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Polter EJ, Christianson B, Steinberg A, Doan M, Ljungman H, Sundaram ME, VanWormer JJ, Williams CL, McLean HQ, Bendixsen C. Urban and rural healthcare providers' perspectives on HPV vaccination in Minnesota. Hum Vaccin Immunother 2023; 19:2291859. [PMID: 38095606 PMCID: PMC10730133 DOI: 10.1080/21645515.2023.2291859] [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: 09/16/2023] [Accepted: 12/03/2023] [Indexed: 12/18/2023] Open
Abstract
Human papillomavirus (HPV) vaccination can dramatically reduce the incidence of HPV-associated cancers. However, HPV vaccination coverage in rural areas is lower than in urban areas, and overall HPV vaccination coverage in the United States remains lower than other adolescent vaccines. We conducted 20 qualitative interviews with adolescent healthcare providers and clinic staff in urban and rural Minnesota and assessed their perspectives on HPV vaccination. Guiding interview topics included: strategies to persuade families to vaccinate their children, the impact of the patient-provider relationship and the clinical environment on vaccination uptake, and provider perceptions of parents' vaccine attitudes. In thematic analysis, all participants reported using common vaccination strategies, such as framing the HPV vaccine in terms of cancer prevention. The analysis also revealed three themes described as occurring uniquely or more intensely in rural communities than urban communities: the rural value of choice or independence, the spread of misinformation, and close-knit, multifaceted patient-provider relationships in clinical practice. Interventions aimed at increasing HPV vaccination should consider the distinctive circumstances of rural healthcare providers and patients.
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Affiliation(s)
- Elizabeth J. Polter
- Minnesota Department of Health, Infectious Disease Epidemiology, Prevention and Control Division, St. Paul, MN, USA
| | - Ben Christianson
- Minnesota Department of Health, Infectious Disease Epidemiology, Prevention and Control Division, St. Paul, MN, USA
| | - Anne Steinberg
- Minnesota Department of Health, Infectious Disease Epidemiology, Prevention and Control Division, St. Paul, MN, USA
| | - Melody Doan
- Minnesota Department of Health, Infectious Disease Epidemiology, Prevention and Control Division, St. Paul, MN, USA
| | - Hanna Ljungman
- Minnesota Department of Health, Infectious Disease Epidemiology, Prevention and Control Division, St. Paul, MN, USA
| | - Maria E. Sundaram
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Jeffrey J. VanWormer
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Charnetta L. Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Huong Q. McLean
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Casper Bendixsen
- National Farm Medicine Center, Marshfield Clinic Research Institute, Marshfield, WI, USA
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Freeman RE, Leary CS, Graham JM, Albers AN, Wehner BK, Daley MF, Newcomer SR. Geographic proximity to immunization providers and vaccine series completion among children ages 0-24 months. Vaccine 2023; 41:2773-2780. [PMID: 36964002 PMCID: PMC10229224 DOI: 10.1016/j.vaccine.2023.03.025] [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: 02/02/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVES In the U.S., vaccination coverage is lower in rural versus urban areas. Spatial accessibility to immunization services has been a suspected risk factor for undervaccination in rural children. Our objective was to identify whether geographic factors, including driving distance to immunization providers, were associated with completion of recommended childhood vaccinations. METHODS We analyzed records from Montana's immunization information system for children born 2015-2017. Using geolocated address data, we calculated distance in road miles from children's residences to the nearest immunization provider. A multivariable log-linked binomial mixed model was used to identify factors associated with completion of the combined 7-vaccine series by age 24 months. RESULTS Among 26,085 children, 16,503 (63.3%) completed the combined 7-vaccine series by age 24 months. Distance to the nearest immunization provider ranged from 0 to 81.0 miles (median = 1.7; IQR = 3.2), with the majority (92.1%) of children living within 10 miles of a provider. Long distances (>10 miles) to providers had modest associations with not completing the combined 7-vaccine series (adjusted prevalence ratio [aPR]: 0.97, 95% confidence interval [CI]: 0.96-0.99). After adjustment for other factors, children living in rural areas (measured by rural-urban commuting area) were significantly less likely to have completed the combined 7-vaccine series than children in metropolitan areas (aPR: 0.88, 95% CI: 0.85-0.92). CONCLUSIONS Long travel distances do not appear to be a major barrier to childhood vaccination in Montana. Other challenges, including limited resources for clinic-based strategies to promote timely vaccination and parental vaccine hesitancy, may have greater influence on rural childhood vaccination.
