Vaccination Programs: Clinic-Based Client Education when Used Alone

This review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice and policy related to increasing appropriate vaccination.

Five studies were included in the review; four provided a common measurement of changes in vaccination rates.

• Overall vaccination rates increased by a median of 10 percentage points (4 studies with 6 study arms).
  • This estimate was based largely on three related study arms focused on increasing pneumococcal polysaccharide vaccinations among older adult patients in one clinical setting.
  • Changes in vaccination rates from the other three study arms were inconsistent and smaller in magnitude.
• One study did not evaluate changes in vaccination rates, and found only a very small change in the number of vaccinations administered.

• Is this educational approach applicable to a wider range of vaccines and populations?

• Two studies focused on increasing pneumococcal polysaccharide vaccinations among older adult patients in one clinical setting

Effectiveness Review

Analytic Framework

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Effectiveness Review

Summary Evidence Table

Effectiveness Review

Eubelen C, Brendel F, Belche JL, Freyens A, Vanbelle S, Giet D. Effect of an audiovisual message for tetanus booster vaccination broadcast in the waiting room. BMC Fam Pract 2011;12:104. doi: 10.1186/1471-2296-12-104.

Elangovan S, Kallail KJ, Vargo G. Improving Pneumococcal vaccination rates in an elderly population by patient education in an outpatient clinic. Journal of the American Board of Family Practice 1996;9:411-3.

Herman CJ, Speroff T, Cebu RD. Improving compliance with immunization in the older adult: results of a randomized cohort study. Journal of the American Geriatric Society 1994; 42:1154-9.

Jacobson TA, Thomas DM, Morton FJ et al. Use of a low-literacy patient education tool to enhance Pneumococcal vaccination rates: a randomized controlled trial. JAMA 1999; 282(7):646-50.

Thomas DM, Ray SM, Morton FJ et al. Patient education strategies to improve Pneumococcal vaccination rates: randomized trial. Journal of Investigative Medicine 2003;51(3)141-8.

Effectiveness Review

The Task Force findings are based on studies included in the original review (search period 1980-1997) combined with studies identified in the updated search (search period 1997- February 2012). Reference lists of articles reviewed as well as lists in review articles were also searched, and members of our coordination team were consulted for additional references.

Details of the original search (1980-1997)

The following five electronic databases were searched during the original review period of 1980 up to 1997: MEDLINE, Embase, Psychlit, CAB Health, and Sociological Abstracts. The team also reviewed reference lists in articles and consulted with immunization experts. To be included in the review, a study had to:

• have a publication date of 1980 1997;
• address universally recommended adult, adolescent, or childhood vaccinations;
• be a primary study rather than, for example, a guideline or review;
• take place in an industrialized country or countries;
• be written in English;
• meet the evidence review and Guide chapter development team’s definition of the interventions; provide information on one or more outcomes related to the analytic frameworks; and
• compare a group of persons who had been exposed to the intervention with a group who had not been exposed or who had been less exposed. In addition, we excluded studies with least suitable designs for two interventions (provider reminder/recall and client reminder/recall) where the literature was most extensive.

Details of the update search (1997- February 2012)

The team conducted a broad literature search to identify studies assessing the effectiveness of Vaccine Preventable Disease interventions in improving vaccination rates. The following nine databases were searched during the period of 1997 up to February 2012: CABI, CINAHL, The Cochrane Library, EMBASE, ERIC, MEDLINE, PSYCHINFO, Soci Abs and WOS. Reference lists of articles reviewed as well as lists in review articles were also searched, and subject matter experts consulted for additional references. To be included in the updated review, a study had to:

• have a publication date of 1997- February 2012;
• evaluate vaccinations with universal recommendations;
• meet the evidence review and Guide chapter development team’s definition of the interventions;
• be a primary research study with one or more outcomes related to the analytic frameworks;
• take place in an high income country or countries;
• be written in English
• compare a group of persons who had been exposed to the intervention with a group who had not been exposed or who had been less exposed. In addition, we excluded studies with least suitable designs for two interventions (provider reminder/recall and client reminder/recall) where the literature was most extensive

Search Terms

1. Immunization
2. Vaccination
3. Immunization Programs

• Clinic-based client education can be included in two multicomponent interventions approaches recommended by the CPSTF:
  • Health care system-based interventions implemented in combination
  • Community-based interventions implemented in combination
• The CPSTF recommends educational approaches delivered in other settings (e.g. schools or child care centers).