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. 2014 Nov 19;2014(11):CD010232.
doi: 10.1002/14651858.CD010232.pub2.

Interventions aimed at communities to inform and/or educate about early childhood vaccination

Ingvil Saeterdal  1 , Simon Lewin, Astrid Austvoll-Dahlgren, Claire Glenton, Susan Munabi-Babigumira
Affiliations

Interventions aimed at communities to inform and/or educate about early childhood vaccination

Ingvil Saeterdal et al. Cochrane Database Syst Rev. .

Abstract

Background: A range of strategies are used to communicate with parents, caregivers and communities regarding child vaccination in order to inform decisions and improve vaccination uptake. These strategies include interventions in which information is aimed at larger groups in the community, for instance at public meetings, through radio or through leaflets. This is one of two reviews on communication interventions for childhood vaccination. The companion review focuses on face-to-face interventions for informing or educating parents.

Objectives: To assess the effects of interventions aimed at communities to inform and/or educate people about vaccination in children six years and younger.

Search methods: We searched CENTRAL, MEDLINE, EMBASE and five other databases up to July 2012. We searched for grey literature in the Grey Literature Report and OpenGrey. We also contacted authors of included studies and experts in the field. There were no language, date or settings restrictions.

Selection criteria: Individual or cluster-randomised and quasi-randomised controlled trials, interrupted time series (ITS) and repeated measures studies, and controlled before-and-after (CBA) studies. We included interventions aimed at communities and intended to inform and/or educate about vaccination in children six years and younger, conducted in any setting. We defined interventions aimed at communities as those directed at a geographic area, and/or interventions directed to groups of people who share at least one common social or cultural characteristic. Primary outcomes were: knowledge among participants of vaccines or vaccine-preventable diseases and of vaccine service delivery; child immunisation status; and unintended adverse effects. Secondary outcomes were: participants' attitudes towards vaccination; involvement in decision-making regarding vaccination; confidence in the decision made; and resource use or cost of intervention.

Data collection and analysis: Two authors independently reviewed the references to identify studies for inclusion. We extracted data and assessed risk of bias in all included studies.

Main results: We included two cluster-randomised trials that compared interventions aimed at communities to routine immunisation practices. In one study from India, families, teachers, children and village leaders were encouraged to attend information meetings where they received information about childhood vaccination and could ask questions. In the second study from Pakistan, people who were considered to be trusted in the community were invited to meetings to discuss vaccine coverage rates in their community and the costs and benefits of childhood vaccination. They were asked to develop local action plans and to share the information they had been given and continue the discussions in their communities.The trials show low certainty evidence that interventions aimed at communities to inform and educate about childhood vaccination may improve knowledge of vaccines or vaccine-preventable diseases among intervention participants (adjusted mean difference 0.121, 95% confidence interval (CI) 0.055 to 0.189). These interventions probably increase the number of children who are vaccinated. The study from India showed that the intervention probably increased the number of children who received vaccinations (risk ratio (RR) 1.67, 95% CI 1.21 to 2.31; moderate certainty evidence). The study from Pakistan showed that there is probably an increase in the uptake of both measles (RR 1.63, 95% CI 1.03 to 2.58) and DPT (diptheria, pertussis and tetanus) (RR 2.17, 95% CI 1.43 to 3.29) vaccines (both moderate certainty evidence), but there may be little or no difference in the number of children who received polio vaccine (RR 1.01, 95% CI 0.97 to 1.05; low certainty evidence). There is also low certainty evidence that these interventions may change attitudes in favour of vaccination among parents with young children (adjusted mean difference 0.054, 95% CI 0.013 to 0.105), but they may make little or no difference to the involvement of mothers in decision-making regarding childhood vaccination (adjusted mean difference 0.043, 95% CI -0.009 to 0.097).The studies did not assess knowledge among participants of vaccine service delivery; participant confidence in the vaccination decision; intervention costs; or any unintended harms as a consequence of the intervention. We did not identify any studies that compared interventions aimed at communities to inform and/or educate with interventions directed to individual parents or caregivers, or studies that compared two interventions aimed at communities to inform and/or educate about childhood vaccination.

Authors' conclusions: This review provides limited evidence that interventions aimed at communities to inform and educate about early childhood vaccination may improve attitudes towards vaccination and probably increase vaccination uptake under some circumstances. However, some of these interventions may be resource intensive when implemented on a large scale and further rigorous evaluations are needed. These interventions may achieve most benefit when targeted to areas or groups that have low childhood vaccination rates.'

PubMed Disclaimer

Conflict of interest statement

The authors of this review are employed by the Norwegian Knowledge Centre for the Health Services. We receive in‐kind support from the Knowledge Centre such as time, office materials, library access and support from colleagues. The Knowledge Centre has no inappropriate interest in the findings of this review.

The funder of this work, the Norwegian Research Council's GLOBVAC programme, does not have any inappropriate vested interest in the findings of this review.

Simon Lewin and Claire Glenton are editors for the Cochrane Consumers and Communication Review Group. They did not have any influence over the Review Group's editorial process or decision to publish this review.

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
4
4
Forest plot of comparison: Interventions aimed at communities versus routine immunisation practices, outcome: Immunisation status of child.
1.1
1.1. Analysis
Comparison 1 Interventions aimed at communities versus no intervention, Outcome 1 Infant received ≥ 1 vaccination_unadjusted.
1.2
1.2. Analysis
Comparison 1 Interventions aimed at communities versus no intervention, Outcome 2 Infant received ≥ 1 vaccination_adjusted for clustering and other variables_additional data from study authors.
1.3
1.3. Analysis
Comparison 1 Interventions aimed at communities versus no intervention, Outcome 3 Child received measles vaccine_unadjusted.
1.4
1.4. Analysis
Comparison 1 Interventions aimed at communities versus no intervention, Outcome 4 Child received measles vaccine_adjusted for clustering.
1.5
1.5. Analysis
Comparison 1 Interventions aimed at communities versus no intervention, Outcome 5 Child received full course of DPT vaccine_unadjusted.
1.6
1.6. Analysis
Comparison 1 Interventions aimed at communities versus no intervention, Outcome 6 Child received full course of DPT vaccine_adjusted for clustering.
1.7
1.7. Analysis
Comparison 1 Interventions aimed at communities versus no intervention, Outcome 7 Child received polio vaccination in the last 12 months_unadjusted.
1.8
1.8. Analysis
Comparison 1 Interventions aimed at communities versus no intervention, Outcome 8 Child received polio vaccination in the last 12 months_adjusted for clustering.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD010232

References

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