Vaccination Programs: Community-Wide Education When Used Alone

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Summary of CPSTF Finding

The Community Preventive Services Task Force (CPSTF) finds insufficient evidence to determine whether community-wide education alone increases vaccination rates. Included studies reported mixed results, and it is uncertain whether findings would be applicable to more diverse communities.

Intervention

Community-wide education aims to motivate people within a target population or geographic area to seek vaccinations. Materials and messages often emphasize the importance of vaccinations and explain when and where people can get vaccinated. Approaches may include person-to-person interactions, community mobilization, and mass or small media. These interventions may also target vaccination providers in the community.

CPSTF Finding and Rationale Statement

Read the full CPSTF Finding and Rationale Statement for details including implementation issues, possible added benefits, potential harms, and evidence gaps.

About The Systematic Review

This CPSTF finding is based on evidence from a Community Guide systematic review completed in 2010 (6 studies with 8 study arms, search period 1980-2009) combined with more recent evidence (1 study, search period 2009-February 2012).

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.

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The systematic review included seven studies with nine study arms.

  • Overall, vaccination rates increased by a median of 6 percentage points (4 studies with 6 study arms).

Summary of Economic Evidence

An economic review of this intervention was not conducted because the CPSTF did not have enough information to determine if the intervention works.

Applicability

Applicability of this intervention across different settings and populations was not assessed because the CPSTF did not have enough information to determine if the intervention works.

Evidence Gaps

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)
  • How effective are community-wide education interventions when implemented alone?
  • How effective are interventions when used in communities that have disparities in vaccination rates?
  • What is the impact of community-wide education on the uptake of new vaccines, or new vaccine recommendations?
  • How well do interventions work when there is an outbreak of vaccine-preventable disease (e.g., pertussis or measles) or a public health emergency (e.g., pandemic influenza)?
  • How does effectiveness differ between direct-to-consumer mass and small media advertising by vaccine manufacturers and campaigns conducted by healthcare systems and public health programs?

Study Characteristics

  • Studies were from the United States, Australia, and Finland.
  • Included studies focused on older adults and children.
  • Studies evaluated intervention effects on the uptake of influenza, pneumococcal, hepatitis B and MMR vaccines.

Analytic Framework

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.

Summary Evidence Table

Effectiveness Review

Summary Evidence Table

Included Studies

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained n several publications).

Effectiveness Review

Holzman GS, Harwell TS, Johnson EA, Goldbaum G, Helgerson SD. A Media campaign to promote pneumococcal vaccinations: Is a telephone survey an effective evaluation strategy? J Public Health Management Practice 2005;11:228-34.

Luthi J, Mean F, Ammon C, Burnand B. Evaluation of a population-based prevention program against influenza among Swiss elderly people. Swiss Med Wkly 2002;132:592-7.

McPhee SJ, Nguyen T, Euler GL, Mock J, Wong C, Lam T, Nguyen W, Nguyen S, Huynh Ha M, Do ST, Buu C. Successful promotion of hepatitis B vaccinations among Vietnamese-American children ages 3 to 18: Results of a controlled trial. Pediatrics 2003;111:1278-88.

Paunio M, Virtanen M, Peltola H, Cantell K, Paunio P, Valle M, Karanko V, Helnonen. Increase of vaccination coverage by mass media and individual approach: intensified measles, mumps, and rubella prevention program in Finland. Am J Epidemiol 1991;133:1152-60.

Shenson D, Quinley J, DiMartino D, Stumpf P, Caldwell M, Lee, T. Pneumococcal immunizations at flu clinics: the impact of community-wide outreach. J Community Health 2001;26:191-201.

Wallace C, Corben P, Turahui J, Gilmoir R. The Role of television advertising in increasing pneumococcal vaccination coverage among the elderly, North Coast, New South Wales, 2006. Aust N Z Public Health 2008;32:467-70.

Yoo BK, Holland ML, Bhattacharya J, Phelps CE, Szilagyi PG. Effects of mass media coverage on timing and annual receipt of influenza vaccination among Medicare elderly. Health Serv Res 2010;45(5 Pt 1):1287-309. doi: 10.1111/j.1475-6773.2010.01127.x.

Search Strategies

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

Considerations for Implementation

The CPSTF did not have enough evidence to determine whether the intervention is or is not effective. This does not mean that the intervention does not work, but rather that additional research is needed to determine whether or not the intervention is effective.