HELPinKids&Adults Knowledge Synthesis of the Management of Vaccination Pain and High Levels of Needle Fear

Abstract

The HELPinKids&Adults knowledge synthesis for the management of vaccination-related pain and high levels of needle fear updated and expanded upon the 2010 HELPinKIDS knowledge synthesis and clinical practice guideline for pain mitigation during vaccine injections in childhood. Interventions for vaccine pain management in adults and treatment of individuals with high levels of needle fear, phobias, or both were included, thereby broadening the reach of this work. The present paper outlines the overarching limitations of this diverse evidence base and provides recommendations for future research. Consistent with the framing of clinical questions in the systematic reviews, the Participants, Intervention, Comparison, Outcome, Study design (PICOAS) framework was used to organize these predominant issues and research directions. The major limitations we identified across systematic reviews were an overall dearth of trials on vaccination, lack of methodological rigor, failure to incorporate important outcomes, poor study reporting, and various sources of heterogeneity. Future research directions in terms of conducting additional trials in the vaccination context, improving methodological quality and rigor, assessment of global acceptability and feasibility of interventions, and inclusion of outcomes that stakeholders consider to be important (eg, compliance) are recommended. Given concerns about pain and fear are known contributors to vaccine hesitancy, improving and expanding this evidence base will be integral to broader efforts to improve vaccine compliance and public health worldwide.

The fear of needles: A systematic review and meta‐analysis

“…While needle fear is occasionally mentioned as a contributor to vaccine hesitancy, there are relatively few studies designed to address this problem (Salmon, Dudley, Glanz, & Omer, ). There is a lack of applied public health and clinical research on methods of delivery which target factors such as needle size, injection speed, or nonneedle approaches (Noel et al., ). It is perhaps not surprising that a routine childhood vaccine that does not involve a needle has the highest rates of vaccination (i.e., polio vaccination rate = 93.7% in year 2015 in the United States) (National Center for Health Statistics, ).…”

Methodology for Knowledge Synthesis of the Management of Vaccination Pain and Needle Fear

“… 16 – 22 Finally, we include a manuscript that outlines overarching limitations in the included evidence base and provides recommendations about areas worthy of additional investigation. 23 Separately, we present the 2015 HELPinKids&Adults clinical practice guideline developed from this knowledge synthesis. 24 …”

The number of injected same-day preschool vaccines relates to preadolescent needle fear and HPV uptake

“…22–24 To our knowledge, however, no study has correlated vaccination experiences with later fear, thus a target intervention to slow the rapid rise of needle phobia is debatable: is it the total number, the age at vaccination, parental anxiety, injection pain, or the intensity of the event? 5,6 …”

“…4–6 According to hospitalized children, needle punctures are their greatest source of pain next to their disease. 7 The effects of untreated needle pain are remembered even by preverbal children, 8,9 and may amplify with age: up to 15% of geriatric patients refuse flu shots due to injection fear, 10 and 28% of HIV patients delayed being tested.…”

“…15 The blood donation literature supports that needle-associated vasovagal responses 16 are primarily predicted by acquired needle fear and lead to decreased blood donation, 17–19 and recent work suggests vaccines play a role in the development of fear. 5,6 …”