CHEC-UP: A Digital Intervention to Reduce Disparities in Well-Child and Immunization Completion in Community Health 


  • Nivedita Mohanty Chief Research Officer, AllianceChicago, Chicago, Illinois, USA
  • Ta-Yun Yang Research Data Scientist, AllianceChicago, Chicago, Illinois, USA
  • Jennifer Morrison Pediatric Nurse Practitioner, IWS Family Health Center; Clinical Research Scientist, AllianceChicago, Chicago, Illinois, USA
  • Tania Hossain Pediatrician, Heartland Health Centers, Chicago, Illinois, USA
  • Andrea Wilson Innovation Strategist, AllianceChicago, Chicago, Illinois, USA
  • Abbey Ekong Research Manager, AllianceChicago, Chicago, Illinois, USA



artificial intelligence, chatbot, childhood immunization, community health, well-child visit



Well-child visits and immunizations among children in the U.S. declined at the pandemic’s onset and vulnerable populations have been disproportionately affected. This pilot project tested an innovative mechanism to use chatbots to engage caregivers in evidence-based preventive care for children.  


We used artificial intelligence (AI)-enabled chatbots to personalize messages and facilitate appointment scheduling over a five-month period. Chatbots introduced a novel way to connect vulnerable populations to care and challenged traditional convention of provider-patient engagement.


The pilot study was conducted at a Community Health Center in Chicago, Illinois that serves roughly 10,500 children, and 82% of patients are racial and/or ethnic minorities. 


We targeted outreach to 250 English and Spanish-speaking families with children 0-17 years of age for proactive outreach using chatbots promoting well-child visit completion and up-to-date immunization status; moreover, a special emphasis was placed on the 0-2 age group as the first two years represent a critical time for primary prevention of vaccine-preventable diseases.

The intervention focused on pre-visit engagement by launching an AI-enabled chatbot to deliver personalized messages and facilitate appointment scheduling via mobile devices. CHEC-UP also provided evidence-based anticipatory guidance prior to an appointment. Coaching in preparation for the visit with trusted information has the potential to educate, improve confidence and promote shared decisions between the parent and provider. Patient experience was measured via surveys deployed via the chatbot.

Main Outcome Measures & Results

Chatbots facilitated a relative increase in well-child visits and immunizations by 27% in the intervention group. Well-child visits and immunizations in the intervention group increased 13% compared to the control group. Survey results and patient interviews indicated a high level of patient satisfaction using the chatbot. In addition to a favorable perception of the chatbots, patients also identified future use cases for chatbots.

Engaging patients with chatbots improved vaccination and well-child uptake. Patients were highly satisfied with chatbot engagement. By engaging patients and caregivers, chatbots present the potential to proactively engage patients in care and optimize vaccination uptake and realize one of societies’ greatest public health achievements: decreasing the spread of communicable diseases.


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HRSA Maternal & Child Health. Submission requirements for the promoting pediatric primary prevention (P4) challenge. Health Resources & Services Administration. Available from: [cited 25 October 2022].

Brandtzaeg PB, Følstad A. Chatbots: changing user needs and motivations. Interactions. 2018;25(5):38–43. doi: 10.1145/3236669

Broderick A, Haque F. Mobile health and patient engagement in the safety net: a survey of community health centers and clinics. Issue Brief (Commonw Fund). 2015 May;9:1–9. PMID: 26040018.

Dumit EM, Novillo-Ortiz D, Contreras M, Velandia M, Danovaro-Holliday MC. The use of eHealth with immunizations: an overview of systematic reviews. Vaccine. 2018;36(52):7923–8. doi: 10.1016/j.vaccine.2018.06.076

Samuels RC, Ward VL, Melvin P, Macht-Greenberg M, Wenren LM, Yi J, et al. Missed appointments: factors contributing to high no-show rates in an urban pediatrics primary care clinic. Clin Pediatr. 2015;54(10):976–82. doi: 10.1177/0009922815570613

McNally VV, Bernstein HH. The effect of the COVID-19 pandemic on childhood immunizations: ways to strengthen routine vaccination. Pediatr Ann. 2020;49(12):e516–22. doi: 10.3928/19382359-20201115-01

Patel Murthy B, Zell E, Kirtland K, Jones-Jack N, Harris L, Sprague C, et al. Impact of the COVID-19 pandemic on administration of selected routine childhood and adolescent vaccinations—10 U.S. Jurisdictions, March-September 2020. MMWR Morb Mortal Wkly Rep. 2021 Jun 11;70(23):840–5. doi: 10.15585/mmwr.mm7023a2

Bramer CA, Kimmins LM, Swanson R, Kuo J, Vranesich P, Jacques-Carroll LA, et al. Decline in child vaccination coverage during the COVID-19 pandemic—Michigan Care Improvement Registry, May 2016–May 2020. MMWR Morb Mortal Wkly Rep. 2020 May 22;69(20):630–1. doi: 10.15585/mmwr.mm6920e1

Zubler JM, Wiggins LD, Macias MM, Whitaker TM, Shaw JS, Squires JK, et al. Evidence-informed milestones for developmental surveillance tools. Pediatrics. 2022 Mar 1;149(3):e2021052138. doi: 10.1542/peds.2021-052138

Hu R, Shi L, Sripipatana A, Liang H, Sharma R, Nair S, et al. The association of patient-centered medical home designation with quality of care of HRSA-funded health centers. Med Care. 2018;56(2):130–8. doi: 10.1097/MLR.0000000000000862

Demeke HB, Pao LZ, Clark H, Romero L, Neri A, Shah R, et al. Telehealth practice among health centers during the COVID-19 pandemic—United States, July 11–17, 2020. Morb Mortal Wkly Rep. 2020;69(50):1902. doi: 10.15585/mmwr.mm6950a4

CDC: catch up on well-child visits and recommended vaccinations. Available from: [cited 12 September 2022].

eCQI Resource Center ( childhood immunization status. Available from: [cited 12 September 2022].

Urbina C, Muyalde CM, Gudmundsson S. Patient and provider response to a prenatal pre-visit chatbot. Human Genetics Theses 96. 2021. Available from: [cited 25 October 2022].

Stockwell MS, Kharbanda EO, Martinez RA, Lara M, Vawdrey D, Natarajan K, et al. Text4Health: impact of text message reminder–recalls for pediatric and adolescent immunizations. Am J Public Health. 2012;102(2):e15–21. doi: 10.2105/AJPH.2011.300331



How to Cite

Mohanty, N., Yang, T.-Y. ., Morrison, J., Hossain, T., Wilson, A., & Ekong, A. (2022). CHEC-UP: A Digital Intervention to Reduce Disparities in Well-Child and Immunization Completion in Community Health . Telehealth and Medicine Today, 7(5).

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