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Real FJ, Zackoff MW, Rosen BL. Using Technology to Overcome Vaccine Hesitancy. Pediatr Clin North Am 2023; 70:297-308. [PMID: 36841597 DOI: 10.1016/j.pcl.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Technology holds great potential to address many vaccine hesitancy determinants and support vaccine uptake given its ability to amplify positive messages, support knowledge, and enhance providers' recommendations. Modalities previously implemented with variable success have included automated reminder systems, decision support for clinicians, online education programs, social media campaigns, and virtual reality curricula. Further research is needed to identify the optimal uses of technology at the patient/parent and provider levels to overcome vaccine hesitancy. The most effective interventions will likely be multipronged providing patients, parents, and providers with information related to vaccine status.
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Affiliation(s)
- Francis J Real
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, USA; Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, USA.
| | - Matthew W Zackoff
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, USA; Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, USA
| | - Brittany L Rosen
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, USA; Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, USA
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Choi J, Tamí-Maury I, Cuccaro P, Kim S, Markham C. Digital Health Interventions to Improve Adolescent HPV Vaccination: A Systematic Review. Vaccines (Basel) 2023; 11:vaccines11020249. [PMID: 36851127 PMCID: PMC9963303 DOI: 10.3390/vaccines11020249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
Digital technologies are being increasingly utilized in healthcare to provide pertinent and timely information for primary prevention, such as vaccination. This study aimed to conduct a systematic review to describe and assess current digital health interventions to promote HPV vaccination among adolescents and parents of adolescents, and to recommend directions for future interventions of this kind. Using appropriate medical subject headings and keywords, we searched multiple databases to identify relevant studies published in English between 1 January 2017 and 31 July 2022. We screened and selected eligible studies for inclusion in the final analysis. We reviewed a total of 24 studies, which included interventions using text messages (4), mobile apps (4), social media and websites (8), digital games (4), and videos (4). The interventions generally improved determinants of HPV vaccination, such as HPV-related knowledge, vaccine-related conversations, and vaccination intentions. In particular, text message and social media interventions targeted improved vaccine uptake behaviors, but little meaningful change was observed. In conclusion, digital health interventions can cost-effectively provide education about HPV vaccination, offer interactive environments to alleviate parental vaccine hesitancy, and ultimately help adolescents engage in HPV vaccine uptake.
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Affiliation(s)
- Jihye Choi
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Irene Tamí-Maury
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Paula Cuccaro
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Sooyoun Kim
- Institute of Health and Environment, Seoul National University, Seoul 08826, Republic of Korea
| | - Christine Markham
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Correspondence:
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Hasnan S, Tan NC. Multi-domain narrative review of vaccine hesitancy in childhood. Vaccine 2021; 39:1910-1920. [PMID: 33750590 DOI: 10.1016/j.vaccine.2021.02.057] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/11/2022]
Abstract
Vaccine hesitancy, where individuals delay or refuse some or all vaccines, is a perennial problem. It undermines the success of the immunisation programmes and places the society, especially vulnerable populations such as children, at risk of contracting infectious diseases. The phenomenon has been extensively analysed based on four aspects - confidence, complacency, convenience and costs. We suggest the alternative use of a multi-dimensional framework adapted from the "Generalist Wheel of Knowledge, Understanding and Inquiry" that was developed by Prof Larry Green and Kurt Stange, to assess the multiple facilitators and barriers towards vaccine hesitancy in childhood vaccination. The framework identifies domains in the healthcare system namely the child and parent/family, the clinician, the healthcare system and policy, and the infectious disease and corresponding vaccine that influence vaccine hesitancy. This narrative review includes literature beyond those covered by the World health Organisation Global Vaccine Action Plan (WHO GVAP). It identifies emotional distress, past negative experience and misconceptions that contribute to vaccine hesitancy in children and family, while attitude and motivation underpin vaccine hesitancy in clinicians. The healthcare system contributes to vaccine hesitancy when enforcements, diligent monitoring and transparency are absent or lacking. Inefficient dissemination of information about the disease and its associated vaccine as well as inadequate surveillance of misinformation add to vaccine hesitancy. The inter-domain factors highlight the roles of relationship between the clinician, child and parent, information mastery of the clinician, prioritisation of resources and equity in combating vaccine hesitancy. Using this framework, we present evidence-based strategies which have been effective in mitigating vaccine hesitancy for each domain and their corresponding inter-domains. By providing new perspectives of a complex problem and its potential solutions, this narrative review aims to complement and support the WHO GVAP by developing a coordinated multi-domain strategy to mitigate vaccine hesitancy in childhood.