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Affiliation(s)
- Rain E Freeman
- Center for Population Health Research, University of Montana, Missoula, MT, United States; School of Public and Community Health Sciences, University of Montana, Missoula, MT, United States.
| | - Cindy S Leary
- Center for Population Health Research, University of Montana, Missoula, MT, United States; School of Public and Community Health Sciences, University of Montana, Missoula, MT, United States
| | - Jonathan M Graham
- Center for Population Health Research, University of Montana, Missoula, MT, United States; Department of Mathematical Sciences, University of Montana, Missoula, MT, United States
| | - Alexandria N Albers
- Center for Population Health Research, University of Montana, Missoula, MT, United States; School of Public and Community Health Sciences, University of Montana, Missoula, MT, United States
| | - Bekki K Wehner
- Montana Immunization Program, Department of Public Health and Human Services, Helena, MT, United States
| | - Matthew F Daley
- Kaiser Permanente Colorado, Institute for Health Research, Aurora, CO, United States; University of Colorado School of Medicine, Department of Pediatrics, Aurora, CO, United States
| | - Sophia R Newcomer
- Center for Population Health Research, University of Montana, Missoula, MT, United States; School of Public and Community Health Sciences, University of Montana, Missoula, MT, United States
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Rahmadhan MAWP, Azizi MI, Handayani PW, Monicha A. Design of a Reminder and Recall System in a Contact Tracing Application to Support Coronavirus Booster Vaccination. Healthc Inform Res 2023; 29:93-102. [PMID: 37190733 DOI: 10.4258/hir.2023.29.2.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/29/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVES The rate of coronavirus disease 2019 (COVID-19) booster vaccination in Indonesia remains relatively low, representing 15.33% of the overall vaccination target as of April 2022. The implementation of a reminder and recall system has been shown to be effective in increasing vaccination rates. In prior research, reminders and recalls were sent through traditional media, such as mail, and had not yet been integrated into modern media, such as smartphone applications and (in particular) contact tracing applications. Therefore, the present study was conducted to design a reminder and recall system for the PeduliLindungi contact tracing application. METHODS We used the design science research (DSR) methodology with three iterations. The first iteration produced a low-fidelity prototype (or wireframe), and the next yielded a high-fidelity (clickable) prototype. RESULTS The final prototype included three main features: a reminder and recall mechanism, online registration for COVID-19 booster vaccination, and educational articles. The evaluation consisted of interviews in the first iteration, interviews and the System Usability Scale (SUS) questionnaire in the second, and the Post-Study System Usability Questionnaire (PSSUQ) in the third. The SUS value obtained in the second iteration was 71.6, indicating good (acceptable) results, while in the third iteration, the system usefulness, information quality, interface quality, and overall PSSUQ values were 2.456, 2.473, 2.230, and 2.397, respectively, indicating good quality of the resulting design. CONCLUSIONS This research contributes to two areas: implementation of a reminder and recall system in the PeduliLindungi contact tracing application and enhancement of contact tracing applications using DSR methodology.
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Affiliation(s)
| | | | | | - Annisa Monicha
- Faculty of Computer Science, Universitas Indonesia, West Java, Indonesia
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Chiem A, Olaoye F, Quinn R, Saini V. Reasons and suggestions for improving low immunization uptake among children living in low socioeconomic status communities in Northern Alberta, Canada - A qualitative study. Vaccine 2022; 40:4464-4472. [PMID: 35701329 DOI: 10.1016/j.vaccine.2022.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 05/30/2022] [Accepted: 06/02/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Under-immunization increases the risk of acquiring vaccine-preventable diseases in children and the community. The targeted coverage rate for routine childhood immunization in Alberta, especially in disadvantaged communities in rural and remote geographic areas, has not been achieved for many years. This study was conducted to identify reasons for under-immunization in children in low socioeconomic status (SES) communities and propose suggestions to address issues/concerns identified by low SES parents for improving immunization coverage in their communities. METHODS Fourteen semi-structured phone interviews of low SES parents with under-immunized children living in rural and remote geographic areas in Northern Alberta were conducted. Transcripts were analyzed to identify relevant themes. RESULTS Busy lifestyles of many parents prevented them from taking their children to clinics for immunization, which were exacerbated by long distances to clinics, transportation issues, operating hours of clinics, and lack of reminders. Many disadvantaged parents also exhibited varying levels of vaccine hesitancy due to safety concerns, especially about newer vaccines, thereby causing some parents to delay immunizing their child intentionally. CONCLUSION Implementing procedures to alleviate access issues, such as offering extended operating hours, opening drop-in clinics/satellite clinics in distant areas, nurse visits to their homes, updating contact information of parents, frequent reminder options and addressing safety and effectiveness concerns about vaccines in plain language using evidence-based communication strategies can promote timely immunization among children of low SES parents.
