Parental Financial Incentives for Increasing Preschool Vaccination Uptake: Systematic Review

Abstract

BACKGROUND AND OBJECTIVE: Financial incentives have been used to promote vaccination uptake but are not always viewed as acceptable. Quasimandatory policies, such as requiring vaccinations for school enrollment, are widely implemented in some countries. A systematic review was conducted to determine the effectiveness, acceptability, and economic costs and consequences of parental financial incentives and quasimandatory schemes for increasing the uptake of preschool vaccinations in high-income countries. METHODS: Electronic databases and gray literature were searched for randomized controlled trials, controlled before-and-after studies, and time series analyses examining the effectiveness of parental financial incentives and quasimandatory schemes, as well as any empirical studies exploring acceptability. All included studies were screened for information on economic costs and consequences. Two reviewers independently assessed studies for inclusion, extracted data, and assessed the quality of selected articles by using established instruments. Studies were synthesized in narrative reviews. RESULTS: Four studies on the effectiveness and 6 on the acceptability of parental financial incentives and quasimandatory interventions met the inclusion criteria. Only 1 study reported on costs and consequences. Studies of effectiveness had low risk of bias but displayed substantial heterogeneity in terms of interventions and methods. CONCLUSIONS: There was insufficient evidence to conclude whether these interventions were effective. Studies of acceptability suggested a preference, in settings where this already occurs, for incentives linking vaccinations to access to education. There was insufficient evidence to draw conclusions on economic costs and consequences.

Effectiveness and acceptability of parental financial incentives and quasi-mandatory schemes for increasing uptake of vaccinations in preschool children: systematic review, qualitative study and discrete choice experiment

“…A more detailed understanding of what aspects of acceptability of health-promoting financial incentives are common across all settings and which are context-specific -as well as what determines context-specific differenceswould be helpful. Our results support findings from US studies and the current systematic review around the acceptability of quasi-mandatory schemes for increasing the uptake of vaccination, 56 suggesting that the introduction of such schemes, with the inclusion of an opt-out system, would be acceptable to parents and professionals, and could encourage the normalisation of vaccination while being equitable for parents across the socioeconomic spectrum.…”

Strategies intended to address vaccine hesitancy: Review of published reviews

“…The search strategy yielded 15 literature reviews or metaanalysis that met the eligibility criteria [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. The majority of these were published in the last 3 years (9/15).…”

“…Both of these reviews included almost exclusively studies conducted in the United States. Williams, after reviewing the effectiveness of 15 interventions to improve attitudes, vaccination intent or vaccine uptake, was unable to identify any type of intervention as being more effective than others [24]. She also noticed that few studies identified parents as vaccine-hesitant prior to participation [25].…”

“…All other regulatory interventions primarily focused on provision of funded vaccine coupled with mandatory vaccination policies for health-care workers (HCWs) and were implemented at a jurisdictional and/or organisational level. The small number of studies showed limited effectiveness of this strategy Wigham (2014) …”

“…These authors concluded that there was not sufficient evidence to show whether parental incentives and quasi-mandatory interventions were effective for increasing uptake of preschool vaccinations. Studies reviewed by these authors have also indicated that quasi-mandatory interventions linking vaccination to education were acceptable, although the risk of bias in the relevant studies was high, and they were conducted in contexts where such interventions were widespread [24].…”