STRATEGIES FOR ADDRESSING VACCINE HESITANCY – A SYSTEMATIC REVIEW WHO SAGE working group dealing with vaccine hesitancy October 2014 TABLE OF CONTENTS Table of figures ............................................................................................................................................... 1 Table of tables ................................................................................................................................................ 3 Abbreviations .................................................................................................................................................. 4 Definitions………………………………………………………………………………………………………………………………………………….6 Acknowledgements ........................................................................................................................................ 7 Executive Summary…………………………………………………………………………………………………………………………………….8 SECTION 1 SYSTEMATIC LITERATURE REVIEW - STRATEGIES FOR ADDRESSING VACCINE HESITANCY ..................... 22 1.1 INTRODUCTION .................................................................................................................................... 22 1.1.a Objectives .................................................................................................................................................... 22 1.2 METHODS ............................................................................................................................................................ 23 1.2.a. Search methods .......................................................................................................................................... 23 1.2.b. Selection criteria ......................................................................................................................................... 25 1.2.c. Data extraction ........................................................................................................................................... 26 1.3 RESULTS .............................................................................................................................................................. 26 1.3.a. Literature identified .................................................................................................................................... 26 1.3.b. Scope of the literature and descriptive analyses ........................................................................................ 30 1.3.c. Summary of effects ......................................................................................................................... 43 1.4 SECTION SUMMARY .............................................................................................................................. 56 SECTION 2 EVALUATION OF THE VACCINE HESITANCY RESEARCH (PICO & GRADE) ................................................. 60 2.1 OBJECTIVES ......................................................................................................................................... 73 2.2 METHODS ........................................................................................................................................... 73 2.2.a Criteria for considering studies for this review ............................................................................................. 73 2.2.b Types of studies ............................................................................................................................................ 73 2.2.c Types of participants .................................................................................................................................... 73 2.2.d Types of interventions .................................................................................................................................. 73 2.2.e Types of outcome measures ......................................................................................................................... 74 2.2.f Search methods for identification of studies ................................................................................................. 74 2.2.g Data collection and analysis ............................................................................................................. 74 2.3 ASSESSMENT OF DATA QUALITY ............................................................................................................ 76 2.4 RESULTS .............................................................................................................................................. 77 2.4.a Description of studies ................................................................................................................................... 77 2.4.b Results of the search .................................................................................................................................... 77 2.4.c Included studies ............................................................................................................................................ 77 2.4.d Data analysis .................................................................................................................................. 82 2.5 SECTION SUMMARY ............................................................................................................................. 92 SECTION 3 SYNTHESIS OF FINDINGS, CONCLUSIONS AND IMPLICATIONS FOR RESEARCH & PRACTICE .............. ….132 3.1 SYNTHESIS OF FINDINGS ………………………………………………………………….......................................................... …….….132 3.2 CONCLUSIONS AND IMPLICATIONS …………………………………………………………………....................................................133 3.3 OPPORTUNITIES …………………………………………………………………..................................................................................134 3.4 LIMITATIONS ………………………………………………………………….......................................................................................134 3.5 IMPLICATIONS FOR RESEARCH AND PRACTICE…………………………………………………………………....................................135 4.1 REFERENCES………………………………………………………………….......................................................................136 5.1 APPENDICES ………………………………………………………………….......................................................................149 i 1 Table of figures Figure 1 Search process flow chart (peer reviewed literature) -vaccine hesitancy Figure 2 Search process flow chart (grey literature) -vaccine hesitancy Figure 3 Search process flow chart (grey literature) – reproductive health Figure 4 Evaluated and suggested peer reviewed and grey literature articles on vaccine hesitancy Figure 5 Evaluated peer reviewed strategies by publication year (2007-2013) and WHO region Figure 6 Evaluated grey literature articles by publication year (1996-2013) and WHO region Figure 7 Evaluated peer reviewed strategies by vaccine and WHO region (2007-2013) Figure 8 Evaluated grey literature strategies by vaccine and WHO region (1996-2013) Figure 9 Evaluated peer reviewed strategies by target population and WHO region (2007-2013) Figure 10 Evaluated grey literature strategies by target population and WHO region (1996-2013) Figure 11 Evaluated peer reviewed strategies by theme (2007-2013) Figure 12 Evaluated grey literature strategies by theme (1996-2013) Figure 13 Evaluated peer reviewed strategies by outcome (2007-2013) Figure 14 Evaluated grey literature strategies by outcome (1996-2013) Figure 15 Evaluated peer reviewed and grey literature strategies by the SAGE WG Model of Determinants of Vaccine Hesitancy Figure 16: Evaluated and suggested strategies for RHT hesitancy by WHO region Figure 17: Evaluated strategies by RHT and WHO region Figure 18: Evaluated strategies by target population and WHO region Figure 19: Evaluated strategies by theme Figure 20: Evaluated and suggested strategies for RHT (coded to the SAGE WG Model of Determinants of Vaccine Hesitancy) Figure 21: Effect of incentive-based, multi-component and other interventions on uptake of Hepatitis A and B vaccines; Evidence from the peer reviewed literature Figure 22: Effect of dialogue-based, incentive-based, multi-component, reminder / recall and other interventions on uptake of HPV vaccination; Evidence from the peer reviewed literature Figure 23: Effect of dialogue based, incentive-based, multi-component, reminder / recall and other interventions on uptake of influenza vaccination; Evidence from the peer reviewed literature Figure 24: Effect of dialogue based, incentive based, multi-component, reminder / recall and other interventions on uptake of individual childhood vaccination; Evidence from the peer reviewed literature 2 Figure 25: Effect of dialogue based, incentive based, multi-component, reminder / recall and other interventions on uptake of combined childhood vaccinations; Evidence from the peer reviewed literature Figure 26: Effect of a dialogue-based, incentive based multi-component, reminder / recall and other interventions on uptake of adult and adolescent vaccines; Evidence from the peer reviewed literature Figure 27: Effect of dialogue based and multi-component interventions on vaccine uptake; Evidence from the grey literature Figure 28: Effect of dialogue based, multi-component and other interventions on knowledge, awareness and attitudes to vaccination; Evidence from the peer reviewed literature Figure 29: Effect of multi-component and other intervention types on knowledge, awareness and attitudes to vaccination; Evidence