Community health worker intervention improves early childhood vaccination rates: results from a propensity-score matching evaluation

Abstract

Background Arizona’s Health Start Program is a statewide community health worker (CHW) maternal and child health home visiting intervention. The objective of this study was to test if participation in Health Start during 2006–2016 improved early childhood vaccination completion rates. Methods This retrospective study used 11 years of administrative, birth certificate, and immunization records. Propensity score matching was used to identify control groups, based on demographic, socioeconomic, and geographic characteristics. Results are reported by historically disadvantaged subgroups and/or with a history of low vaccine uptake, including Hispanic/Latinx and American Indian children, and children of low socioeconomic status and from rural areas, children with teen mothers and first-born children. The average treatment-on-the-treated (ATT) effect estimated the impact of Health Start on timely completion of seven early childhood vaccine series: diphtheria/tetanus toxoids and acellular/whole-cell pertussis (DTaP/DTP), Haemophilus influenzae type b (Hib), hepatitis B (Hep. B), measles-mumps-rubella (MMR), pneumococcal conjugate vaccine (PCV13), poliovirus, and varicella. Results Vaccination completion rates (by age five) were 5.0% points higher for Health Start children as a group, and on average 5.0% points higher for several subgroups of mothers: women from rural border counties (ATT 5.8), Hispanic/Latinx women (ATT 4.8), American Indian women (ATT 4.8), women with less than high school education (ATT 5.0), teen mothers (ATT 6.1), and primipara women (ATT 4.5), compared to matched control groups (p-value ≤ 0.05). Time-to-event analyses show Health Start children complete vaccination sooner, with a hazard rate for full vaccination 13% higher than their matches. Conclusion A state-operated home visiting intervention with CHWs as the primary interventionist can effectively promote early childhood vaccine completion, which may reduce the incidence of preventable diseases and subsequently improve children’s health. Effects of CHW interventions on vaccination uptake is particularly relevant given the rise in vaccine-preventable diseases in the US and globally. Trial registration Approved by the University of Arizona Research Institutional Review Board (Protocol 1701128802), 25 January 2017.

Building Trust and Awareness to Increase AZ Native Nation Participation in COVID-19 Vaccines

“…Considering the trust and impact CHRs have in their communities, and that the majority of Arizona Native nations employ CHR programs [15], they are recognized as key assets in approaching community members and relaying preventative health messages. Our findings reinforce those that demonstrate CHR's value in promoting access to preventative care, like vaccines, through education and navigation [18,19].…”

Preventive Interventions to Reduce the Burden of Rheumatic Heart Disease in Populations at Risk: A Systematic Review

“…Existing evidence corroborates the crucial role that community health workers play in improving health outcomes in communities for various conditions, such as diabetes, maternal and child health, and vaccination. 60 , 61 , 62 It is important to note that this Australian study was conducted in a well‐resourced country, and the sample size for analysis was small (29 individuals), which may limit the generalizability of the findings. However, these results are promising and provide valuable recommendations for low‐resourced countries that have an existing community health worker workforce supporting community health services.…”

Determinants of Equity in Coverage of Measles-Containing Vaccines in Wales, UK, during the Elimination Era

“…Evidence from this study is useful to develop tailored interventions; for example, community health care visits [ 31 ], which in this case could be prioritised for large households with multiple unvaccinated children, or joint scheduling for siblings that require catch-up. Having had previous vaccines meant there was a higher chance of having had measles-containing vaccine, suggesting it may be efficient for catch-up campaigns to target more than one vaccine programme.…”