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Norman G, Kletter M, Dumville J. Interventions to increase vaccination in vulnerable groups: rapid overview of reviews. BMC Public Health 2024; 24:1479. [PMID: 38831275 PMCID: PMC11145854 DOI: 10.1186/s12889-024-18713-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 04/25/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVE Groups which are marginalised, disadvantaged or otherwise vulnerable have lower uptake of vaccinations. This differential has been amplified in COVID-19 vaccination compared to (e.g.) influenza vaccination. This overview assessed the effectiveness of interventions to increase vaccination in underserved, minority or vulnerable groups. METHODS In November 2022 we searched four databases for systematic reviews that included RCTs evaluating any intervention to increase vaccination in underserved, minority or vulnerable groups; our primary outcome was vaccination. We used rapid review methods to screen, extract data and assess risk of bias in identified reviews. We undertook narrative synthesis using an approach modified from SWiM guidance. We categorised interventions as being high, medium or low intensity, and as targeting vaccine demand, access, or providers. RESULTS We included 23 systematic reviews, including studies in high and low or middle income countries, focused on children, adolescents and adults. Groups were vulnerable based on socioeconomic status, minority ethnicity, migrant/refugee status, age, location or LGBTQ identity. Pregnancy/maternity sometimes intersected with vulnerabilities. Evidence supported interventions including: home visits to communicate/educate and to vaccinate, and facilitator visits to practices (high intensity); telephone calls to communicate/educate, remind/book appointments (medium intensity); letters, postcards or text messages to communicate/educate, remind/book appointments and reminder/recall interventions for practices (low intensity). Many studies used multiple interventions or components. CONCLUSION There was considerable evidence supporting the effectiveness of communication in person, by phone or in writing to increase vaccination. Both high and low intensity interventions targeting providers showed effectiveness. Limited evidence assessed additional clinics or targeted services for increasing access; only home visits had higher confidence evidence showing effectiveness. There was no evidence for interventions for some communities, such as religious minorities which may intersect with gaps in evidence for additional services. None of the evidence related to COVID-19 vaccination where inequalities of outcome are exacerbated. PROSPERO REGISTRATION CRD42021293355.
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Affiliation(s)
- Gill Norman
- NIHR Innovation Observatory, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Maartje Kletter
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Jo Dumville
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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2
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Su Y, Zhang X, Zhang S. The impact of collective action dilemma on vaccine hesitancy: Evidence from China. Hum Vaccin Immunother 2023; 19:2256041. [PMID: 37747070 PMCID: PMC10521338 DOI: 10.1080/21645515.2023.2256041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/01/2023] [Indexed: 09/26/2023] Open
Abstract
Vaccine hesitancy has dramatically decreased the speed of vaccination and stalled global health development. While the factors influencing vaccine hesitancy and mitigation measures have been explored in depth by existing studies, research from the perspective of human interaction is lacking. Based on the theory of collective action, this paper analyzes how free riding behavior affects vaccine hesitancy and how the vaccine hesitancy caused by free riding behavior can be solved. Using 2,203 survey data sets from China, this paper examines the influence of the collective action dilemma - represented by free riding behavior - on COVID-19 vaccine hesitancy. The empirical results show that the existence of free riding behavior is an essential cause of vaccine hesitancy. Based on this conclusion, this paper discusses how to further alleviate the problem of vaccine hesitancy caused by collective action dilemmas by promoting cooperation. The findings of this paper may be helpful to promote various types of vaccines and further suggest that countries should assume the perspective of solving the collective action dilemma to achieve increased vaccination rates.
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Affiliation(s)
- Yiqing Su
- School of Public Policy and Management, Guangxi University, Nanning, China
| | - Xiaoting Zhang
- School of Public Policy and Management, Guangxi University, Nanning, China
| | - Shifei Zhang
- School of Public Policy and Management, Guangxi University, Nanning, China
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3
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Steffens MS, Bullivant B, King C, Bolsewicz K. “I’m scared that if I have the vaccine, it’s going to make my lung condition worse, not better.” COVID-19 vaccine acceptance in adults with underlying health conditions – a qualitative investigation. Vaccine X 2022; 12:100243. [PMCID: PMC9686055 DOI: 10.1016/j.jvacx.2022.100243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 10/09/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022] Open
Abstract
Background Sustained uptake of COVID-19 vaccines, including booster doses, will continue to be key to minimising morbidity and mortality caused by COVID-19. Because hesitancy can affect people’s motivation to get vaccinated, understanding and addressing factors influencing acceptance is critical to achieving high uptake. This is especially the case for adults with underlying health conditions, who are at increased risk of severe illness from COVID-19. The aim of this study was to investigate barriers and facilitators of COVID-19 vaccine acceptance in adults with underlying health conditions during the initial rollout of COVID-19 vaccines in Australia. Methods We conducted semi-structured, qualitative interviews with 15 adults with underlying health conditions in New South Wales (NSW) in April 2021, focusing on their previous vaccination experiences and feelings about COVID-19 vaccination. We categorised participants as accepting, hesitant or refusing. We analysed interviews thematically, informed by the World Health Organization (WHO) Behavioural and Social Drivers of Vaccination framework. Results Most (12/15) participants were hesitant about COVID-19 vaccination. Barriers to COVID-19 vaccine acceptance included concerns about vaccine safety and effectiveness; heightened perceptions of risk regarding the vaccines; low perceptions of COVID-19 risk; and negative social influences. Facilitators included perceived benefits of vaccination and positive social influences. Conclusions For some adults with underlying health conditions, perceptions of heightened vulnerability to COVID-19 vaccine side effects contributed to vaccine hesitancy during the initial rollout of COVID-19 vaccines. We recommend supporting GPs and specialists to proactively reach out and recommend COVID-19 vaccination to this population; encouraging chronic disease organisations to act as trusted advocates of COVID-19 vaccination; and actively communicating evolving knowledge about vaccine safety.
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Affiliation(s)
- Maryke S Steffens
- National Centre for Immunisation Research and Surveillance, Sydney, NSW, Australia,The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia,Corresponding author at: NCIRS, Locked Bag 4001, Westmead NSW 2145, Australia
| | - Bianca Bullivant
- National Centre for Immunisation Research and Surveillance, Sydney, NSW, Australia,The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Catherine King
- National Centre for Immunisation Research and Surveillance, Sydney, NSW, Australia,The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Katarzyna Bolsewicz
- National Centre for Immunisation Research and Surveillance, Sydney, NSW, Australia,The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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4
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Murphy RP, Taaffe C, Ahern E, McMahon G, Muldoon O. A meta-analysis of influenza vaccination following correspondence: Considerations for COVID-19. Vaccine 2021; 39:7606-7624. [PMID: 34836661 PMCID: PMC8592234 DOI: 10.1016/j.vaccine.2021.11.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/18/2021] [Accepted: 11/08/2021] [Indexed: 11/20/2022]
Abstract
Background High vaccination rates are needed to protect against influenza and to end the COVID-19 pandemic. Health authorities need to know if supplementing mass communications with direct correspondence to the community would increase uptake. Objectives The primary objective is to determine if sending a single written message directly to individuals increases influenza vaccine uptake, and a secondary objective is to identify any identified content shown to increase influenza vaccine uptake. Methods MEDLINE, Embase, Cochrane CENTRAL, PsycINFO, and PubMed were searched for RCTs testing a single correspondence for members of the community in OECD countries to obtain influenza vaccination. A meta-analysis with inverse-variance, random-effects modelling was used to estimate a mean, weighted risk ratio effect size measure of vaccine uptake. Studies were quality assessed and analysis was undertaken to account for potential publication bias. Results Twenty-eight randomized controlled trials were included, covering 45 interventions. Of the 45 interventions, 37 (82.2%) report an increase in influenza vaccination rates. A formal meta-analysis shows that sending a single written message increased influenza vaccine uptake by 16%, relative to the no contact comparator group (RR = 1.16, 95% CI [1.13-1.20], Z = 9.25, p < .001). Analysis shows that the intervention is effective across correspondence type, age group, time, and location, and after allowing for risk of publication bias. Limitations The generalizability of results across the OECD may be questioned. Conclusions and implications The implication for public health authorities organizing vaccination programs for influenza, and arguably also for COVID-19, is that sending written vaccination correspondence to members of the community is likely to increase uptake. Keywords: vaccine uptake, COVID-19, influenza, direct correspondence, meta-analysis. This study is pre-registered on osf.io; details can be found at https://osf.io/98mr7
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Affiliation(s)
- Robert P Murphy
- Stirling Management School, University of Stirling, Ireland; Department of Health, Ireland.