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Affiliation(s)
- Alexander Chiem
- School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, Saskatchewan S7N 2Z4, Canada
| | - Funmilayo Olaoye
- Research & Innovation, Provincial Population and Public Health, Alberta Health Services, 10101, Southport Road SW, Calgary, Alberta T2W 3N2, Canada
| | - Renee Quinn
- Population and Public Health, North Zone, Alberta Health Services, 4720 55 Street, Cold Lake, Alberta T9M 1V8, Canada
| | - Vineet Saini
- Research & Innovation, Provincial Population and Public Health, Alberta Health Services, 10101, Southport Road SW, Calgary, Alberta T2W 3N2, Canada; Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, Alberta T2N 4Z6, Canada.
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Albers AN, Thaker J, Newcomer SR. Barriers to and facilitators of early childhood immunization in rural areas of the United States: a systematic review of the literature. Prev Med Rep 2022; 27:101804. [PMID: 35656229 PMCID: PMC9152779 DOI: 10.1016/j.pmedr.2022.101804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/23/2022] [Accepted: 04/18/2022] [Indexed: 12/22/2022] Open
Abstract
Early childhood vaccination coverage is low in rural areas of the United States. Reminder-recall & positive family-provider relationships facilitate vaccine uptake. Parental hesitancy is a barrier to early childhood vaccination in the rural U.S. Vaccine referrals & distance to providers are also rural-specific barriers. To increase vaccine coverage, interventions across rural populations are needed.
Early childhood vaccination rates are lower in rural areas of the U.S. compared with suburban and urban areas. Our aim was to identify barriers to and facilitators of early childhood immunization in rural U.S. communities. We completed a systematic review of original research conducted in the U.S. between January 1, 2000-July 25, 2021. We searched PubMed, Cumulative Index for Nursing and Allied Health Literature, and Web of Science. We included studies that examined barriers to and facilitators of routine immunizations in children <36 months old in rural areas. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we reported studies’ methodologies and targeted populations, definitions of rurality, and common themes across studies that reflected barriers to or facilitators of vaccination. Ultimately, 17 papers met inclusion criteria for review. The majority of studies (10/17) were conducted within one U.S. state, and the same number (10/17) were conducted prior to 2005. Facilitators of vaccine uptake in rural communities identified across studies included reminder/recall systems and parents’ relationships with providers. Parental hesitancy, negative clinic experiences, referrals outside of primary care settings, and distance to providers were identified as barriers to vaccination in rural settings. This review revealed a limited scope of evidence on barriers to and facilitators of early childhood immunization in rural communities. More investigations of the causes of low vaccine coverage and the effectiveness of interventions for increasing vaccine uptake are urgently needed in rural pediatric populations to address persistent rural–urban immunization disparities.
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Jong KM, Sikora CA, MacDonald SE. Childhood immunization appointment reminders and recalls: strengths, weaknesses and opportunities to increase vaccine coverage. Public Health 2021; 194:170-175. [PMID: 33951552 DOI: 10.1016/j.puhe.2021.02.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/15/2021] [Accepted: 02/27/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Childhood immunization coverage has been shown to be greatly impacted by parental forgetfulness regarding immunizations and appointments. Evidence supports the use of reminders and recalls to overcome this barrier, which remind parents about upcoming immunization appointments and inform them once their child is overdue for an immunization. In this study, we sought to identify reminder/recall strategies used throughout a large Canadian province and determine the perceived strengths, weaknesses and areas of improvement of existing strategies. STUDY DESIGN AND METHODS An environmental scan was performed in 2018 in two phases: (1) interviews with public health leaders from the five zones of Alberta and (2) an online survey of public health centres across the province. Data analysis occurred in 2018 and 2019. RESULTS Commonly reported strengths of reminders and recalls included their ability to increase appointment attendance and remind parents about immunizations, respectively. A major identified weakness was their time-consuming/resource-intensive nature. Many participants believed reminder/recalls could be improved by modernizing delivery methods. Educational information or strategies to overcome language barriers were rarely incorporated into reminder/recall systems. CONCLUSIONS There was support for incorporating text messaging and automation into reminder/recall systems while encouraging continued exploration of novel reminder/recall delivery methods. Tailoring reminder/recalls to the needs and preferences of target populations can maximize the effectiveness of these systems. This includes modernizing methods of delivery, addressing language barriers, providing educational information, and allotting some degree of flexibility to local level management of reminder/recalls.