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Affiliation(s)
| | - Ngiap Chuan Tan
- SingHealth Polyclinics, 167 Jalan Bukit Merah, Connection One Tower 5, #15-10, Singapore 160267, Singapore.
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Montagni I, Mabchour I, Tzourio C. Digital Gamification to Enhance Vaccine Knowledge and Uptake: Scoping Review. JMIR Serious Games 2020; 8:e16983. [PMID: 32348271 PMCID: PMC7265110 DOI: 10.2196/16983] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/13/2020] [Accepted: 03/20/2020] [Indexed: 01/18/2023] Open
Abstract
Background Vaccine hesitancy is a growing threat to population health, and effective interventions are needed to reduce its frequency. Digital gamification is a promising new approach to tackle this public health issue. Objective The purpose of this scoping review was to assess the amount and quality of outcomes in studies evaluating gamified digital tools created to increase vaccine knowledge and uptake. Methods We searched for peer-reviewed articles published between July 2009 and August 2019 in PubMed, Google Scholar, Journal of Medical Internet Research, PsycINFO, PsycARTICLES, Psychology and Behavioral Sciences Collection, and SocINDEX. Studies were coded by author, year of publication, country, journal, research design, sample size and characteristics, type of vaccine, theory used, game content, game modality, gamification element(s), data analysis, type of outcomes, and mean quality score. Outcomes were synthesized through the textual narrative synthesis method. Results A total of 7 articles met the inclusion criteria and were critically reviewed. Game modalities and gamification elements were diverse, but role play and a reward system were present in all studies. These articles included a mixture of randomized controlled trials, quasi-experimental studies, and studies comprising quantitative and qualitative measures. The majority of the studies were theory-driven. All the identified gamified digital tools were highly appreciated for their usability and were effective in increasing awareness of vaccine benefits and motivation for vaccine uptake. Conclusions Despite the relative paucity of studies on this topic, this scoping review suggests that digital gamification has strong potential for increasing vaccination knowledge and, eventually, vaccination coverage.
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Affiliation(s)
- Ilaria Montagni
- Bordeaux Population Health U1219, Inserm-University of Bordeaux, Bordeaux, France.,Institute of Public Health, Epidemiology and Development (ISPED), University of Bordeaux, Bordeaux, France
| | - Inass Mabchour
- Faculty of Medicine Hyacinthe Bastaraud, University of Antilles-Guyane, Pointe-à-Pitre, Guadeloupe
| | - Christophe Tzourio
- Bordeaux Population Health U1219, Inserm-University of Bordeaux, Bordeaux, France
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Šálek J, Čelko AM, Dáňová J. Vaccination Perception and Attitude among Undergraduate Medical and Teacher Education Students at Charles University, Prague, Czech Republic. Vaccines (Basel) 2020; 8:vaccines8010136. [PMID: 32204313 PMCID: PMC7157727 DOI: 10.3390/vaccines8010136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/12/2020] [Accepted: 03/17/2020] [Indexed: 11/16/2022] Open
Abstract
This cross-sectional comparative study was designed to evaluate different opinions and their impact on vaccine confidence, as perceived by students of two different university programs (medicine and teacher education), as both of them play important roles in patient education, with the latter major shaping the skills of critical thinking. Multi-item, opinion-based, paper-and-pencil anonymous questionnaires were distributed among students of medicine and teacher education. Data were sorted and divided into two sets to be analyzed using logistic regression. Out of a total of 722 respondents, 386 were medical students and 336 were teacher education students. While most respondents said they were not in favor of alternative medicine, a significantly higher number of alternative medicine followers were teacher education students. The positive vaccination perception rate (PVPR) is not dependent on the behavioral factors of student respondents (irrespective of their major) but is largely affected by their attitude to alternative medicine. Fear of infection dramatically increased the PVPR (up to 6.7 times) in those who were versus were not afraid of getting infected or were not quite sure whether to fear it. Fear of side effects of vaccination clearly decreased the PVPR, by at least 84%.