| | | | - Elayne Ahern
- School of Psychology, Dublin City University, Ireland
| | - Grace McMahon
- Department of Psychology, University of Limerick, Ireland
| | - Orla Muldoon
- Department of Psychology, University of Limerick, Ireland
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5
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Evans S, Klas A, Mikocka-Walus A, German B, Rogers G, Ling M, Fernando J, Kothe E, Westrupp E. "Poison" or "protection"? A mixed methods exploration of Australian parents' COVID-19 vaccination intentions. J Psychosom Res 2021; 150:110626. [PMID: 34583017 PMCID: PMC8503786 DOI: 10.1016/j.jpsychores.2021.110626] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The success of COVID-19 vaccination programs relies on community attitudes, yet little is known about parents' views. We aimed to explore the reasons behind Australian parents' vaccine intentions for themselves and for their children. METHOD This mixed methods study relates to Wave 13 (January 2021) of a longitudinal study of Australian parents' experiences during COVID-19 and contained 1094 participants (83% mothers). We used multinomial logistic regression to understand demographic predictors of vaccine intention, and a descriptive template thematic analysis to analyse open-ended questions about parents' reasons for vaccine intentions for themselves and their children. RESULTS 64% of Australian parents intend on vaccination, 26% are unsure and 9% intend to decline; 48% intend to vaccinate their children, 38% are unsure, and 14% intend to decline. Relative to those intending to vaccinate, parents unsure (OR = -0.63, 95% CI: 0.46, -0.84, p = .002) or not intending (OR = -0.41, 95% CI: 0.24, 0.67 p < .001) to vaccinate were more likely to have lower trust in doctors. Similar predictors emerged for parents who did not intend to vaccinate their children (OR = 0.47, 95% CI: 0.31, 0.70, p < .001). Qualitative data indicated that many parents had not made a firm decision, including a lack of alignment between intentions and reasons. For example, parents who said 'yes' to vaccination, often then expressed hesitance and a focus on risks in their written response. Reasons for hesitancy for themselves included concerns about testing, side effects, and long-term outcomes. Similar themes were present for children, but parents expressed a strong desire to protect their children, and an eagerness for health information. CONCLUSION Based on prior research and the themes identified here, a multipronged campaign that includes education/promotion, good access to vaccines and role models, is likely to support parents to make informed decisions regarding COVID-19 vaccination.
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Affiliation(s)
- S. Evans
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Victoria, Australia,Corresponding author at: School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - A. Klas
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Victoria, Australia,Deakin University, Misinformation Lab, School of Psychology, Victoria, Australia
| | - A. Mikocka-Walus
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Victoria, Australia
| | - B. German
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Victoria, Australia
| | - G.D. Rogers
- School of Medicine, Deakin University, Victoria, Australia
| | - M. Ling
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Victoria, Australia,Deakin University, Misinformation Lab, School of Psychology, Victoria, Australia
| | - J.W. Fernando
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Victoria, Australia
| | - E. Kothe
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Victoria, Australia,Deakin University, Misinformation Lab, School of Psychology, Victoria, Australia
| | - E.M. Westrupp
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Victoria, Australia,Department of Paediatrics, University of Melbourne, Victoria, Australia,Judith Lumley Centre, La Trobe University, Victoria, Australia
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6
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Sabbatucci M, Odone A, Signorelli C, Siddu A, Maraglino F, Rezza G. Improved Temporal Trends of Vaccination Coverage Rates in Childhood after the Mandatory Vaccination Act, Italy 2014-2019. J Clin Med 2021; 10:2540. [PMID: 34201199 PMCID: PMC8230222 DOI: 10.3390/jcm10122540] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/23/2021] [Accepted: 06/04/2021] [Indexed: 11/28/2022] Open
Abstract
Maintaining high vaccine coverage (VC) for pediatric vaccinations is crucial to ensure herd immunity, reducing the risk of vaccine-preventable diseases (VPD). The Italian vaccination Law (n. 119/2017) reinforced mandates for polio, diphtheria, tetanus, and hepatitis B, extending the mandate to pertussis, Haemophilus influenzae type b, chickenpox, measles, mumps, and rubella, for children up to 16 years of age. We analyzed the national temporal trends of childhood immunization rates from 2014 to 2019 to evaluate the impact of the mandatory reinforcement law set in 2017 as a sustainable public health strategy in Italy. In a 3-year period, 9 of the 10 compulsory vaccinations reached the threshold of 95% and VC for chicken pox increased up to 90.5%, significantly. During the same period, the recommended vaccinations (against meningococcus B and C, pneumococcus, and rotavirus) also recorded a significant increase in VC trends. In conclusion, although the reinforcement of compulsory vaccination generated a wide public debate that was amplified by traditional and social media, the 3-year evaluation highlights positive results.
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Affiliation(s)
- Michela Sabbatucci
- Department Infectious Diseases, National Institute of Health, 00161 Rome, Italy
- Ministry of Health, Directorate General Health Prevention, Communicable Diseases and International Prophylaxis, 20379 Rome, Italy; (A.S.); (F.M.); (G.R.)
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Carlo Signorelli
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy;
| | - Andrea Siddu
- Ministry of Health, Directorate General Health Prevention, Communicable Diseases and International Prophylaxis, 20379 Rome, Italy; (A.S.); (F.M.); (G.R.)
| | - Francesco Maraglino
- Ministry of Health, Directorate General Health Prevention, Communicable Diseases and International Prophylaxis, 20379 Rome, Italy; (A.S.); (F.M.); (G.R.)
| | - Giovanni Rezza
- Ministry of Health, Directorate General Health Prevention, Communicable Diseases and International Prophylaxis, 20379 Rome, Italy; (A.S.); (F.M.); (G.R.)
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7
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Removing conscientious objection: The impact of 'No Jab No Pay' and 'No Jab No Play' vaccine policies in Australia. Prev Med 2021; 145:106406. [PMID: 33388333 DOI: 10.1016/j.ypmed.2020.106406] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 12/22/2020] [Accepted: 12/29/2020] [Indexed: 02/07/2023]
Abstract
Vaccine refusal and hesitancy pose a significant public health threat to communities. Public health authorities have been developing a range of strategies to improve childhood vaccination coverage. This study examines the effect of removing conscientious objection on immunisation coverage for one, two and five year olds in Australia. Conscientious objection was removed from immunisation requirement exemptions for receipt of family assistance payments (national No Jab No Pay) and enrolment in childcare (state No Jab No Play). The impact of these national and state-level policies is evaluated using quarterly coverage data from the Australian Immunisation Register linked with regional data from the Australian Bureau of Statistics at the statistical area level between 2014 and 2018. Results suggest that there have been overall improvements in coverage associated with No Jab No Pay, and states that implemented additional No Jab No Play and tightened documentation requirement policies tended to show more significant increases. However, policy responses were heterogeneous. The improvement in coverage was largest in areas with greater socioeconomic disadvantage, lower median income, more benefit dependency, and higher pre-policy baseline coverage. Overall, while immunisation coverage has increased post removal of conscientious objection, the policies have disproportionally affected lower income families whereas socioeconomically advantaged areas with lower baseline coverage were less responsive. More effective strategies require investigation of differential policy effects on vaccine hesitancy, refusal and access barriers, and diagnosis of causes for unresponsiveness and under-vaccination in areas with persistently low coverage, to better address areas with persistent non-compliance with accordant interventions.
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8
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ElBagoury M, Tolba MM, Nasser HA, Jabbar A, Elagouz AM, Aktham Y, Hutchinson A. The find of COVID-19 vaccine: Challenges and opportunities. J Infect Public Health 2021; 14:389-416. [PMID: 33647555 PMCID: PMC7773313 DOI: 10.1016/j.jiph.2020.12.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 11/30/2020] [Accepted: 12/20/2020] [Indexed: 12/19/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus (SARS-CoV-2), a novel corona virus, causing COVID-19 with Flu-like symptoms is the first alarming pandemic of the third millennium. SARS-CoV-2 belongs to beta coronavirus as Middle East respiratory syndrome coronavirus (MERS-CoV). Pandemic COVID-19 owes devastating mortality and destructively exceptional consequences on Socio-Economics life around the world. Therefore, the current review is redirected to the scientific community to owe comprehensive visualization about SARS-CoV-2 to tackle the current pandemic. As systematically shown through the current review, it indexes unmet medical problem of COVID-19 in view of public health and vaccination discovery for the infectious SARS-CoV-2; it is currently under-investigational therapeutic protocols, and next possible vaccines. Furthermore, the review extensively reports the precautionary measures to achieve" COVID-19/Flatten the curve". It is concluded that vaccines formulation within exceptional no time in this pandemic is highly recommended, via following the same protocols of previous pandemics; MERS-CoV and SARS-CoV, and excluding some initial steps of vaccination development process.
