The card was bright yellow and used pre-printed stickers with 42-point font.
  • Harder to lose: The card was placed in a plastic jacket with a hanging string.
  • More actionable: Only essential pieces of information were included on the outer sides of the card, which the mother could see at a glance: the next immunization dates and days of week.

These small tweaks had an outsized impact: 67% of the redesigned card group completed the immunization schedule, compared with 39% of those who received the standard card. Furthermore, the intervention was cost effective: each new card cost only 5 cents to produce.

Small, cheap and effective—this example of success was made possible by closely observing the challenges, however seemingly minor, facing intended users.

Source: Usman (2011), Randomized controlled trial to improve childhood immunization adherence in rural Pakistan: redesigned immunization card and maternal education