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Meta-Analysis
. 2023 Nov:137:104894.
doi: 10.1016/j.healthpol.2023.104894. Epub 2023 Sep 4.

Behavioral interventions for vaccination uptake: A systematic review and meta-analysis

Amyn A Malik  1 , Noureen Ahmed  2 , Mehr Shafiq  3 , Jad A Elharake  4 , Erin James  5 , Kate Nyhan  6 , Elliott Paintsil  7 , Hannah Camille Melchinger  2 , Yale Behavioral Interventions Team  5 , Fauzia A Malik  2 , Saad B Omer  8
Affiliations
Meta-Analysis

Behavioral interventions for vaccination uptake: A systematic review and meta-analysis

Amyn A Malik et al. Health Policy. 2023 Nov.

Abstract

Background: Human behavior and more specifically behavioral insight-based approaches to vaccine uptake have often been overlooked. While there have been a few narrative reviews indexed in Medline on behavioral interventions to increase vaccine uptake, to our knowledge, none have been systematic reviews and meta-analyses covering not just high but also low-and-middle income countries.

Methods: We included 613 studies from the Medline database in our systematic review and meta-analysis categorizing different behavioral interventions in 9 domains: education campaigns, on-site vaccination, incentives, free vaccination, institutional recommendation, provider recommendation, reminder and recall, message framing, and vaccine champion. Additionally, considering that there is variability in the acceptance of vaccines among different populations, we assessed studies from both high-income countries (HICs) and low- to middle-income countries (LMICs), separately.

Findings: Our results showed that behavioral interventions can considerably improve vaccine uptake in most settings. All domains that we examined improved vaccine uptake with the highest effect size associated with provider recommendation (OR: 3.4 (95%CI: 2.5-4.6); Domain: motivation) and on-site vaccination (OR: 2.9 (95%CI: 2.3-3.7); Domain: practical issues). While the number of studies conducted in LMICs was smaller, the quality of studies was similar with those conducted in HICs. Nevertheless, there were variations in the observed effect sizes.

Interpretation: Our findings indicate that "provider recommendation" and "on-site vaccination" along with other behavioral interventions can be employed to increase vaccination rates globally.

Keywords: Behavioral interventions; Meta-analysis; Systematic review; Vaccine uptake.

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Conflict of interest statement

Declaration of Competing Interest None.

Figures

Figure 1.
Figure 1.
Studies included and excluded at each stage of review process.
Figure 2.
Figure 2.
Forrest Plot showing ORs and respective 95% CIs for all studies included in the meta-analysis by domains
Figure 3.
Figure 3.
Forrest Plot showing ORs and respective 95% CIs for all studies from LMICs included in the meta-analysis by domains
Figure 4.
Figure 4.
Forrest Plot showing ORs and respective 95% CIs for all RCTs included in the meta-analysis by domains
Figure 5.
Figure 5.
Forrest Plot showing ORs and respective 95% CIs for all high-GRADE studies included in the meta-analysis by domains
See this image and copyright information in PMC

References

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