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Affiliation(s)
- Marwan ElBagoury
- University of South Wales, Pontypridd, Wales, United Kingdom; The Student Science and Technology Online Research Coop, Ontario, Canada.
| | - Mahmoud M Tolba
- Pharmaceutical division, ministry of health and population, Cairo, Egypt
| | - Hebatallah A Nasser
- Microbiology and Public Health Department, Faculty of Pharmacy, Heliopolis University, Cairo, Egypt
| | - Abdul Jabbar
- Department of Clinical Medicine, University of Veterinary and Animal Sciences, Lahore Punjab Pakistan
| | - Ahmed M Elagouz
- University of South Wales, Pontypridd, Wales, United Kingdom
| | - Yahia Aktham
- University of South Wales, Pontypridd, Wales, United Kingdom
| | - Amy Hutchinson
- The Student Science and Technology Online Research Coop, Ontario, Canada; McMaster University, Hamilton, Canada
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9
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Interventions to reduce the burden of vaccine-preventable diseases among migrants and refugees worldwide: A scoping review of published literature, 2006-2018. Vaccine 2020; 38:7217-7225. [PMID: 33008670 DOI: 10.1016/j.vaccine.2020.09.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/21/2020] [Accepted: 09/16/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Disparities in vaccine-preventable disease (VPD) burden and immunisation coverage between migrants and refugees and their host populations have been described in numerous countries worldwide. Effective strategies are required to reduce the health disparities and immunisation inequities experienced by migrants and refugees. METHODS Using Arksey and O'Malley's framework, we conducted a scoping review to identify available literature on interventions aimed at reducing VPD burden among migrants and refugees worldwide. We searched for relevant empirical, peer-reviewed literature published in English between 2006 and 2018 using MEDLINE, Ovid EMBASE, CINAHL, Sociological Abstracts, and Web of Science databases. Relevant information from the studies, including intervention type, details and outcomes, were charted in Microsoft Excel and results were summarised using a descriptive analytical method. RESULTS Seventy studies met the inclusion criteria. The number of published studies increased over the years. The majority of studies were conducted in high-income countries. More studies were conducted among migrants (not including refugees) (n = 48, 66%) than specifically among refugees (n = 25, 34%). Interventions were implemented in a variety of settings, including health care (n = 31, 42%), community (n = 29, 39%), off-shore (n = 7, 9%), national (n = 4, 5%), school (n = 2, 3%), and workplace (n = 1, 1%). Studies reported interventions focused at the individual (to facilitate uptake of health services) (n = 4, 5%), community (to raise awareness) (n = 25, 34%), provider (to offer health services) (n = 12, 16%) and/or system (to increase compliance with recommendations) (n = 33, 45%) level. To be effective, interventions were designed to overcome commonly identified barriers to accessing services related to language, culture, distance and cost. Engagement with community members and organisations was an effective way to co-design interventions that address migrants' specific needs. CONCLUSIONS Studies emphasised the importance of interventions that address the heterogeneity within and between migrant and refugee populations. Considerable variation in practice remains, therefore more evaluation of interventions is needed to inform policy and programme decision-making.
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10
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Spinks J, Bettington E, Downes M, Nissen L, Wheeler A. Does policy change to allow pharmacist provision of influenza vaccination increase population uptake? A systematic review. AUST HEALTH REV 2020; 44:582-589. [PMID: 32674753 DOI: 10.1071/ah19196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 12/02/2019] [Indexed: 11/23/2022]
Abstract
Objective The aims of this study were to estimate the effect of pharmacists' vaccinating for influenza on overall vaccination rates and to assess whether any effect differs for at-risk subgroups compared with the general population. Methods A systematic review was undertaken, adhering to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Databases were searched during July 2019 and included Medline (Ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus and the Cochrane Library. Results The largest difference reported in overall population vaccination rates associated with pharmacists undertaking influenza vaccinations was an increase of 10%; the smallest showed no discernible effect. The effect was graduated: pharmacists with the most autonomy demonstrated the largest rate increases. There was evidence of substitution by pharmacists, but the effect size was small. Conclusions The effect of allowing pharmacists to administer influenza vaccinations appears positive, but small. Given that pharmacists are likely to provide vaccinations at a lower cost than doctors, there may be cost-savings to the health system and consumers. Future research may include evaluating pharmacist-provided vaccinations compared with (or in combination with) other strategies, such as advertising, to increase access and uptake across the range of providers, as well as ongoing research to address vaccine hesitancy. What is known about the topic? In Australia, and many other countries, community pharmacies provide an alternative and accessible option for influenza vaccination; however the effect on overall vaccination rates remains unclear. What does this paper add? This systematic review of the international literature suggests that pharmacist-provided vaccinations increase uptake; substitution of doctors by pharmacists may result in cost savings. What are the implications for practitioners? The findings of this study are important for health policy makers and health workforce researchers aiming to maximise population vaccination rates and workforce efficiency. In the absence of available Australian data, data from the international experience of legislating pharmacists to vaccinate against influenza are summarised and critiqued. Results can be used when determining the best health workforce and policy mix with regard to the vaccination workforce.
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Affiliation(s)
- Jean Spinks
- Centre for Applied Health Economics, 1.11 N78, 170 Kessels Road, Griffith University, Nathan, Qld 4111, Australia. ; and Menzies Health Institute Queensland, Griffith University, Brisbane, Qld 4111, Australia. ; and Corresponding author.
| | - Emilie Bettington
- Australian Government, Department of Health, Level 15, 160 Ann Street, Brisbane, Qld 4000, Australia.
| | - Martin Downes
- Centre for Applied Health Economics, 1.11 N78, 170 Kessels Road, Griffith University, Nathan, Qld 4111, Australia. ; and Menzies Health Institute Queensland, Griffith University, Brisbane, Qld 4111, Australia.
| | - Lisa Nissen
- Faculty of Health, Level 9, Q Block, Room 911, Queensland University of Technology, Brisbane, Qld 4000, Australia.
| | - Amanda Wheeler
- Menzies Health Institute Queensland, Griffith University, Brisbane, Qld 4111, Australia. ; and School of Human Services and Social Work, N17 1.02, 170 Kessels Road, Griffith University, Nathan, Qld 4111, Australia
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11
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Bolsewicz K, Thomas S, Moore D, Gately C, Dixon A, Cook P, Lewis P. Using the Tailoring Immunization Programmes guide to improve child immunisation in Umina, New South Wales: we could still do better. Aust J Prim Health 2020; 26:325-331. [PMID: 32659208 DOI: 10.1071/py19247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/02/2020] [Indexed: 11/23/2022]
Abstract
In the Central Coast Local Health District of New South Wales, Australia, childhood immunisation (CI) rates are around 95%, but pockets of underimmunisation exist. Using the World Health Organization's Tailoring Immunization Programmes, we identified areas of potential low vaccine coverage using Australian Immunisation Register (AIR) data (2016-18) and investigated factors that influence CI. Individual and group interviews with carers, community members and service providers (n=52 participants) were conducted. Data were analysed thematically and the themes presented to stakeholders for feedback before finalisation. During 2018, Umina had 218 children at least 1 month overdue for at least one vaccination. Five themes emerged: (1) broader socioeconomic factors may apply pressures that influence CI; (2) parents largely supported immunisation and knew of its benefits to their children and the community; (3) immunisation service providers are committed, experienced and collaborate with community partners; (4) there is potential to increase access to free immunisation services in Umina; and (5) AIR data and reminder systems could be better used to inform service delivery and prompt parents before immunisations are due. This study identified opportunities to improve CI coverage in Umina and new information useful in developing a tailored immunisation strategy. Awareness of the pressures socioeconomic factors may have on families could help plan and deliver supportive primary health care that includes equitable access to immunisation.
