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Systematic Review
The CPSTF recommends community-based interventions implemented in combination to increase vaccinations in targeted populations, on the basis of strong evidence of effectiveness in increasing vaccination rates.
The conclusion of strong evidence was based on findings from 18 studies that evaluated coordinated interventions to:
- Increase community demand
- Enhance access to vaccination services, and
- Reduce missed opportunities by vaccination providers
In 13 of the 18 studies, the community-based effort combined one or more interventions to increase community demand for vaccinations with one or more interventions to enhance access to vaccination services.
The Task Force notes that implementing manual outreach and tracking or home visits can be resource-intensive and costly, relative to other options for increasing vaccination rates. Such interventions should be used only when there is demonstrated need, and resources are available.
This Task Force finding is based on evidence from a Community Guide systematic review completed in 2010 (17 studies; search period 1980 - 2010) combined with more recent evidence (1 study, search period 2010 - 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.
All of the included studies provided a common measure of change and showed a median increase in vacation rates of 14 percentage points (IQI: 7 to 24 percentage points).
The included studies evaluated a variety of interventions in different combinations. The Task Force examined the evidence of differences attributable to specific interventions and combinations of interventions using different strategic approaches.
Fourteen studies implemented an effective combination of one or more interventions to increase community demand with one or more interventions to enhance access to vaccination services and showed a median increase in vaccination rates of 16 percentage points (IQI: 12 to 26 percentage points).
Client reminder and recall systems were used in most of the evaluated programs (15 study arms). Systems were implemented by vaccination providers, established as one part of a community manual outreach and tracking program, or generated from a regional immunization information system (IIS).
This CPSTF concludes that coordinated interventions may be especially important in communities that have wide disparities in vaccination coverage. Program planners should consider community characteristics, such as mobility and fragmentation of health care, in the selection and combination of interventions to increase vaccination rates and reduce disparities.
Partnerships between community organizations and vaccination providers are likely to be an essential component of effective, sustained community-based efforts. Most studies involved partnerships with existing vaccination providers in
the community to increase access to vaccinations, rather than creating new vaccination services. Coalitions represent one way to establish effective partnerships, with the size of the coalition varying based on the community, targeted population, and scope of the problem. Four studies involved community coalitions that used the principles of community-based participatory research.
More evidence is needed on the effectiveness of these programs in adolescents, and when implemented in rural settings. More economic information on these interventions is needed, specifically, evaluations on the efficiencies of the resource-intensive components of manual outreach and tracking and home visits. Future research could compare program effectiveness based on differences in the component interventions and strategic combinations. Additional research also should examine ways to sustain these programs, especially when provided by existing community-based organizations.