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Affiliation(s)
- K M Jong
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - C A Sikora
- Alberta Health Services, Edmonton, Alberta, Canada; Department of Medicine, Division of Preventive Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - S E MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta.
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Reeves SL, Fullerton HJ, Cohn LM, Dombkowski KJ, Boulton ML, Braun TM, Lisabeth LD. Missed Opportunities for Transcranial Doppler Screening Among Children With Sickle Cell Disease. Clin Pediatr (Phila) 2016; 55:1093-9. [PMID: 26538586 DOI: 10.1177/0009922815614351] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Transcranial Doppler (TCD) screening rates remain low among children with sickle cell disease (SCD). We assessed TCD screening rates and missed opportunities for TCD screening. Children 2 to 16 years old with SCD enrolled in Michigan Medicaid for ≥1 year (2007-2011) were identified through newborn screening. Receipt of TCD screening and presence of a missed opportunity (≥1 SCD-related outpatient visit, no TCD screening) were identified through administrative claims. Potential correlates of missed opportunities included SCD-related health services, comorbidities, and demographics. Logistic regression with generalized estimating equations modeled associations between a missed opportunity and correlates. Overall, 353 children contributed 1066 person-years. TCD screening was low yearly (10%-32%); missed opportunities occurred in 73% of the person-years. Increasing age (odds ratio [OR] = 1.11; confidence interval CI = 1.07, 1.15), previous TCD screening (OR = 0.26; CI = 0.16, 0.41), and 4 to 5 (OR = 0.48; CI = 0.26, 0.87) or ≥6 outpatient visits (OR = 0.26; CI = 0.14, 0.49) were associated with a missed opportunity. Reduction of missed opportunities is a potential strategy to increase TCD screening rates.
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Affiliation(s)
- Sarah L Reeves
- University of Michigan School of Public Health, Ann Arbor, MI, USA University of Michigan, Department of Pediatrics, Ann Arbor, MI, USA
| | | | - Lisa M Cohn
- University of Michigan, Department of Pediatrics, Ann Arbor, MI, USA
| | | | | | - Thomas M Braun
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Lynda D Lisabeth
- University of Michigan School of Public Health, Ann Arbor, MI, USA University of Michigan, Department of Neurology, Ann arbor, MI, USA
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Bekondi C, Zanchi R, Seck A, Garin B, Giles-Vernick T, Gody JC, Bata P, Pondy A, Tetang SM, Ba M, Ekobo CS, Rousset D, Sire JM, Maylin S, Chartier L, Njouom R, Vray M. HBV immunization and vaccine coverage among hospitalized children in Cameroon, Central African Republic and Senegal: a cross-sectional study. BMC Infect Dis 2015; 15:267. [PMID: 26164361 PMCID: PMC4499446 DOI: 10.1186/s12879-015-1000-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 06/26/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Hepatitis B is a major health concern in Africa. The vaccine against hepatitis B virus (HBV) was introduced into the Expanded Programme on Immunization (EPI) of Cameroon and Senegal in 2005, and of CAR (Central African Republic) in 2008. A cross-sectional study was conducted to assess HBV immunization coverage following the vaccine's introduction into the EPI and factors associated with having been vaccinated. METHODS All hospitalized children, regardless of the reasons for their hospitalization, between 3 months and 6 years of age, for whom a blood test was scheduled during their stay and whose condition allowed for an additional 2 mL blood sample to be taken, and who provided the parent's written consent were included. All children anti-HBs- and anti-HBc + were tested for HBsAg. Vaccination coverage was assessed in three different ways: immunization card, maternal recall and serologic anti-HBs profile. RESULTS 1783 children were enrolled between April 2009 and May 2010. An immunization card was only available for 24 % of the children. The median age was 21 months. Overall HBV immunization coverage based on immunization cards was 99 %, 49 % and 100 % in Cameroon, CAR and Senegal, respectively (p < 0,001). The immunization rate based on maternal recall was 91 %, 17 % and 88 % in Cameroon, CAR and Senegal, respectively (p < 0,001). According to serology (anti-HBs titer ≥ 10 mUI/mL and anti-HBc-), the coverage rate was 68 %, 13 % and 46 % in Cameroon, CAR and Senegal, respectively (p < 0,001). In Senegal and Cameroon, factors associated with having been vaccinated were: mother's higher education (OR = 2.2; 95 % CI [1.5-3.2]), no malnutrition (OR = 1.6; 95 % CI [1.1-2.2]), access to flushing toilets (OR = 1.6; 95 % CI [1.1-2.3]), and < 24 months old (OR = 2.1; 95 % CI [1.3-3.4] between 12 and 23 months and OR = 2.7; 95 % CI [1.6-4.4] < 12 months). The prevalence of HBV-infected children (HBsAg+) were 0.7 %, 5.1 %, and 0.2 % in Cameroon, CAR and Senegal, respectively (p < 0.001). CONCLUSIONS Assessing immunization coverage based on immunization cards, maternal recall or administrative data could be usefully reinforced by epidemiological data combined with immunological profiles. Serology-based studies should be implemented regularly in African countries, as recommended by the WHO. Malnutrition, lack of maternal education and poverty are factors associated with vaccine non-compliance. The countries' vaccination programs should actively address these problems.