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Affiliation(s)
- Katarzyna Bolsewicz
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; and Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287, Australia
| | - Susan Thomas
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; and Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287, Australia; and Corresponding author.
| | - Donna Moore
- Central Coast Local Health District, PO Box 361, Gosford, NSW 2250, Australia
| | - Colleen Gately
- Central Coast Local Health District, PO Box 361, Gosford, NSW 2250, Australia
| | - Andrew Dixon
- Central Coast Local Health District, PO Box 361, Gosford, NSW 2250, Australia
| | - Paul Cook
- Central Coast Local Health District, PO Box 361, Gosford, NSW 2250, Australia
| | - Peter Lewis
- Central Coast Local Health District, PO Box 361, Gosford, NSW 2250, Australia
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Menzies R, Aqel J, Abdi I, Joseph T, Seale H, Nathan S. Why is influenza vaccine uptake so low among Aboriginal adults? Aust N Z J Public Health 2020; 44:279-283. [PMID: 32583522 DOI: 10.1111/1753-6405.13004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 04/01/2020] [Accepted: 05/01/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Determine major barriers to, and facilitators of, influenza vaccination of Aboriginal adults, in order to improve coverage from the current level of 30%. METHODS i) A focus group with 13 Aboriginal Immunisation Healthcare Workers; and ii) a cross-sectional survey of Aboriginal people aged ≥18 years at the 2017 New South Wales Koori Knockout (29 September-2 October). RESULTS The focus group nominated poor identification of Aboriginality in general practice. Of 273 survey respondents, a substantial minority (30%) were unaware of their eligibility for free influenza vaccination. More than half (52%) believed the vaccine could cause influenza, 40% reported there were better ways than vaccination for avoiding infection and 30% said they would not have the vaccine if it was offered to them. Regarding health service access, few reported experiencing difficulty (17%), feeling uncomfortable (15%) or being discriminated against (8%), but 53% reported not receiving a reminder from a health professional. CONCLUSIONS Misconceptions about influenza disease and vaccine among Aboriginal people and inadequate identification of Aboriginality in general practice appear to be the greatest barriers to vaccination, rather than health service access in general. Implications for public health: More active communication to and targeting of Aboriginal adults is required; this is even more urgent following the arrival of COVID-19.
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Affiliation(s)
- Robert Menzies
- School of Public Health and Community Medicine, University of NSW, New South Wales.,Kirby Institute, University of NSW, New South Wales
| | - Jalil Aqel
- School of Public Health and Community Medicine, University of NSW, New South Wales
| | - Ikram Abdi
- School of Public Health and Community Medicine, University of NSW, New South Wales
| | - Telphia Joseph
- School of Public Health and Community Medicine, University of NSW, New South Wales
| | - Holly Seale
- School of Public Health and Community Medicine, University of NSW, New South Wales
| | - Sally Nathan
- School of Public Health and Community Medicine, University of NSW, New South Wales
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13
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Menzies R, Heron L, Lampard J, McMillan M, Joseph T, Chan J, Storken A, Marshall H. A randomised controlled trial of SMS messaging and calendar reminders to improve vaccination timeliness in infants. Vaccine 2020; 38:3137-3142. [PMID: 32147296 DOI: 10.1016/j.vaccine.2020.02.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 02/11/2020] [Accepted: 02/16/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The effectiveness of SMS reminders in improving vaccination coverage has been assessed previously, with effectiveness varying between settings. However, there are very few studies on their effect on the timeliness of vaccination. DESIGN Unblinded, randomised controlled trial with blocked sampling. METHODS 1594 Australian infants and young children were recruited to assess the impact of (1) SMS reminders only, (2) a personalised calendar, (3) SMS reminder and personalised calendar and (4) no intervention, on receipt of vaccine within 30 days of the due date. Outcomes were measured for receipt of vaccines due at 2, 4, 6, 12 and 18 months of age. A post-hoc assessment was also conducted of the impact of a new national "No jab No Pay" policy introduced during the trial, which removed philosophical objections as an exemption for financial penalties for non-vaccination. RESULTS There was a statistically significant improvement in on-time vaccination only at the 12 month schedule point amongst infants who received SMS reminders alone (RR 1.09, 95% CI 1.01-1.18) or in combination with a personalised calendar (1.11, CI 1.03-1.20) compared to controls. This impact was limited to participants who had received one or more previous doses late. No statistically significant impacts of calendar interventions alone were seen. There was a high rate of on-time compliance amongst control participants - 95%, 86%, 80%, 74% at the 4, 6, 12 and 18 month schedule points respectively, which increased more than 10 percentage points after implementation of the "No Jab, No Pay" policy. CONCLUSIONS SMS reminders are more effective in improving timeliness where pre-existing compliance is lower, but the 18 month schedule point appeared to be less amenable to intervention. Australia and New Zealand Clinical Trial Registration No. ACTRN12614000970640.
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Affiliation(s)
- R Menzies
- Kirby Institute, University of New South Wales, Kensington, NSW, Australia.
| | - L Heron
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Westmead, NSW, Australia; Kids Research Institute, The Children's Hospital Westmead, Westmead, NSW, Australia
| | - J Lampard
- Kids Research Institute, The Children's Hospital Westmead, Westmead, NSW, Australia
| | - M McMillan
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - T Joseph
- Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - J Chan
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Westmead, NSW, Australia; National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - A Storken
- Department of Health, South Australia, Adelaide, SA, Australia
| | - H Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
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14
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Abstract
BACKGROUND Adolescent vaccination has received increased attention since the Global Vaccine Action Plan's call to extend the benefits of immunisation more equitably beyond childhood. In recent years, many programmes have been launched to increase the uptake of different vaccines in adolescent populations; however, vaccination coverage among adolescents remains suboptimal. Therefore, understanding and evaluating the various interventions that can be used to improve adolescent vaccination is crucial. OBJECTIVES To evaluate the effects of interventions to improve vaccine uptake among adolescents. SEARCH METHODS In October 2018, we searched the following databases: CENTRAL, MEDLINE Ovid, Embase Ovid, and eight other databases. In addition, we searched two clinical trials platforms, electronic databases of grey literature, and reference lists of relevant articles. For related systematic reviews, we searched four databases. Furthermore, in May 2019, we performed a citation search of five other websites. SELECTION CRITERIA Randomised trials, non-randomised trials, controlled before-after studies, and interrupted time series studies of adolescents (girls or boys aged 10 to 19 years) eligible for World Health Organization-recommended vaccines and their parents or healthcare providers. DATA COLLECTION AND ANALYSIS Two review authors independently screened records, reviewed full-text articles to identify potentially eligible studies, extracted data, and assessed risk of bias, resolving discrepancies by consensus. For each included study, we calculated risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI) where appropriate. We pooled study results using random-effects meta-analyses and assessed the certainty of the evidence using GRADE. MAIN RESULTS We included 16 studies (eight individually randomised trials, four cluster randomised trials, three non-randomised trials, and one controlled before-after study). Twelve studies were conducted in the USA, while there was one study each from: Australia, Sweden, Tanzania, and the UK. Ten studies had unclear or high risk of bias. We categorised interventions as recipient-oriented, provider-oriented, or health systems-oriented. The interventions targeted adolescent boys or girls or both (seven studies), parents (four studies), and providers (two studies). Five studies had mixed participants that included adolescents and parents, adolescents and healthcare providers, and parents and healthcare providers. The outcomes included uptake of human papillomavirus (HPV) (11 studies); hepatitis B (three studies); and tetanus-diphtheria-acellular-pertussis (Tdap), meningococcal, HPV, and influenza (three studies) vaccines among adolescents. Health education improves HPV vaccine uptake compared to usual practice (RR 1.43, 95% CI 1.16 to 1.76; I² = 0%; 3 studies, 1054 participants; high-certainty evidence). In addition, one large study provided evidence that a complex multi-component health education intervention probably results in little to no difference in hepatitis B vaccine uptake compared to simplified information leaflets on the vaccine (RR 0.98, 95% CI 0.97 to 0.99; 17,411 participants; moderate-certainty evidence). Financial incentives may improve HPV vaccine uptake compared to usual practice (RR 1.45, 95% CI 1.05 to 1.99; 1 study, 500 participants; low-certainty evidence). However, we are uncertain whether combining health education and financial incentives has an effect on hepatitis B vaccine uptake, compared to usual practice (RR 1.38, 95% CI 0.96 to 2.00; 1 study, 104 participants; very low certainty evidence). Mandatory vaccination probably leads to a large increase in hepatitis B vaccine uptake compared to usual practice (RR 3.92, 95% CI 3.65 to 4.20; 1 study, 6462 participants; moderate-certainty evidence). Provider prompts probably make little or no difference compared to usual practice, on completion of Tdap (OR 1.28, 95% CI 0.59 to 2.80; 2 studies, 3296 participants), meningococcal (OR 1.09, 95% CI 0.67 to 1.79; 2 studies, 3219 participants), HPV (OR 0.99, 95% CI 0.55 to 1.81; 2 studies, 859 participants), and influenza (OR 0.91, 95% CI 0.61 to 1.34; 2 studies, 1439 participants) vaccination schedules (moderate-certainty evidence). Provider education with performance feedback may increase the proportion of adolescents who are offered and accept HPV vaccination by clinicians, compared to usual practice. Compared to adolescents visiting non-participating clinicians (in the usual practice group), the adolescents visiting clinicians in the intervention group were more likely to receive the first dose of HPV during preventive visits (5.7 percentage points increase) and during acute visits (0.7 percentage points for the first and 5.6 percentage points for the second doses of HPV) (227 clinicians and more than 200,000 children; low-certainty evidence). A class-based school vaccination strategy probably leads to slightly higher HPV vaccine uptake than an age-based school vaccination strategy (RR 1.09, 95% CI 1.06 to 1.13; 1 study, 5537 participants; moderate-certainty evidence). A multi-component provider intervention (including an education session, repeated contacts, individualised feedback, and incentives) probably improves uptake of HPV vaccine compared to usual practice (moderate-certainty evidence). A multi-component intervention targeting providers and parents involving social marketing and health education may improve HPV vaccine uptake compared to usual practice (RR 1.41, 95% CI 1.25 to 1.59; 1 study, 25,869 participants; low-certainty evidence). AUTHORS' CONCLUSIONS Various strategies have been evaluated to improve adolescent vaccination including health education, financial incentives, mandatory vaccination, and class-based school vaccine delivery. However, most of the evidence is of low to moderate certainty. This implies that while this research provides some indication of the likely effect of these interventions, the likelihood that the effects will be substantially different is high. Therefore, additional research is needed to further enhance adolescent immunisation strategies, especially in low- and middle-income countries where there are limited adolescent vaccination programmes. In addition, it is critical to understand the factors that influence hesitancy, acceptance, and demand for adolescent vaccination in different settings. This is the topic of an ongoing Cochrane qualitative evidence synthesis, which may help to explain why and how some interventions were more effective than others in increasing adolescent HPV vaccination coverage.