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Abstract
The avalanche of online information on immunization is having a major impact on the percentage of the population who choose to get vaccinated. Vaccine misinformation spreads widely with the interactive Web 2.0 and social media; this can bury science-based information. A plethora of immunization misinformation online is affecting trust in health care professionals and in public immunization programs. There are no simple solutions to this, but seven evidence-based strategies can help. First, listen to patients' and parents' concerns, and demonstrate responsiveness by adopting best immunization practices, such as pain mitigation. Second, recognize and alert others to anti-immunization tactics, namely, conspiracy theories, fake experts, selectivity, demands that vaccines be 100% safe and effective, misrepresentation and false logic. Third, avoid unproductive debates with those who have strongly held views, both in person and when using social media. Be respectful, stick to your key message, identify where to find useful information and exit. Fourth, consider establishing an attractive, easily searchable online presence that reflects the complex art of persuasion. Emphasize the benefits of vaccine, use reader-friendly graphics and highlight facts with stories to strengthen your case. Fifth, work with social media platform providers, not to stifle freedom of expression, but to help ensure that misinformation is not favoured in searches. Sixth, promote curriculum development in the schools to improve students' understanding of the benefits and safety of immunization and to foster critical thinking skills. To do this, optimize the use of age-appropriate comics and interactive learning tools such as electronic games. Seventh, to shift the narrative in specific communities with low vaccination rates, work with community leaders to build tailored programs that foster trust and reflect local values.
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Wilson L, Rubens-Augustson T, Murphy M, Jardine C, Crowcroft N, Hui C, Wilson K. Barriers to immunization among newcomers: A systematic review. Vaccine 2018; 36:1055-1062. [PMID: 29395515 DOI: 10.1016/j.vaccine.2018.01.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/09/2018] [Accepted: 01/10/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Currently, there is a lack of comprehensive evidence exploring vaccine decision-making among newcomers. We conducted a systematic review of qualitative studies aimed at identifying factors that influence newcomers' decision-making with regards to vaccination. METHODS We conducted a search of MEDLINE, EMBASE, CINAHL and Cochrane Central. To be included, studies needed to employ a qualitative methodology and address newcomer attitudes, beliefs, and/or perceptions regarding vaccination. Two independent reviewers screened the articles for relevant information and applied a content analysis methodology to code the identified barriers. RESULTS Twenty-one studies were included in this review, and four types of barriers were identified: cultural factors, knowledge barriers, insufficient access to healthcare, and vaccine hesitancy. Insufficient knowledge about vaccination and the virus being prevented and concerns about safety were the most commonly reported barriers. A sub-analysis of barriers specific to HPV indicated that cultural beliefs about sexuality and incomplete knowledge about the role of HPV in the development of cervical cancer are major barriers to vaccine uptake. CONCLUSION Strategies to improve vaccination uptake in newcomers should consider focusing on the barriers identified in this review while taking into account the unique opportunities for promoting uptake within newcomer populations.
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Affiliation(s)
- Lindsay Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON K1Y 4E9, Canada.
| | - Taylor Rubens-Augustson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON K1Y 4E9, Canada; Faculty of Medicine, Lund University, Box 117, 221 00 Lund, Sweden.
| | - Malia Murphy
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON K1Y 4E9, Canada.
| | - Cindy Jardine
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405-87 Ave, Edmonton, AB T6G 1C9, Canada.
| | - Natasha Crowcroft
- Public Health Ontario, 480 University Avenue, Toronto, ON M5G 1V2, Canada; Laboratory Medicine and Pathobiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada.
| | - Charles Hui
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON K1H 8M5, Canada.
| | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON K1Y 4E9, Canada.
