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Parental reminder, recall and educational interventions to improve early childhood immunisation uptake: A systematic review and meta-analysis

Tuesday, 17th of May 2016

“•Parental reminder strategies significantly increase immunisation uptake.

•Parental education may significantly increase uptake, but further research is needed.”

 

Vaccine, Volume 33, Issue 25, 9 June 2015, Pages 2862–2880

Review

Parental reminder, recall and educational interventions to improve early childhood immunisation uptake: A systematic review and meta-analysis

Hannah Harveya, Nadja Reisslanda, James Masonb,

a Department of Psychology, Durham University, Durham DH1 3LE, UK

b Durham University School of Medicine, Pharmacy and Health, Wolfson Research Institute, Stockton-On-Tees TS17 6BH, UK

Received 16 January 2015, Revised 21 April 2015, Accepted 23 April 2015, Available online 2 May 2015

Excerpts below; full text is at http://www.sciencedirect.com/science/article/pii/S0264410X1500571X

Highlights

•28 trials involving 14,936 parent–child dyads examined immunisation uptake strategies.

•The methodological quality of trials was generally low.

•All parental interventions appear associated with improvements in uptake, although findings were inconsistent.

•Parental reminder strategies significantly increase immunisation uptake.

•Parental education may significantly increase uptake, but further research is needed.

Abstract

Vaccination is one of the most effective ways of reducing childhood mortality. Despite global uptake of childhood vaccinations increasing, rates remain sub-optimal, meaning that vaccine-preventable diseases still pose a public health risk. A range of interventions to promote vaccine uptake have been developed, although this range has not specifically been reviewed in early childhood. We conducted a systematic review and meta-analysis of parental interventions to improve early childhood (0–5 years) vaccine uptake. Twenty-eight controlled studies contributed to six separate meta-analyses evaluating aspects of parental reminders and education. All interventions were to some extent effective, although findings were generally heterogeneous and random effects models were estimated.

Receiving both postal and telephone reminders was the most effective reminder-based intervention (RD = 0.1132; 95% CI = 0.033–0.193). Sub-group analyses suggested that educational interventions were more effective in low- and middle-income countries (RD = 0.13; 95% CI = 0.05–0.22) and when conducted through discussion (RD = 0.12; 95% CI = 0.02–0.21). Current evidence most supports the use of postal reminders as part of the standard management of childhood immunisations. Parents at high risk of non-compliance may benefit from recall strategies and/or discussion-based forums, however further research is needed to assess the appropriateness of these strategies.

1. Introduction

The reduction in global mortality associated with vaccinations is second only to the introduction of safe drinking water [1]. According to the World Health Organisation, childhood vaccinations prevent an estimated 2–3 million deaths per year. Yet despite global increases in childhood vaccine uptake, rates remain sub-optimal (<95%), with vaccine-preventable diseases still posing a public health risk [2]. Neither is this risk limited to low- and middle-income countries (LMICs). Factors such as poor access to healthcare, indigenous or ethnic status, a large family size and low educational achievement are associated with pockets of low coverage in high-income countries (HICs) [3].

Maintaining reductions in mortality from vaccine-preventable disease relies upon continued immunisation uptake that, during childhood, is reliant on parental decision-making and subsequent attendance at vaccine clinics [4]. However, several factors may act as barriers to childhood immunisation. Factors include parental concerns about vaccine safety, a lack of knowledge about the recommended schedule, pain caused by the injections, distrust of the medical community and difficulty accessing clinics [5]. Therefore, it is important to understand the effectiveness of interventions implemented by primary care settings that are designed to improve childhood immunisation. Interventions to increase childhood immunisation have been targeted at a variety of groups, including healthcare providers, healthcare practices and parents [6]. This review will focus on the effectiveness of interventions targeted at parents. Many strategies have been trialled, including financial incentives [7] and home vaccination [8]. However, as the majority of trials have addressed (a) the lack of schedule awareness using parental reminder systems and/or (b) knowledge about the safety and efficacy of vaccines through educational leaflets or discussion-groups, these interventions will be the primary focus of this review. Systems designed to remind parents that their child was due (reminder) or overdue (recall) their immunisations have been linked to a 1.5 times increase in uptake [9]. The effects of parental education are less clear, with evidence presented both for [10] and [11] and against [3] their utility.

Previous reviews have focussed on the efficacy of intervention strategies in isolation and not all have made specific recommendations regarding childhood immunisations. Today, primary health care services are under increasing pressure to meet immunisation expectations at both an organisational and patient level [12]. In order to facilitate physician judgements about interventions to increase childhood immunisation, and to increase the efficacy of intervention implementation and policy updates, a review comparing the effectiveness of multiple interventions to be compared is timely. Therefore, a systematic review and meta-analysis was conducted to evaluate available evidence on parental interventions to improve childhood (birth to 5 years) vaccine uptake.