Background Vaccination efforts are a vital part of controlling the spread of diseases, however, lack of vaccine acceptance undermines the efficacy of this public health effort. Current evidence suggests that the most effective interventions to support vaccination uptake and positive vaccination beliefs are multicomponent, and dialogue based. Peer-based education interventions are such a strategy that involves an individual within the same group to act as the vaccine educator. Objective This review aims to consolidate the quantitative evidence surrounding the effectiveness and experience of peer-based education initiatives to improve vaccination beliefs and behaviors. Methods We conducted a systematic search of PubMed, Web of Science, and a hand reference search. The search was conducted between April and June 2022. The inclusion criteria encompassed using peers, being education based, and being an intervention that addresses vaccination beliefs and behaviors (e.g. vaccination uptake). Results Systematic screening revealed 16 articles in the final review. Half of the studies focused on students as their study population. The human papillomavirus vaccine was the most common vaccine assessed in the studies, followed by COVID and influenza vaccines. 11 out of 16 of the articles reported a positive impact of the peer intervention and two studies had mixed results. Six studies suggest a mixed peer- healthcare expert approach. Conclusions Despite reported positive effects of using peer-education based initiatives to improve vaccine uptake and beliefs, this systematic review reveals that there is limited existing research in support of this strategy. The strategies that initially appear the most effect are those with a combined peer and health-expert approach, and those that have more group specific and long-term peer interventions. More research is needed to confirm these results and to assess the effectiveness of a peer-based education intervention in a wider variety of settings and for other vaccine types.
Background: Anthroposophic communities have gained the attention of public health authorities due to low vaccination uptake. This systematic review aimed to summarize the evidence available on the relationship between anthroposophy and vaccine beliefs. The systematic review addressed aimed to collate evidence documenting outbreaks linked to anthroposophic communities, literature on vaccination coverage in anthroposophic communities and lastly describe literature that summarizes theories and factors influencing vaccine decision making in anthroposophic communities. Methods: This is a systematic review using following databases: Medline, Web of Science, Psycinfo and CINAHL. Article screening was conducted by two researchers. Data was summarized to address the research questions. For the third research question the qualitative data was analyzed using thematic analysis with the assistance of Nvivo12.0. Results: There were 12 articles documenting 18 measles outbreaks linked to anthroposophic communities between the years 2000 and 2012. Seven articles describe lower vaccination uptake in anthroposophic communities than in other communities, although one article describes that vaccination uptake in low-income communities with a migrant background have lower coverage than the anthroposophic community they studied. We found eight articles examining factors and theories influencing vaccine decision making in anthroposophic communities. The qualitative analysis revealed four common themes. Firstly, there was a very broad spectrum of vaccine beliefs among the anthroposophic communities. Secondly, there was a consistent narrative about problems or concerns with vaccines, including toxicity, lack of trust in the system. Thirdly, there was a strong notion of the importance of making individual and well-informed choice as opposed to simply following the masses. Lastly, making vaccine choices was highly stigmatized by those outside of the anthroposophic community but also those within the community. Conclusion: Continued research and monitoring of vaccine beliefs in the anthroposophic community is important particularly in view of current COVID-19 vaccine decision debates. The importance of the Waldorf school and community context in influencing vaccine decision making warrants further investigation.
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