Evidence-based strategies to increase vaccination uptake: a review

Abstract

Purpose of review To summarize evidence-based strategies for improving pediatric immunization rates including physician behaviors, clinic and public health processes, community-based and parent-focused interventions, and legal and policy approaches Recent findings Studies continue to show the effectiveness of audit and feedback, provider reminders, standing orders, and reminder/recall to increase immunization rates. Provider communication strategies may improve immunization rates including use of a presumptive approach and motivational interviewing. Centralized reminder/recall (using a state Immunization Information System) is more effective and cost-effective compared to a practice-based approach. Recent work shows the success of text messages for reminder/recall for vaccination. Web-based interventions, including informational vaccine websites with interactive social media components, have shown effectiveness at increasing uptake of pediatric and maternal immunizations. Vaccination requirements for school attendance continue to be effective policy interventions for increasing pediatric and adolescent vaccination rates. Allowance for and ease of obtaining exemptions to vaccine requirements are associated with increased exemption rates. Summary Strategies to increase vaccination rates include interventions that directly impact physician behavior, clinic and public health processes, patient behaviors, and policy. Combining multiple strategies to work across different settings and addressing different barriers may offer the best approach to optimize immunization coverage.

Policy statement from the Society for Healthcare Epidemiology of America (SHEA): Only medical contraindications should be accepted as a reason for not receiving all routine immunizations as recommended by the Centers for Disease Control and Prevention

“…All HCP should be familiar with indications for immunization 14 and evidence-based interventions that improve vaccine coverage (eg, standing orders, patient reminders/recall for vaccination, and provider reminders). 12,15 Furthermore, HCP should be aware of common concerns regarding immunization (eg, vaccine will cause disease due to antigen in the vaccine, lack of effectiveness, and safety), and they should be prepared to allay these concerns. Videos such as those available from the American Academy of Pediatrics (https://www.aap.org/en-us/advocacy-and-policy/aaphealth-initiatives/immunizations/Pages/Communication-Aids.…”

Vaccine Hesitancy: Drivers and How the Allergy Community Can Help

“… 57 Recent reviews also identify multiple interventions that have shown success in addressing hesitancy directly with patients or indirectly through support of clinicians. 58 , 59 Many of these interventions and strategies focus on supporting successful provider-patient communication about vaccines and building a culture of immunization support through practice-level activities and systems. 60 …”

Behavioural Science-Informed Strategies for Increasing COVID-19 Vaccine Uptake in Children and Youth

“…Healthcare provider recommendation is a well-researched strategy for increasing vaccine uptake in children. 22,[26][27][28][29] In order for healthcare providers to make an effective vaccine recommendation, it is necessary to inform, prompt and provide educational training and resources to providers about evolving COVID-19 vaccine recommendations and the rationale for vaccinating children and youth. 16,[30][31][32][33][34][35][36][37][38][39] It may be helpful to partner with primary care providers to administer vaccines in their offices, 40 and ensure parents are supported to have adequate paid time off for their children's appointments.…”

“…To maximize impactful communication with parents, the use of shared decision-making and motivational interviewing techniques have been identified as useful strategies. 17,29,42,43…”

“…Reminders for the next vaccine dose and recall for missed vaccination have also demonstrated impact. 29,[44][45][46][47][48][49] Personalized reminders focused on children, youth, parents, or providers have been shown to be effective. 17,49,50 In a vaccine registry, reminders can be sent directly to individuals who have received one COVID-19 vaccine dose to prompt individuals when they are due for their second dose.…”