Cluster randomized trial of a toolkit and early vaccine delivery to improve childhood influenza vaccination rates in primary care

Zimmerman, Richard K.; Nowalk, Mary Patricia; Lin, Chyongchiou J.; Hannibal, Kristin; Moehling, Krissy K.; Huang, Hsin Hui; Matambanadzo, Annamore; Troy, Judith A.; Allred, Norma J.; Gallik, Greg; Reis, Evelyn Cohen

doi:10.1016/j.vaccine.2014.04.057

Cited by 28 publications

(33 citation statements)

References 28 publications

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“…As previously reported, this intervention resulted in significant overall increases in influenza vaccination uptake in eight of ten intervention sites, a final Intervention arm vaccination rate of 54%, and significantly larger increases in mean uptake in the Intervention arm than the Control arm. 12 However, those results did not examine rates by age and racial group, whereas the present study did.…”

Section: Discussioncontrasting

confidence: 66%

“…The intervention has been previously described, 12 in which all CONSORT criteria for a cluster randomized controlled trial 11 have been met. The intervention was based on the 4 Pillars Toolkit, a practice improvement toolkit that was developed for use in raising adult immunization rates 13, 14 and recommends strategies around four key elements: Pillar 1, Convenient vaccination services; Pillar 2, Notification of patients about the importance of immunization and the availability of vaccines; Pillar 3, Enhanced office systems to facilitate immunization; and Pillar 4, Motivation through an office immunization champion who monitors progress and encourages adherence to vaccination-promoting office practices.…”

Section: Methodsmentioning

confidence: 99%

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Increasing Childhood Influenza Vaccination

Nowalk¹,

Lin²,

Hannibal³

et al. 2014

American Journal of Preventive Medicine

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Background Since the 2008 inception of universal childhood influenza vaccination, national rates have risen more dramatically among younger children than older children and reported rates across racial/ethnic groups are inconsistent. Interventions may be needed to address age and racial disparities to achieve the recommended childhood influenza vaccination target of 70%. Purpose To evaluate an intervention to increase childhood influenza vaccination across age and racial groups. Methods In 2011–2012, 20 primary care practices treating children were randomly assigned to Intervention and Control arms of a cluster randomized controlled trial to increase childhood influenza vaccination uptake using a toolkit and other strategies including early delivery of donated vaccine, in-service staff meetings, and publicity. Results The average vaccination differences from pre-intervention to the intervention year were significantly larger in the Intervention arm (n=10 practices) than the Control arm (n=10 practices), for children aged 2–8 years (10.2 percentage points (pct pts) Intervention vs 3.6 pct pts Control) and 9–18 years (11.1 pct pts Intervention vs 4.3 pct pts Control, p<0.05), for non-white children (16.7 pct pts Intervention vs 4.6 pct pts Control, p<0.001), and overall (9.9 pct pts Intervention vs 4.2 pct pts Control, p<0.01). In multi-level modeling that accounted for person- and practice-level variables and the interactions among age, race and intervention, the likelihood of vaccination increased with younger age group (6–23 months), white race, commercial insurance, the practice’s pre-intervention vaccination rate, and being in the Intervention arm. Estimates of the interaction terms indicated that the intervention increased the likelihood of vaccination for non-white children in all age groups and white children aged 9–18 years. Conclusions A multi-strategy intervention that includes a practice improvement toolkit can significantly improve influenza vaccination uptake across age and racial groups without targeting specific groups, especially in practices with large percentages of minority children.

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Section: Discussioncontrasting

confidence: 66%

Section: Methodsmentioning

confidence: 99%

Increasing Childhood Influenza Vaccination

Nowalk¹,

Lin²,

Hannibal³

et al. 2014

American Journal of Preventive Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

“…Methods for sample size calculation and randomization have been previously published (Zimmerman RK et al, 2014). The parent randomized cluster trial, which met all CONSORT criteria (Campbell MK, Piaggio G, Elbourne DR, & DG, 2012), was designed to test the effectiveness of a multi-strategy intervention to increase childhood influenza vaccination rates among all children in primary care practices.…”

Section: Methodsmentioning

confidence: 99%

“…A description of the intervention and the results for the first year of intervention have been previously published (Zimmerman RK et al, 2014). A summary of the strategies is included in the Supplemental material (Table A-1).…”