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Affiliation(s)
- Leila H Abdullahi
- University of Cape TownVaccines for Africa Initiative, Institute of Infectious Disease and Molecular MedicineAnzio RoadCape TownSouth Africa7925
| | - Benjamin M Kagina
- University of Cape TownVaccines for Africa Initiative, Institute of Infectious Disease and Molecular MedicineAnzio RoadCape TownSouth Africa7925
| | - Valantine Ngum Ndze
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesPO Box 241Cape TownSouth Africa8000
| | - Gregory D Hussey
- University of Cape TownVaccines for Africa Initiative, Institute of Infectious Disease and Molecular MedicineAnzio RoadCape TownSouth Africa7925
| | - Charles S Wiysonge
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesPO Box 241Cape TownSouth Africa8000
- South African Medical Research CouncilCochrane South AfricaFrancie van Zijl Drive, Parow ValleyCape TownWestern CapeSouth Africa7505
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15
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Liaw JY, White AV, Gorton S, Axford-Haines L. Lessons to be learned: Using National Immunisation strategies to improve adherence to acute rheumatic fever secondary prophylaxis. J Paediatr Child Health 2019; 55:1170-1176. [PMID: 31410921 DOI: 10.1111/jpc.14596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/22/2019] [Accepted: 07/25/2019] [Indexed: 11/29/2022]
Abstract
Rheumatic heart disease, as a result of a single or recurrent episode of acute rheumatic fever (ARF), remains a significant cause of morbidity and mortality in northern and remote Australia; ARF has a peak incidence among 5-14-year-old Aboriginal and Torres Strait Islander children. Long-term regular benzathine penicillin G injections are the only currently successful secondary prevention strategy; however, rates of adherence remain critically low. In contrast, rates of adherence to immunisations on the National Immunisation Program (NIP) Schedule are high, even among this target population. This article compares strategies used to implement and improve ARF secondary prophylaxis with those used in the NIP. Some successful NIP strategies, such as Service Incentive Payment for health providers, home-visiting delivery models and integration into the National Immunisation Register, if applied to ARF secondary prophylaxis have the potential to improve benzathine penicillin G adherence.
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Affiliation(s)
- Joshua Y Liaw
- Discipline of Child and Adolescent Health, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Andrew V White
- Discipline of Child and Adolescent Health, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Department of Paediatrics, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Susan Gorton
- Discipline of Child and Adolescent Health, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Louise Axford-Haines
- Rheumatic Heart Disease Register and Control Program (Queensland) Public Health Unit, Townsville Hospital and Health Service, Townsville, Queensland, Australia
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16
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Homel J, Edwards B. Factors associated with delayed infant immunization in a nationally representative cohort study. Child Care Health Dev 2018; 44:583-591. [PMID: 29460321 DOI: 10.1111/cch.12560] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 01/15/2018] [Accepted: 01/29/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Many children in developed countries do not receive recommended vaccines on time. However, knowledge about factors related to timeliness remains limited. Quantifying the relative impact of parental attitudes compared with socio-demographic factors for delayed immunization would inform policy responses. METHODS Participants in the nationally representative Longitudinal Study of Australian Children were matched with their vaccination histories in the Australian Childhood Immunisation Register (N = 4,121). Information about the children and their families were collected in face-to-face interviews in 2003-2004. We considered whether children had completed the primary course for each recommended antigen due by 6 months old. Children were categorized as either fully immunized, delayed, or totally non-immunized. The outcome was examined using logistic regression. Population attributable fractions were estimated for key predictors. RESULTS Delayed immunization was significantly associated with indicators of social disadvantage as well as parental disagreement with immunization. Attributable fractions for delayed immunization included lone motherhood (3.8%; 95% confidence interval CI [0.8, 6.7]), larger family size (39.5%; 95% CI [31.2, 46.8]), residential mobility (3.3%; 95% CI [0.1, 6.5]), lack of private hospital insurance (9.4%; 95% CI [0.7, 17.3]), a medical condition in the child (2.0%; 95% CI [0.2, 3.9]), and parental disagreement with immunization (2.1%; 95% CI [0.3, 3.9]). CONCLUSIONS Parental attitudes accounted for a relatively small percentage of delayed infant immunization. In contrast, many children who did not receive vaccines on time were characterized by social disadvantage, especially larger family size. Researchers and policy-makers should consider how to make timely immunization easier for busy parents.
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Affiliation(s)
- J Homel
- Griffith Criminology Institute, Griffith University, Mount Gravatt, QLD, Australia
| | - B Edwards
- ANU Centre for Social Research and Methods, Australian National University, Canberra, ACT, Australia
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17
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Costa-Pinto JC, Willaby HW, Leask J, Hoq M, Schuster T, Ghazarian A, O'Keefe J, Danchin MH. Parental Immunisation Needs and Attitudes Survey in paediatric hospital clinics and community maternal and child health centres in Melbourne, Australia. J Paediatr Child Health 2018; 54:522-529. [PMID: 29168910 DOI: 10.1111/jpc.13790] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 09/12/2017] [Accepted: 09/25/2017] [Indexed: 11/29/2022]
Abstract
AIM Despite Australia's high vaccination rates, an estimated 3.3% of children are under-vaccinated due to vaccine refusal and the proportion of parents with concerns is unclear. Amongst Australian parents, we aimed to determine the prevalence of vaccine concerns, resources and health-care providers (HCPs) accessed and satisfaction with these resources in two different settings. We also aimed to identify relationships between the level of vaccine concern, socio-economic status and vaccine uptake. METHODS Parents of children under 5 years attending general paediatric clinics in a tertiary paediatric hospital (n = 301/398, 76%) and children under 19 months attending community maternal child health centres (n = 311/391, 81%) completed the survey. Vaccination status was obtained from the Australian Childhood Immunisation Register. RESULTS Despite high support for vaccination (98%, confidence interval (CI) 97-99), 43% of parents reported vaccine concerns (CI 40-47) including the number of vaccines given in the first 2 years (25%, CI 22 to 29), vaccine ingredients (22%, CI 19-25), allergies (18%, CI 15-21), weakening of the immune system (17%, CI 14-20) and autism (11%, CI 8-13). HCPs were the most commonly accessed and trusted information source. In all, 23% of parents reported insufficient knowledge to make good vaccination decisions (CI 20-26). There was little evidence of an association between parental vaccine acceptance or socio-economic status and vaccination status. CONCLUSIONS Despite high support for vaccines, nearly half of Australian parents have some concerns and a quarter lack vaccine decision-making confidence regarding childhood vaccines. Parents frequently access and report high trust in HCPs, who are best placed to address parental vaccine concerns through provision of clear information, using effective communication strategies. Further research in more highly hesitant populations is required to determine the relationship between the level and nature of vaccination concerns and vaccine uptake.