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Affiliation(s)
- Claudine Bekondi
- Laboratoire des Virus Oncogènes, Institut Pasteur de Bangui, rue Pasteur, BP 923, Bangui, République Centrafricaine.
| | - Roberta Zanchi
- Unité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, 25-28 rue du Docteur Roux, 75015, Paris, France.
| | - Abdoulaye Seck
- Laboratoire de Biologie Médicale, Institut Pasteur de Dakar, 36 Avenue Pasteur, Dakar, Sénégal.
| | - Benoit Garin
- Institut Pasteur de Madagascar, BP 1274, Antananarivo, Madagascar.
| | - Tamara Giles-Vernick
- Unité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, 25-28 rue du Docteur Roux, 75015, Paris, France.
| | - Jean Chrysotome Gody
- Services des soins intensifs, Complexe Pédiatrique, BP 911, Bangui, République Centrafricaine.
| | - Petulla Bata
- Complexe Pédiatrique, BP 911, Bangui, République Centrafricaine.
| | - Angèle Pondy
- Centre Mère-Enfant, Fondation Chantal Biya, Yaoundé, Cameroun.
| | | | | | | | - Dominique Rousset
- Laboratoire de Virologie, Institut Pasteur Guyane, 23 avenue Pasteur, BP 6010, 97306, Cayenne, France.
| | - Jean-Marie Sire
- Département de virologie, Hôpital Saint Louis, Paris, France. .,Institut National de la Santé et de la Recherche Médicale, Faculté de Médecine Paris-Diderot, Paris, France.
| | - Sarah Maylin
- Service de Microbiologie CHU St Louis, 75010, Paris, France.
| | - Loïc Chartier
- Unité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, 25-28 rue du Docteur Roux, 75015, Paris, France.
| | - Richard Njouom
- Service de Virologie, Centre Pasteur du Cameroun, P.O.Box 1274, Yaoundé, Cameroun.
| | - Muriel Vray
- Unité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, 25-28 rue du Docteur Roux, 75015, Paris, France.
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Pereira JA, Quach S, Heidebrecht CL, Quan SD, Kolbe F, Finkelstein M, Kwong JC. Barriers to the use of reminder/recall interventions for immunizations: a systematic review. BMC Med Inform Decis Mak 2012; 12:145. [PMID: 23245381 PMCID: PMC3541955 DOI: 10.1186/1472-6947-12-145] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 11/26/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although many studies have demonstrated the benefits of reminder/recall (RR) measures to address patient under-immunization and improve immunization coverage, they are not widely implemented by healthcare providers. We identified providers' perceived barriers to their use from existing literature. METHODS We conducted a systematic review of relevant articles published in English between January 1990 and July 2011 that examined the perceptions of healthcare providers regarding barriers to tracking patient immunization history and implementing RR interventions. We searched MEDLINE, PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Academic Search Premier, and PsychINFO. Additional strategies included hand-searching the references of pertinent articles and related reviews, and searching keywords in Google Scholar and Google. RESULTS Ten articles were included; all described populations in the United States, and examined perceptions of family physicians, pediatricians, and other immunization staff. All articles were of moderate-high methodological quality; the majority (n=7) employed survey methodology. The most frequently described barriers involved the perceived human and financial resources associated with implementing an RR intervention, as well as low confidence in the accuracy of patient immunization records, given the lack of data sharing between multiple immunization providers. Changes to staff workflow, lack of appropriate electronic patient-tracking functionalities, and uncertainty regarding the success of RR interventions were also viewed as barriers to their adoption. CONCLUSIONS Although transitioning to electronic immunization records and registries should facilitate the implementation of RR interventions, numerous perceived barriers must still be overcome before the full benefits of these methods can be realized.