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Carolan K, Verran J, Crossley M, Redfern J, Whitton N, Amos M. Impact of educational interventions on adolescent attitudes and knowledge regarding vaccination: A pilot study. PLoS One 2018; 13:e0190984. [PMID: 29351325 PMCID: PMC5774691 DOI: 10.1371/journal.pone.0190984] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/22/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Current immunisation levels in England currently fall slightly below the threshold recommended by the World Health Organization, and the three-year trend for vaccination uptake is downwards. Attitudes towards vaccination can affect future decisions on whether or not to vaccinate, and this can have significant public health implications. Interventions can impact future vaccination decisions, and these interventions can take several forms. Relatively little work has been reported on the use of vaccination interventions in young people, who form the next generation of individuals likely to make vaccination decisions. METHOD We investigated the impact of two different types of educational intervention on attitudes towards vaccination in young people in England. A cohort of young people (n = 63) was recruited via a local school. This group was divided into three sub-groups; one (n = 21) received a presentation-based intervention, one (n = 26) received an interactive simulation-based intervention, and the third (n = 16) received no intervention. Participants supplied information on (1) their attitudes towards vaccination, and (2) their information needs and views on personal choice concerning vaccination, at three time points: immediately before and after the intervention, and after six months. RESULTS Neither intervention had a significant effect on participants' attitudes towards vaccination. However, the group receiving the presentation-based intervention saw a sustained uplift in confidence about information needs, which was not observed in the simulation-based intervention group. DISCUSSION Our findings with young people are consistent with previous work on vaccination interventions aimed at adults, which have shown limited effectiveness, and which can actually reduce intention to vaccinate. Our findings on the most effective mode of delivery for the intervention should inform future discussion in the growing "games for health" domain, which proposes the use of interactive digital resources in healthcare education.
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Affiliation(s)
- Kate Carolan
- School of Computing, Mathematics and Digital Technology, Manchester Metropolitan University, Manchester, United Kingdom
| | - Joanna Verran
- School of Healthcare Science, Manchester Metropolitan University, Manchester, United Kingdom
| | - Matthew Crossley
- School of Computing, Mathematics and Digital Technology, Manchester Metropolitan University, Manchester, United Kingdom
| | - James Redfern
- School of Healthcare Science, Manchester Metropolitan University, Manchester, United Kingdom
| | - Nicola Whitton
- Faculty of Education, Manchester Metropolitan University, Manchester, United Kingdom
| | - Martyn Amos
- School of Computing, Mathematics and Digital Technology, Manchester Metropolitan University, Manchester, United Kingdom
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Bhatti UA, Huang M, Wang H, Zhang Y, Mehmood A, Di W. Recommendation system for immunization coverage and monitoring. Hum Vaccin Immunother 2017; 14:165-171. [PMID: 29068748 DOI: 10.1080/21645515.2017.1379639] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Immunization averts an expected 2 to 3 million deaths every year from diphtheria, tetanus, pertussis (whooping cough), and measles; however, an additional 1.5 million deaths could be avoided if vaccination coverage was improved worldwide. 11 Data source for immunization records of 1.5 M: http://www.who.int/mediacentre/factsheets/fs378/en/ New vaccination technologies provide earlier diagnoses, personalized treatments and a wide range of other benefits for both patients and health care professionals. Childhood diseases that were commonplace less than a generation ago have become rare because of vaccines. However, 100% vaccination coverage is still the target to avoid further mortality. Governments have launched special campaigns to create an awareness of vaccination. In this paper, we have focused on data mining algorithms for big data using a collaborative approach for vaccination datasets to resolve problems with planning vaccinations in children, stocking vaccines, and tracking and monitoring non-vaccinated children appropriately. Geographical mapping of vaccination records helps to tackle red zone areas, where vaccination rates are poor, while green zone areas, where vaccination rates are good, can be monitored to enable health care staff to plan the administration of vaccines. Our recommendation algorithm assists in these processes by using deep data mining and by accessing records of other hospitals to highlight locations with lower rates of vaccination. The overall performance of the model is good. The model has been implemented in hospitals to control vaccination across the coverage area.
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Affiliation(s)
- Uzair Aslam Bhatti
- a State Key Laboratory of Marine Resource Utilization in South China Sea , Hainan University , Haikou , China.,b Computer Science , College of Information Science & Technology, Hainan University , Haikou , China
| | - Mengxing Huang
- a State Key Laboratory of Marine Resource Utilization in South China Sea , Hainan University , Haikou , China.,b Computer Science , College of Information Science & Technology, Hainan University , Haikou , China
| | - Hao Wang
- c Big Data Lab, Dept. of ICT and Natural Sciences , Norwegian University of Science and Technology , Aalesund , Norway
| | - Yu Zhang
- a State Key Laboratory of Marine Resource Utilization in South China Sea , Hainan University , Haikou , China.,b Computer Science , College of Information Science & Technology, Hainan University , Haikou , China
| | - Anum Mehmood
- d College of Molecular Biology and Biochemistry, Hainan University , Haikou , China
| | - Wu Di
- a State Key Laboratory of Marine Resource Utilization in South China Sea , Hainan University , Haikou , China.,b Computer Science , College of Information Science & Technology, Hainan University , Haikou , China
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