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Affiliation(s)
- Jessica C Costa-Pinto
- Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Harold W Willaby
- School of Public Health, University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
| | - Julie Leask
- School of Public Health, University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
| | - Monsurul Hoq
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Tibor Schuster
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Alice Ghazarian
- Centre for Community Child Health, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Jacinta O'Keefe
- Vaccine and Immunisation Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Margie H Danchin
- Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Vaccine and Immunisation Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics and School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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18
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Thomas S, Cashman P, Islam F, Baker L, Clark K, Leask J, Butler R, Durrheim DN. Tailoring immunisation service delivery in a disadvantaged community in Australia; views of health providers and parents. Vaccine 2018; 36:2596-2603. [PMID: 29631887 DOI: 10.1016/j.vaccine.2018.03.072] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 02/23/2018] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
Abstract
In 2014 the Australian immunisation target was raised from 90% to 95% of children to be fully immunised. A national priority is to identify geographic areas of low coverage and implement strategies to improve immunisation rates. Using The World Health Organization's Tailoring Immunization Programmes (TIP) Guidelines, the aim of this study was to identify areas of low immunisation coverage for children in the Hunter New England Local Health District, New South Wales, and to gain a deeper understanding of the factors influencing immunisation in those areas in order to develop tailored strategies for increasing immunisation coverage. Data from the Australian Immunisation Register was used to identify geographic areas of low coverage. Data from interviews and focus groups with parents and service providers were used to gain a deeper understanding of the factors influencing immunisation in those areas. The regional city of Maitland in New South Wales was identified as having a persistently high number and relatively high proportion of children not fully immunised (n = 427, 15.4% in 2016). Themes from 59 stakeholder interviews and focus groups included; (i) limited engagement with health services unless the need is urgent, (ii) multi-dimensional access barriers to immunisation services in Maitland, (iii) a flexible, supportive family centred, primary health care approach, utilising strong partnerships, is most likely to be effective in increasing childhood immunisation rates in Maitland, (iv) data can be used more effectively to inform service providers about trends and individual children not fully immunised. TIP guidelines proved useful for identifying areas of low coverage and providing an understanding of determining factors and the strategies most likely to be effective. Understanding the complex problems many parents face and the access barriers that contribute to low immunisation coverage is essential in developing appropriate solutions. Finding ways to support parents and remove those barriers can contribute to higher coverage. In Maitland, targeted outreach and home visiting has been implemented in consultation with community and health service representatives to ensure that the children from socially disadvantaged populations identified do not miss out on vaccination.
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Affiliation(s)
- Susan Thomas
- University of Newcastle, School of Medicine and Public Health, Newcastle, NSW, Australia.
| | - Patrick Cashman
- Hunter New England Local Health District, Population Health, Wallsend, NSW, Australia
| | - Fakhrul Islam
- Hunter New England Local Health District, Population Health, Wallsend, NSW, Australia
| | - Loretta Baker
- Hunter New England Local Health District, East Maitland Community Health Centre, Maitland, NSW, Australia
| | - Katrina Clark
- Hunter New England Local Health District, Population Health, Wallsend, NSW, Australia
| | - Julie Leask
- University of Sydney, Faculty of Nursing and Midwifery and School of Public Health, Faculty of Medicine, Sydney, NSW, Australia
| | - Robb Butler
- World Health Organization Regional Office for Europe, Division of Health Emergencies and Communicable Diseases, Amsterdam, The Netherlands
| | - David N Durrheim
- University of Newcastle, School of Medicine and Public Health, Newcastle, NSW, Australia; Hunter New England Local Health District, Population Health, Wallsend, NSW, Australia
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19
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Meaningful Methods for Increasing Human Papillomavirus Vaccination Rates: An Integrative Literature Review. J Pediatr Health Care 2018; 32:119-132. [PMID: 28918994 DOI: 10.1016/j.pedhc.2017.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/13/2017] [Accepted: 07/21/2017] [Indexed: 11/20/2022]
Abstract
Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States and is a well-known cause of oropharyngeal, cervical, vaginal, vulvar, penile, and anal cancers. Despite the proven efficacy of the HPV vaccine, vaccination rates remain persistently low. Much literature has focused on attitudes toward the HPV vaccine; however, researchers have also investigated strategies clinicians can use to improve vaccination attitudes and acceptance. Such strategies include provider education, vaccine reminder/recall, and chart audit and feedback. The purpose of this integrative review is to uncover the best evidence-based practice interventions, with the aim of improving HPV knowledge, patient-provider conversations, and immunization uptake. This integrative review concludes that multicomponent interventions have a synergistic effect, resulting in increased provider vaccine support, improved patient/parental attitudes toward HPV vaccination, and increased immunization uptake. Such strategies hold much promise for today's pediatric providers as they work to combat current vaccination disparities.
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20
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Enkel SL, Attwell K, Snelling TL, Christian HE. 'Hesitant compliers': Qualitative analysis of concerned fully-vaccinating parents. Vaccine 2017; 36:6459-6463. [PMID: 29031695 DOI: 10.1016/j.vaccine.2017.09.088] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 09/20/2017] [Accepted: 09/28/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Some parents are hesitant about vaccines and yet still vaccinate their children. Vaccine behaviours are not fixed and parents who are concerned but nonetheless adherent to standard schedules could switch to an unconventional schedule, delaying or cherry-picking vaccines. There is a need to better understand vaccine hesitancy in specific contexts, acknowledging cultural and geographical variation, to ensure interventions targeting hesitancy are well directed and received. METHODS To identify the behaviours, knowledge and attitudes of 'hesitant compliers' in Perth, Western Australia, nine one-on-one in-depth interviews were conducted with vaccinating parents of children (<5 years) who were identified as being hesitant. Interview transcripts were analysed qualitatively and themes developed inductively, following a constructivist paradigm. RESULTS Parents saw vaccination as important for themselves and their community, despite their limited knowledge of vaccine preventable diseases. Parents reported concerns about potential side effects, and worried about the safety of the measles-mumps-rubella (MMR) and seasonal influenza vaccines. Concerned about the role of anti-vaccination information in the community, some sought to isolate themselves from parents who did not vaccinate, although others were concerned that this could entrench non-vaccinators' behaviours. Parents' views were all underlaid by two pivotal 'vaccine-related events' that had occurred in the community: the severe injury of a baby from seasonal influenza vaccination in 2010, and the death of a baby from whooping cough in 2015. CONCLUSIONS Parents interpreted pivotal vaccine-related events in the community as requiring them to take personal responsibility for vaccine decisions. Their reports of continued vaccine fears (evident in international studies in recent decades) demonstrate that vaccine scares have long lasting effects. With vaccine rates high and stable, current strategies appear to be have little impact on addressing parental vaccine concerns. Further research is required to determine the prevalence of hesitancy amongst vaccinating parents and identify critical points for intervention.
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Affiliation(s)
- Stephanie L Enkel
- School of Population and Global Health, The University of Western Australia, Australia.
| | - Katie Attwell
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Australia; School of Social Science, The University of Western Australia, Australia
| | - Thomas L Snelling
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Australia; Menzies School of Health Research and Charles Darwin University, Darwin, Australia; Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia
| | - Hayley E Christian
- School of Population and Global Health, The University of Western Australia, Australia; Telethon Kids Institute, The University of Western Australia, Australia
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21
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Attwell K, Smith DT. Parenting as politics: social identity theory and vaccine hesitant communities. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2017. [DOI: 10.1108/ijhg-03-2017-0008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to develop a theoretical framework for understanding the identity politics associated with parental hesitancy and refusal of vaccines for their children (“vaccine hesitancy or refusal” or “VHR”). Understanding these identity politics helps policymakers to craft appropriate communication interventions that do not make the problem worse.
Design/methodology/approach
Social identity theory is a way of understanding how group identities develop around the lifestyle practices that often include refusal to vaccinate, and how this group identity is accentuated by conflict with the pro-vaccinating societal mainstream. This paper critically appraises existing studies of VHR to explore this groupness across many different contexts.
Findings
Groupness is evident across many different contexts. There are also key group characteristics: preference for natural birth and breastfeeding, nature as a concept and use of complementary and alternative medicine.
Research limitations/implications
The paper is speculative and theoretical, using existing sources. Future studies will need to demonstrate empirically with new data. However, this theoretical approach sets up a new research agenda.
Social implications
These findings can help governments and policymakers minimise social conflict that risks further polarising vaccine conversations and wedging parents on the fence.
Originality/value
This paper argues that the decision to vaccinate or not is an inherently social one, not a matter of pure individual rationality. This is a novel approach to engaging with what is often characterised and studied as an individual decision.