Section: Methodsmentioning

confidence: 99%

“…Recent research among children of all ages has shown that a multi-strategy intervention that includes a practice improvement toolkit, staff education, feedback and early delivery of vaccines for disadvantaged children can successfully raise influenza vaccination rates and reduce racial disparities (Nowalk et al, 2014; Zimmerman RK et al, 2014). The purpose of this study was to examine the impact of that intervention on influenza vaccine uptake among a subgroup of those children i.e., those with an asthma diagnosis, and to test the intervention’s effectiveness for reducing racial disparities in influenza vaccination rates in this population.…”

Section: Introductionmentioning

confidence: 99%

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Reducing Racial Disparities in Influenza Vaccination Among Children With Asthma

Lin¹,

Nowalk²,

Zimmerman³

et al. 2016

Journal of Pediatric Health Care

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Introduction A multi-faceted intervention to raise influenza vaccination rates was tested among children with asthma. Methods In a pre-post design, eighteen primary care practices implemented the 4 Pillars™ Immunization Toolkit along with other strategies. The primary outcome was the difference in influenza vaccination rates at each practice among children with asthma during the baseline year (pre-intervention) and at the end of year 2 (post intervention), both overall and by race (white vs. non-white). Results Influenza vaccination rates increased significantly in 13 of 18 practices. The percent of vaccinated non-white children increased from 46% to 61% (P<0.01) and the percent of vaccinated white children increased from 58% to 65% (P<0.001). Likelihood of vaccination was significantly lower for non-white children pre-intervention (OR=0.66, 95%CI=0.59–0.73; P<0.001), but this difference was eliminated post intervention (OR=0.95, 95%CI=0.85–1.05; P=.289). Discussion A multi-strategy, evidence-based intervention significantly increased influenza vaccination uptake and reduced racial disparities among children with asthma.

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Face-to-face interventions for informing or educating parents about early childhood vaccination

Kaufman

Ryan

Walsh

et al. 2018

Cochrane Database of Systematic Reviews

168

122

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BackgroundEarly childhood vaccination is an essential global public health practice that saves two to three million lives each year, but many children do not receive all the recommended vaccines. To achieve and maintain appropriate coverage rates, vaccination programmes rely on people having sufficient awareness and acceptance of vaccines.Face‐to‐face information or educational interventions are widely used to help parents understand why vaccines are important; explain where, how and when to access services; and address hesitancy and concerns about vaccine safety or efficacy. Such interventions are interactive, and can be adapted to target particular populations or identified barriers.This is an update of a review originally published in 2013.ObjectivesTo assess the effects of face‐to‐face interventions for informing or educating parents about early childhood vaccination on vaccination status and parental knowledge, attitudes and intention to vaccinate.Search methodsWe searched the CENTRAL, MEDLINE, Embase, five other databases, and two trial registries (July and August 2017). We screened reference lists of relevant articles, and contacted authors of included studies and experts in the field. We had no language or date restrictions.Selection criteriaWe included randomised controlled trials (RCTs) and cluster‐RCTs evaluating the effects of face‐to‐face interventions delivered to parents or expectant parents to inform or educate them about early childhood vaccination, compared with control or with another face‐to‐face intervention. The World Health Organization recommends that children receive all early childhood vaccines, with the exception of human papillomavirus vaccine (HPV), which is delivered to adolescents.Data collection and analysisWe used standard methodological procedures expected by Cochrane. Two authors independently reviewed all search results, extracted data and assessed the risk of bias of included studies.Main resultsIn this update, we found four new studies, for a total of ten studies. We included seven RCTs and three cluster‐RCTs involving a total of 4527 participants, although we were unable to pool the data from one cluster‐RCT. Three of the ten studies were conducted in low‐ or middle‐ income countries.All included studies compared face‐to‐face interventions with control. Most studies evaluated the effectiveness of a single intervention session delivered to individual parents. The interventions were an even mix of short (ten minutes or less) and longer sessions (15 minutes to several hours).Overall, elements of the study designs put them at moderate to high risk of bias. All studies but one were at low risk of bias for sequence generation (i.e. used a random number sequence). For allocation concealment (i.e. the person randomising participants was unaware of the study group to which participant would be allocated), three were at high risk and one was judged at unclear risk of bias. Due to the educational nature of the intervention, blinding of participants and personnel was not possible in any ...

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Cluster randomized trial of a toolkit and early vaccine delivery to improve childhood influenza vaccination rates in primary care

Cited by 28 publications

References 28 publications

Increasing Childhood Influenza Vaccination

Increasing Childhood Influenza Vaccination

Reducing Racial Disparities in Influenza Vaccination Among Children With Asthma

Face-to-face interventions for informing or educating parents about early childhood vaccination

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