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Affiliation(s)
- Jennifer A Pereira
- Surveillance and Epidemiology, Public Health Ontario, 480 University Ave, Suite 300, Toronto, ON M5G 1V2, Canada.
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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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Taddio A, Chambers CT, Halperin SA, Ipp M, Lockett D, Rieder MJ, Shah V. Inadequate pain management during routine childhood immunizations: the nerve of it. Clin Ther 2009; 31 Suppl 2:S152-67. [PMID: 19781434 DOI: 10.1016/j.clinthera.2009.07.022] [Citation(s) in RCA: 159] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2009] [Indexed: 12/17/2022]
Abstract
BACKGROUND Immunization is regarded as one of the most significant medical achievements of all time. Recently, increasing attention has been paid to the pain resulting from routine childhood immunizations. OBJECTIVE This narrative review summarizes existing knowledge about: (1) the epidemiology of childhood immunization pain; (2) the pain experience of children undergoing immunization; (3) current analgesic practices; (4) barriers to practicing pain management in children; and (5) recommendations for improvements in pain management during immunization. METHODS We conducted a search of MEDLINE, PsycINFO, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials for primary research and review articles published from inception of the databases through October 2008. Key search terms included immunization, pain, child/infant, vaccine, and intervention. Additional studies were identified through searches of the reference lists in the retrieved articles. No language restrictions were imposed regarding the type of article (eg, full article, abstract) or language. RESULTS Vaccine injections are the most common iatrogenic procedure performed in childhood and a major source of distress for children (of all ages), their parents, and the participating health care professionals, as well as a direct cause of vaccine nonadherence. In addition, lack of adequate pain management during immunization exposes children to unnecessary suffering and the potential for long-term consequences, such as fear of needles. Numerous pain management strategies are available to reduce vaccine injection pain, including: (1) physical interventions and injection techniques; (2) psychological interventions; and (3) phar-macologic and combined interventions. However, adoption of pain-relieving techniques into clinical practice has been suboptimal. The underutilization of pain management strategies can be attributed to a lack of knowledge about pain and effective pain prevention strategies, and the persistence of attitudes about pain that interfere with optimal clinical practices. Current analgesic practices could be improved substantially if all stakeholders involved in immunization (eg, policy makers, practitioners, consumers) participate in efforts to reduce pain. Treating pain during childhood immunization has the potential to reduce distress during the procedure and greatly improve satisfaction with the immunization experience through more positive experiences for children and their families. Other potential benefits include improved adherence to immunization schedules and reduced sequelae of untreated pain. CONCLUSION Immunization is a global health priority. Medical care can be improved if pain management becomes a routine aspect of the delivery of vaccine injections.
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Affiliation(s)
- Anna Taddio
- Division of Pharmacy Practice, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
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Fu LY, Cowan N, McLaren R, Engstrom R, Teach SJ. Spatial accessibility to providers and vaccination compliance among children with medicaid. Pediatrics 2009; 124:1579-86. [PMID: 19933734 DOI: 10.1542/peds.2009-0233] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We examined the relationship between spatial accessibility to pediatric immunization providers and vaccination compliance in a low-income, urban population of children. METHODS In 2007, we accessed the Washington, DC, Immunization Information System (IIS) to collect data on the immunization statuses and residential addresses of children who were aged 19 to 35 months and had Medicaid insurance. In addition, we calculated each child's spatial accessibility to pediatric vaccination providers by assessing the provider-to-population ratio at each residential address. Spatial accessibility was divided into tertiles (low, medium, and high) of access. The relationship between spatial accessibility to providers and vaccination compliance was examined by using logistic regression analysis adjusting for age, type of vaccination provider, and enrollment in child care status. RESULTS Overall for our cohort of 4195 children, 80.5% of the children were up-to-date with vaccinations. Vaccination coverage ranged from 61.6% to 100% (median: 79.2%) among different neighborhoods. Having the highest level of access to pediatric vaccination providers was associated with 36% higher odds of being up-to-date as compared with having the lowest level of access. The middle tertile of access was associated with 25% higher odds of being up-to-date. CONCLUSIONS Within our low-income, urban population, children with higher spatial accessibility to pediatric vaccination providers were more likely to be up-to-date with vaccinations. This association may guide future studies and efforts to ensure adequate immunization coverage for children regardless of where they live.