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22
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Beard FH, Leask J, McIntyre PB. No Jab, No Pay and vaccine refusal in Australia: the jury is out. Med J Aust 2017; 206:381-383. [DOI: 10.5694/mja16.00944] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 10/26/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Frank H Beard
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, NSW
- School of Public Health, University of Sydney, Sydney, NSW
| | - Julie Leask
- School of Public Health, University of Sydney, Sydney, NSW
| | - Peter B McIntyre
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, NSW
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23
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Leask J, Danchin M. Imposing penalties for vaccine rejection requires strong scrutiny. J Paediatr Child Health 2017; 53:439-444. [PMID: 28168768 DOI: 10.1111/jpc.13472] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/06/2016] [Accepted: 12/06/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Julie Leask
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Margie Danchin
- Vaccine and Immunisation Research Group, Murdoch Children's Research Institutes, Royal Children's Hospital, Melbourne, Victoria, Australia
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Kaufman J, Ryan R, Glenton C, Lewin S, Bosch-Capblanch X, Cartier Y, Cliff J, Oyo-Ita A, Ames H, Muloliwa AM, Oku A, Rada G, Hill S. Childhood vaccination communication outcomes unpacked and organized in a taxonomy to facilitate core outcome establishment. J Clin Epidemiol 2017; 84:173-184. [PMID: 28238788 DOI: 10.1016/j.jclinepi.2017.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/11/2017] [Accepted: 02/18/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We present a comprehensive taxonomy of outcomes for childhood vaccination communication interventions. Adding to our earlier map of trial outcomes, we aimed to (1) identify relevant outcomes not measured in trials, (2) identify outcomes from stakeholder focus groups, and (3) organize outcomes into a taxonomy. STUDY DESIGN AND SETTING We identified additional outcomes from nonvaccination health communication literature and through parent and health care professional focus groups. We organized outcomes into the taxonomy through iterative discussion and informed by organizational principles established by leaders in core outcome research. RESULTS The taxonomy includes three overarching core areas, divided into eight domains and then into outcomes. Core area one is psychosocial impact, including the domains "knowledge or understanding," "attitudes or beliefs," and "decision-making." Core area two is health impact, covering "vaccination status and behaviors" and "health status and well-being." Core area three is community, social, or health system impact, containing "intervention design and implementation," "community participation," and "resource use." CONCLUSION To our knowledge, this taxonomy is the first attempt to conceptualize the range of potential outcomes for vaccination communication. It can be used by researchers selecting outcomes for complex communication interventions. We will also present the taxonomy to stakeholders to establish core outcome domains.
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Affiliation(s)
- Jessica Kaufman
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Health Sciences 2 Rm 412, Bundoora, Victoria 3086, Australia.
| | - Rebecca Ryan
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Health Sciences 2 Rm 412, Bundoora, Victoria 3086, Australia
| | - Claire Glenton
- Norwegian Knowledge Centre for the Health Services, Norwegian Institute of Public Health, PO Box 4404, Nydalen, Oslo N-0403, Norway
| | - Simon Lewin
- Norwegian Knowledge Centre for the Health Services, Norwegian Institute of Public Health, PO Box 4404, Nydalen, Oslo N-0403, Norway; Health Systems Research Unit, South African Medical Research Council, PO Box 19070, Tygerberg 7505, Cape Town, South Africa
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box CH-4002, Basel, Switzerland; Universität Basel, Petersplatz 1, CH-4003, Basel, Switzerland
| | - Yuri Cartier
- International Union for Health Promotion and Education, 42 boulevard de la Libération, Saint-Denis 93203, France
| | - Julie Cliff
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo CP 257, Mozambique
| | - Angela Oyo-Ita
- Department of Community Medicine, University of Calabar, Calabar PMB 1115, Cross River State, Nigeria
| | - Heather Ames
- Norwegian Knowledge Centre for the Health Services, Norwegian Institute of Public Health, PO Box 4404, Nydalen, Oslo N-0403, Norway
| | - Artur Manuel Muloliwa
- Provincial Directorate of Health, Av. Samora Machel n(º) 1016 R/C, C.P. N(º) 14, Nampula, Mozambique
| | - Afiong Oku
- Department of Community Medicine, University of Calabar, Calabar PMB 1115, Cross River State, Nigeria
| | - Gabriel Rada
- Evidence Based Health Care Program, Faculty of Medicine, Pontificia Universidad Católica de Chile, Avda, Libertador Bernardo O'Higgins 340, Santiago, Chile
| | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Health Sciences 2 Rm 412, Bundoora, Victoria 3086, Australia
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Corben P, Leask J. To close the childhood immunization gap, we need a richer understanding of parents' decision-making. Hum Vaccin Immunother 2016; 12:3168-3176. [PMID: 27564975 PMCID: PMC5215493 DOI: 10.1080/21645515.2016.1221553] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/22/2016] [Accepted: 08/03/2016] [Indexed: 12/22/2022] Open
Abstract
Vaccination is widely acknowledged as one of the most successful public health interventions globally and in most high-income countries childhood vaccination coverage rates are moderately high. Yet in many instances, immunisation rates remain below aspirational targets and have shown only modest progress toward those targets in recent years, despite concerted efforts to improve uptake. In part, coverage rates reflect individual parents' vaccination attitudes and decisions and, because vaccination decision-making is complex and context-specific, it remains challenging at individual and community levels to assist parents to make positive decisions. Consequently, in the search for opportunities to improve immunisation coverage, there has been a renewed research focus on parents' decision-making. This review provides an overview of the literature surrounding parents' vaccination decision-making, offering suggestions for where efforts to increase vaccination coverage should be targeted and identifying areas for further research.
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Affiliation(s)
- Paul Corben
- North Coast Public Health, Mid North Coast Local Health District, Port Macquarie, New South Wales, Australia
| | - Julie Leask
- School of Public Health, University of Sydney, University of Sydney, NSW, Australia
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Yang YT, Bhoobun S, Itani T, Jacobsen KH. Europe Should Consider Mandatory Measles Immunization for School Entry. J Pediatric Infect Dis Soc 2016; 5:319-22. [PMID: 26907813 DOI: 10.1093/jpids/piw003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 01/09/2016] [Indexed: 11/14/2022]
Affiliation(s)
- Y Tony Yang
- Department of Health Administration and Policy
| | - Shalinee Bhoobun
- Department of Paediatrics, Evelina London Children's Hospital, Westminster, United Kingdom
| | - Taha Itani
- Department of Public Health Medicine, School of Public Health, Bielefeld University, Germany
| | - Kathryn H Jacobsen
- Department of Global and Community Health, George Mason University, Fairfax, Virginia
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Abdullahi LH, Kagina BMN, Wiysonge CS, Hussey GD. Improving vaccination uptake among adolescents. Hippokratia 2015. [DOI: 10.1002/14651858.cd011895] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Leila H Abdullahi
- University of Cape Town; Vaccines for Africa Initiative, Institute of Infectious Disease and Molecular Medicine; Anzio Road Cape Town South Africa 7925
| | - Benjamin MN Kagina
- University of Cape Town; Vaccines for Africa Initiative, Institute of Infectious Disease and Molecular Medicine; Anzio Road Cape Town South Africa 7925
| | - Charles S Wiysonge
- Stellenbosch University; Centre for Evidence-based Health Care; Francie van Zijl Drive Tygerberg Cape Town South Africa 7505
- South African Medical Research Council; Cochrane South Africa; Cape Town South Africa
| | - Gregory D Hussey
- University of Cape Town; Vaccines for Africa Initiative, Institute of Infectious Disease and Molecular Medicine; Anzio Road Cape Town South Africa 7925
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Mbabazi WB, Tabu CW, Chemirmir C, Kisia J, Ali N, Corkum MG, Bartley GL. Innovations in communication technologies for measles supplemental immunization activities: lessons from Kenya measles vaccination campaign, November 2012. Health Policy Plan 2015; 30:638-44. [PMID: 24920218 PMCID: PMC4421834 DOI: 10.1093/heapol/czu042] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To achieve a measles free world, effective communication must be part of all elimination plans. The choice of communication approaches must be evidence based, locally appropriate, interactive and community owned. In this article, we document the innovative approach of using house visits supported by a web-enabled mobile phone application to create a real-time platform for adaptive management of supplemental measles immunization days in Kenya. METHODS One thousand nine hundred and fifty-two Red Cross volunteers were recruited, trained and deployed to conduct house-to-house canvassing in 11 urban districts of Kenya. Three days before the campaigns, volunteers conducted house visits with a uniform approach and package of messages. All house visits were documented using a web-enabled mobile phone application (episurveyor®) that in real-time relayed information collected to all campaign management levels. During the campaigns, volunteers reported daily immunizations to their co-ordinators. Post-campaign house visits were also conducted within 4 days, to verify immunization of eligible children, assess information sources and detect adverse events following immunization. RESULTS Fifty-six per cent of the 164 643 households visited said that they had heard about the planned 2012 measles vaccination campaign 1-3 days before start dates. Twenty-five per cent of households were likely to miss the measles supplemental dose if they had not been reassured by the house visit. Pre- and post-campaign reasons for refusal showed that targeted communication reduced misconceptions, fear of injections and trust in herbal remedies. Daily reporting of immunizations using mobile phones informed changes in service delivery plans for better immunization coverage. House visits were more remembered (70%) as sources of information compared with traditional mass awareness channels like megaphones (41%) and radio (37%). CONCLUSIONS In high-density settlements, house-to-house visits are easy and more penetrative compared with traditional media approaches. Using mobile phones to document campaign processes and outputs provides real time evidence for service delivery planning to improve immunization coverage.
