Increasing the Immunization of Preschool Children; An Evaluation of Applied Community Interventions

Abstract

We evaluated the relative impact of four procedures designed to encourage parents to obtain immunizations for their children. In a public health setting, the families of 1,133 immunizationdeficient preschool children were randomly assigned to six conditions: (a) a general prompt; (b) a more client-specific prompt; (c) a specific prompt and increased public health clinic access; (d) a specific prompt and monetary incentives; (e) contact control; and (f) no contact control. All interventions, except the general prompt, produced some evidence of improvement when compared with the control groups. The monetary incentive group revealed the largest effect, followed by the increased access group, specific prompt group, and general prompt group, respectively. The data suggest that relatively powerful and immediate effects on preschoolers' clinic attendance for immunization may be produced by monetary incentives in conjunction with dient-specific prompts. However, client-specific prompts alone appear to be the most cost-effective of the interventions.

Parental Financial Incentives for Increasing Preschool Vaccination Uptake: Systematic Review

“…Four studies were identified that met the criteria for inclusion in the effectiveness component, [23][24][25][26] 6 studies for inclusion in the acceptability component, [27][28][29][30][31][32] and 1 for inclusion in the economic component (Fig 1). 31 Studies included in the effectiveness component consisted of 1 cluster randomized controlled trial (RCT), 26 2 nonclustered RCTs, 23,24 and 1 time series analysis.…”

“…31 Studies included in the effectiveness component consisted of 1 cluster randomized controlled trial (RCT), 26 2 nonclustered RCTs, 23,24 and 1 time series analysis. 25 Studies included in the (Table 2).…”

“…26 The cash lottery ticket incentive ($55.20-$221 in 2012 US$) and postal prompt advising that the lottery could be entered on attendance at the clinic were associated with a significant 21% increase in numbers of vaccinations received, compared with control. The effect persisted to at least 3 months after the incentive expired, with a 31.6% increase in number of vaccinations received compared with control.…”

“…Of the studies in the effectiveness component, 3 had low risk of bias, 23,25,26 and the fourth had a strong risk of bias. 24 All quantitative studies in the acceptability component had strong risk of bias, and in particular they were weak on study design and data collection methods (Fig 2).…”

Causes Of Low Preschool Immunization Coverage In The United States

“…In the early 1980s, Yokley & Glen wick (75) found that a specific letter combined with a lottery ticket incentive was more effective in the short term than a specific letter alone or combined with increased clinic hours, and all were more effective than a general mailout. However, by three months postintervention, the specific letter alone was the most cost-effective intervention, at an estimated cost of $2.27 per additional child immunized, compared with $6.91 for the specific letter plus lottery ticket, $6.28 for the specific letter and increased clinic hours, and $3.64 for the general mailout.…”