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Review
. 2022 Apr 25:27:101804.
doi: 10.1016/j.pmedr.2022.101804. eCollection 2022 Jun.

Barriers to and facilitators of early childhood immunization in rural areas of the United States: A systematic review of the literature

Alexandria N Albers  1   2 , Juthika Thaker  1   2 , Sophia R Newcomer  1   2
Affiliations
Review

Barriers to and facilitators of early childhood immunization in rural areas of the United States: A systematic review of the literature

Alexandria N Albers et al. Prev Med Rep. .

Abstract

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.

Keywords: Early childhood immunizations; PRISMA; Preventive health; Rural health; Systematic review.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
PRISMA 2020 flow diagram for systematic review (Page et al., 2021).
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