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Affiliation(s)
- William B Mbabazi
- American Red Cross International Response and Programs, PO Box 41275-00100, Nairobi, Kenya, Division of Vaccines and Immunization, Ministry of Health, PO Box 30016, Nairobi, Kenya, Kenya Red Cross, PO Box 40712-00100, Nairobi, Kenya, UNICEF East and Southern African Regional Office, United Nations Complex, Gigiri, PO Box 44145-00100, Nairobi, Kenya and Bill and Melinda Gates Foundation, PO Box 45335-00100 Nairobi, Kenya
| | - Collins W Tabu
- American Red Cross International Response and Programs, PO Box 41275-00100, Nairobi, Kenya, Division of Vaccines and Immunization, Ministry of Health, PO Box 30016, Nairobi, Kenya, Kenya Red Cross, PO Box 40712-00100, Nairobi, Kenya, UNICEF East and Southern African Regional Office, United Nations Complex, Gigiri, PO Box 44145-00100, Nairobi, Kenya and Bill and Melinda Gates Foundation, PO Box 45335-00100 Nairobi, Kenya
| | - Caleb Chemirmir
- American Red Cross International Response and Programs, PO Box 41275-00100, Nairobi, Kenya, Division of Vaccines and Immunization, Ministry of Health, PO Box 30016, Nairobi, Kenya, Kenya Red Cross, PO Box 40712-00100, Nairobi, Kenya, UNICEF East and Southern African Regional Office, United Nations Complex, Gigiri, PO Box 44145-00100, Nairobi, Kenya and Bill and Melinda Gates Foundation, PO Box 45335-00100 Nairobi, Kenya
| | - James Kisia
- American Red Cross International Response and Programs, PO Box 41275-00100, Nairobi, Kenya, Division of Vaccines and Immunization, Ministry of Health, PO Box 30016, Nairobi, Kenya, Kenya Red Cross, PO Box 40712-00100, Nairobi, Kenya, UNICEF East and Southern African Regional Office, United Nations Complex, Gigiri, PO Box 44145-00100, Nairobi, Kenya and Bill and Melinda Gates Foundation, PO Box 45335-00100 Nairobi, Kenya
| | - Nasra Ali
- American Red Cross International Response and Programs, PO Box 41275-00100, Nairobi, Kenya, Division of Vaccines and Immunization, Ministry of Health, PO Box 30016, Nairobi, Kenya, Kenya Red Cross, PO Box 40712-00100, Nairobi, Kenya, UNICEF East and Southern African Regional Office, United Nations Complex, Gigiri, PO Box 44145-00100, Nairobi, Kenya and Bill and Melinda Gates Foundation, PO Box 45335-00100 Nairobi, Kenya
| | - Melissa G Corkum
- American Red Cross International Response and Programs, PO Box 41275-00100, Nairobi, Kenya, Division of Vaccines and Immunization, Ministry of Health, PO Box 30016, Nairobi, Kenya, Kenya Red Cross, PO Box 40712-00100, Nairobi, Kenya, UNICEF East and Southern African Regional Office, United Nations Complex, Gigiri, PO Box 44145-00100, Nairobi, Kenya and Bill and Melinda Gates Foundation, PO Box 45335-00100 Nairobi, Kenya
| | - Gene L Bartley
- American Red Cross International Response and Programs, PO Box 41275-00100, Nairobi, Kenya, Division of Vaccines and Immunization, Ministry of Health, PO Box 30016, Nairobi, Kenya, Kenya Red Cross, PO Box 40712-00100, Nairobi, Kenya, UNICEF East and Southern African Regional Office, United Nations Complex, Gigiri, PO Box 44145-00100, Nairobi, Kenya and Bill and Melinda Gates Foundation, PO Box 45335-00100 Nairobi, Kenya
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Gibbs RA, Hoskins C, Effler PV. Children with no vaccinations recorded on the Australian Childhood Immunisation Register. Aust N Z J Public Health 2015; 39:294-5. [DOI: 10.1111/1753-6405.12354] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Robyn A. Gibbs
- Communicable Disease Control Directorate, Department of Health; Government of Western Australia
| | - Chantelle Hoskins
- Communicable Disease Control Directorate, Department of Health; Government of Western Australia
| | - Paul V. Effler
- Communicable Disease Control Directorate, Department of Health; Government of Western Australia
- School of Pathology and Laboratory Medicine; University of Western Australia
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Dubé E, Gagnon D, MacDonald NE. Strategies intended to address vaccine hesitancy: Review of published reviews. Vaccine 2015; 33:4191-203. [PMID: 25896385 DOI: 10.1016/j.vaccine.2015.04.041] [Citation(s) in RCA: 337] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
When faced with vaccine hesitancy, public health authorities are looking for effective strategies to address this issue. In this paper, the findings of 15 published literature reviews or meta-analysis that have examined the effectiveness of different interventions to reduce vaccine hesitancy and/or to enhance vaccine acceptance are presented and discussed. From the literature, there is no strong evidence to recommend any specific intervention to address vaccine hesitancy/refusal. The reviewed studies included interventions with diverse content and approaches that were implemented in different settings and targeted various populations. Few interventions were directly targeted to vaccine hesitant individuals. Given the paucity of information on effective strategies to address vaccine hesitancy, when interventions are implemented, planning a rigorous evaluation of their impact on vaccine hesitancy/vaccine acceptance will be essential.
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Affiliation(s)
- Eve Dubé
- Institut National de Santé Publique du Québec, Québec, Canada.
| | | | - Noni E MacDonald
- Department of Paediatrics, Dalhousie University, Canadian Centre for Vaccinology, IWK Health Centre, Halifax, Canada
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Dawson B, Apte SH. Measles outbreaks in Australia: obstacles to vaccination. Aust N Z J Public Health 2015; 39:104-6. [PMID: 25715740 DOI: 10.1111/1753-6405.12328] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Enhancing the work of the Department of Health and Human Services national vaccine program in global immunization: recommendations of the National Vaccine Advisory Committee: approved by the National Vaccine Advisory Committee on September 12, 2013. Public Health Rep 2014; 129 Suppl 3:12-85. [PMID: 25100887 PMCID: PMC4121882 DOI: 10.1177/00333549141295s305] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Robinson P. Forgotten but not gone. Aust N Z J Public Health 2012; 36:505-6. [PMID: 23216477 DOI: 10.1111/j.1753-6405.2012.00940.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Leask J, Kinnersley P, Jackson C, Cheater F, Bedford H, Rowles G. Communicating with parents about vaccination: a framework for health professionals. BMC Pediatr 2012; 12:154. [PMID: 22998654 PMCID: PMC3480952 DOI: 10.1186/1471-2431-12-154] [Citation(s) in RCA: 388] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 09/04/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A critical factor shaping parental attitudes to vaccination is the parent's interactions with health professionals. An effective interaction can address the concerns of vaccine supportive parents and motivate a hesitant parent towards vaccine acceptance. Poor communication can contribute to rejection of vaccinations or dissatisfaction with care. We sought to provide a framework for health professionals when communicating with parents about vaccination. METHODS Literature review to identify a spectrum of parent attitudes or 'positions' on childhood vaccination with estimates of the proportion of each group based on population studies. Development of a framework related to each parental position with determination of key indicators, goals and strategies based on communication science, motivational interviewing and valid consent principles. RESULTS Five distinct parental groups were identified: the 'unquestioning acceptor' (30-40%), the 'cautious acceptor' (25-35%); the 'hesitant' (20-30%); the 'late or selective vaccinator' (2-27%); and the 'refuser' of all vaccines (<2%). The goals of the encounter with each group will vary, depending on the parents' readiness to vaccinate. In all encounters, health professionals should build rapport, accept questions and concerns, and facilitate valid consent. For the hesitant, late or selective vaccinators, or refusers, strategies should include use of a guiding style and eliciting the parent's own motivations to vaccinate while, avoiding excessive persuasion and adversarial debates. It may be necessary to book another appointment or offer attendance at a specialised adverse events clinic. Good information resources should also be used. CONCLUSIONS Health professionals have a central role in maintaining public trust in vaccination, including addressing parents' concerns. These recommendations are tailored to specific parental positions on vaccination and provide a structured approach to assist professionals. They advocate respectful interactions that aim to guide parents towards quality decisions.
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Affiliation(s)
- Julie Leask
- School of Public Health, and Discipline of Paediatrics and Child Health University of Sydney and National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, Australia.
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