Article
Interventions to Improve Influenza, Pneumococcal Polysaccharide, and Hepatitis B Vaccination Coverage Among High-Risk Adults: A Systematic Review

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Overview

Influenza, pneumococcal infections, and hepatitis B, three vaccine-preventable diseases, cause significant morbidity and mortality in the United States. Rates of morbidity and mortality are higher among adults with certain medical conditions, occupational exposures, or risk behaviors. Vaccination coverage rates in these target populations remain low and below national health objectives.

Using methods previously developed for the Guide to Community Preventive Services for reviews of universally

Interventions to Increase Community or Client Demand for Vaccinations

Interventions to increase demand for vaccination services provide information, advice, or both to individual clients or to at-risk community members. Information and advice delivered to individuals at risk may increase or improve their demand for and receipt of vaccinations. In this category, we reviewed the following single-component interventions: clinic-based client education, client reminder systems, community-wide education, client or family incentives, and vaccination requirements. We

Results Part 2. Reviews of Evidence for Interventions to Increase Vaccine Coverage When Implemented in Combination

Most of the available evidence on effectiveness identified in this review of interventions to increase targeted vaccines coverage comes from studies that evaluated interventions implemented in combination (multicomponent interventions). The paucity of evidence on the effectiveness of interventions when implemented alone (see Results Part 1) and the variety of intervention combinations evaluated complicate assessment of the effectiveness of this multicomponent body of evidence. A full

Effectiveness

The qualifying studies identified in this review provide strong evidence of the effectiveness of provider reminder systems when implemented alone in improving targeted vaccination coverage among adults at high risk. Strong evidence of effectiveness was also identified in multicomponent programs directed at clients and providers, when these programs included one or more interventions to enhance access to vaccination combined with one or more interventions to increase demand, one or more

Discussion

This report introduces a new qualitative technique for the organization and assessment of evidence on effectiveness of interventions. These methods provide a useful framework for evaluating a complicated body of evidence, and attempt to incorporate evidence on effectiveness both for specific interventions and for less specific combinations across conceptual categories (strategies). The qualitative techniques developed and implemented here are potentially adaptable to other systematic reviews

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    The names and affiliations of the Task Force members are listed at the front of this supplement and at www.thecommunityguide.org.

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