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Affiliation(s)
- Linda Y Fu
- Goldberg Center for Community Pediatric Health, Children's National Medical Center, Washington, DC 20010, USA.
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Boom JA, Nelson CS, Kohrt AE, Kozinetz CA. Utilizing Peer Academic Detailing to Improve Childhood Immunization Coverage Levels. Health Promot Pract 2008; 11:377-86. [DOI: 10.1177/1524839908321487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Interventions that utilize academic detailing to improve childhood immunization have been implemented across the country. This study evaluates the effectiveness of an academic detailing intervention to increase childhood immunization rates in pediatric and family medicine practices in a major metropolitan area. Educational teams of one physician, nurse, and office manager delivered 83 peer education sessions at practices in the intervention group. Postintervention immunization rates for children 12-23 months of age increased 1% in the intervention group and decreased 3% in the control group. Postintervention coverage levels for children 12-23 months of age did not differ between the intervention and control groups. Results indicated this office-based intervention was not sufficient to effect measurable changes in immunization coverage levels after 1 year of participation. Future interventions need to provide initial feedback regarding practice immunization coverage levels prior to the educational interventions and include multiple encounters.
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Affiliation(s)
| | | | - Alan E. Kohrt
- Children's Healthcare of Atlanta in Atlanta, Georgia
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Falagas ME, Zarkadoulia E. Factors associated with suboptimal compliance to vaccinations in children in developed countries: a systematic review. Curr Med Res Opin 2008; 24:1719-41. [PMID: 18474148 DOI: 10.1185/03007990802085692] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The suboptimal compliance to vaccinations continues to be a major public health problem. SCOPE We conducted a systematic review (PubMed and Cochrane databases) to evaluate factors associated with suboptimal compliance to vaccinations, focusing on children and adolescents in developed countries. We categorized studies according to whether they used an analytical statistical approach. RESULTS We identified 553 potentially relevant articles and evaluated in detail 39 with original data. Factors influencing compliance to vaccinations related to parental-childhood characteristics and healthcare structure-professionals characteristics. Specifically, among the various parental-childhood characteristics studied, non-white race, low socioeconomic status, paying for immunization, lack of health insurance, low parental education, older age of the child, younger maternal age, large family size, late birth order, lack of knowledge about disease and vaccination, negative beliefs/attitudes towards immunization, fear of side-effects/risks/contraindications, not remembering vaccination schedules and appointments, sick child delays, and delayed well child visits were statistically significantly associated with suboptimal compliance. Among healthcare structure-professional characteristics were studied. Skepticism/doubts regarding provided medical information, inadequate support from healthcare providers, lack of available health structures, and problems concerning transportation and accessibility to immunization clinics were statistically significantly associated with suboptimal compliance to vaccination. CONCLUSION By recognizing and understanding factors associated with suboptimal compliance to vaccinations we can better approach the risk populations and target our efforts at stressing and reinforcing the vital importance of immunizations. Methods to enhance compliance to vaccinations may include reminder calls/mail notification of parents, initiation of health education programs for parents and health professionals, and open communication and trust between care takers of children and physicians.
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Franzini L, Boom J, Nelson C. Cost-effectiveness analysis of a practice-based immunization education intervention. ACTA ACUST UNITED AC 2007; 7:167-75. [PMID: 17368412 DOI: 10.1016/j.ambp.2006.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2006] [Revised: 11/28/2006] [Accepted: 12/02/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of academic detailing programs to improve immunization coverage in communities through implementation and evaluation of the Raising Immunizations Thru Education (RITE) program in the Greater Houston area. METHODS RITE was a preintervention and postintervention pilot study with randomized intervention and control sites implemented in private practices in pediatrics and family medicine. Changes in self-reported provider behaviors (n = 186) and comparisons of immunization coverage levels between intervention (n = 61) and control (n = 62) practices were evaluated. Intervention costs, computed from the perspective of an agency wanting to replicate the intervention, included direct expenses and time costs, based on time logs and compensation. Sensitivity analysis describes variations in costs. The cost-effectiveness ratio was computed as dollars per additional outcome unit. RESULTS The RITE intervention improved self-reported provider behavior. The immunization rates in the intervention group increased by 1 per cent, whereas immunization rates in the control group decreased by 2 per cent -3 per cent, but the 3 per cent - 4 per cent difference was not significant. A 1 per cent increase in practice immunization rates costs $424-$550, depending on the up-to-date criteria used and the targeted age group. CONCLUSIONS The costs for 1 additional child with up-to-date immunization status are higher than potential societal savings, as reported in the literature. This intervention does not have a favorable cost-benefit ratio.
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Affiliation(s)
- Luisa Franzini
- University of Texas School of Public Health, Houston, Texas 77030, USA.
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Boom JA, Nelson CS, Laufman LE, Kohrt AE, Kozinetz CA. Improvement in provider immunization knowledge and behaviors following a peer education intervention. Clin Pediatr (Phila) 2007; 46:706-17. [PMID: 17522285 DOI: 10.1177/0009922807301484] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Provider education programs that use academic detailing to improve childhood immunization have been implemented in several states. The purpose of this study was to evaluate the impact of these types of programs to improve immunization-related behaviors in private provider offices. The intervention included peer-based academic detailing in which teams of 1 physician, 1 nurse, and 1 office manager visited pediatric and family practices to deliver an educational presentation and develop practice-specific action plans. Comparison of pre-post intervention surveys showed that providers' willingness to give the maximum number of immunizations due at 1 visit (P < .001) increased. More providers reported routinely screening immunization records at sickness or injury visits (P < .05) and using minimum intervals (P < .001) postintervention. Mean change in baseline and postintervention overall scores was significant for pediatric practices (0.40, P < .05), small practices (0.64, P < .01), Vaccines for Children (VFC) practices (0.74, P < .05), and non-VFC provider practices (0.67, P < .01) but not for family or large practices.
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Affiliation(s)
- Julie A Boom
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas 77030, USA.
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Probst JC, Laditka SB, Wang JY, Johnson AO. Effects of residence and race on burden of travel for care: cross sectional analysis of the 2001 US National Household Travel Survey. BMC Health Serv Res 2007; 7:40. [PMID: 17349050 PMCID: PMC1851736 DOI: 10.1186/1472-6963-7-40] [Citation(s) in RCA: 179] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2006] [Accepted: 03/09/2007] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Travel burden is a key element in conceptualizing geographic access to health care. Prior research has shown that both rural and minority populations bear disproportionate travel burdens. However, many studies are limited to specific types of patient or specific locales. The purpose of our study was to quantify geographic and race-based differences in distance traveled and time spent in travel for medical/dental care using representative national data. METHODS Data were drawn from 2001 National Household Travel Survey (NHTS), a nationally representative, cross-sectional household survey conducted by the US Department of Transportation. Participants recorded all travel on a designated day; the overall response rate was 41%. Analyses were restricted to households reporting at least one trip for medical and/or dental care; 3,914 trips made by 2,432 households. Dependent variables in the analysis were road miles traveled, minutes spent traveling, and high travel burden, defined as more than 30 miles or 30 minutes per trip. Independent variables of interest were rural residence and race. Characteristics of the individual, the trip, and the community were controlled in multivariate analyses. RESULTS The average trip for care in the US in 2001 entailed 10.2 road miles (16.4 kilometers) and 22.0 minutes of travel. Rural residents traveled further than urban residents in unadjusted analysis (17.5 versus 8.3 miles; 28.2 versus 13.4 km). Rural trips took 31.4% longer than urban trips (27.2 versus 20.7 minutes). Distance traveled did not vary by race. African Americans spent more time in travel than whites (29.1 versus 20.6 minutes); other minorities did not differ. In adjusted analyses, rural residence (odds ratio, OR, 2.67, 95% confidence interval, CI 1.39 5.1.5) was associated with a trip of 30 road miles or more; rural residence (OR, 1.80, CI 1.09 2.99) and African American race/ethnicity (OR 3.04. 95% CI 2.0 4.62) were associated with a trip lasting 30 minutes or longer. CONCLUSION Rural residents and African Americans experience higher travel burdens than urban residents or whites when seeking medical/dental care.
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Affiliation(s)
- Janice C Probst
- South Carolina Rural Health Research Center, Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Sarah B Laditka
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Jong-Yi Wang
- South Carolina Rural Health Research Center, Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
- Department of Health Services Policy & Management, School of Public Health, China Medical University, 91 Hsueh-Shih Road, Taichung 40402, Taiwan
| | - Andrew O Johnson
- South Carolina Rural Health Research Center, Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
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