Background
Methods
A. Interventions directed at healthcare workers
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Health Systems Evidence:
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Health system topic | Provider-targeted strategy |
Type of synthesis | Systematic review OR policy brief OR systematic review protocol |
Type of question | Effectiveness |
Publication date range | 2000 to 2010 |
Cochrane Database of Systematic Reviews (CDSR):
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Search all text | (Training OR education OR workshop OR supervision OR (outreach AND visit*) OR (audit AND feedback) OR monitoring) AND (“Immunization”[Mesh] OR “Vaccination”[Mesh] OR “ Immunization Programs”[Mesh]) |
Limits | None |
Database of Abstracts of Reviews of Effectiveness (DARE):
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Search all text | (Training OR education OR workshop OR supervision OR (outreach AND visit*) OR (audit AND feedback) OR monitoring) AND (“Immunization”[Mesh] OR “Vaccination”[Mesh] OR “Immunization Programs”[Mesh]) |
Limits | None |
PubMed:
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Search terms | (Training OR education OR workshop OR supervision OR (outreach AND visit*) OR (audit AND feedback) OR monitoring) AND (“Immunization”[Mesh] OR “Vaccination”[Mesh] OR “Immunization Programs”[Mesh]) |
Publication date | 01 January 2000 to 31 December 2010 |
Publication type | Reviews |
B. Interventions directed at parents or communities
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Health Systems Evidence:
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Health system topic | Consumer-directed strategy |
Type of synthesis | Systematic review OR policy brief OR systematic review protocol |
Type of question | Effectiveness |
Publication date range | 2000 to 2010 |
Cochrane Database of Systematic Reviews (CDSR):
| |
Search all text | (mobiliz* OR mobilis* OR communicat* OR advoca*) AND (“Immunization”[Mesh] OR “Vaccination”[Mesh] OR “Immunization Programs”[Mesh]) |
Limits | None |
Results
Barrier | Frequency | ||
---|---|---|---|
Count | Proportion | ||
1. | Insufficient knowledge of vaccines and EPI practices among staff | 13 | 43.3% |
2. | Financial constraints | 7 | 23.3% |
3. | Staff shortages and high staff turn-over | 7 | 23.30% |
4. | Poor communication among stakeholders | 2 | 6.7% |
5. | Challenges working with the private sector | 2 | 6.7% |
Total
|
30
|
100.0%
|
Barrier | Frequency | ||
---|---|---|---|
Count | Proportion | ||
1. | Insufficient knowledge of vaccines and EPI practices among staff | 14 | 31.1% |
2. | Staff shortages and high staff turn-over | 9 | 20.0% |
3. | Financial constraints | 8 | 17.8% |
4. | Poor communication among stakeholders | 6 | 13.3% |
5. | Challenges working with the private sector | 3 | 6.7% |
6. | Resistance from parents and anti-immunisation rumours | 3 | 6.7% |
7. | Vaccine stock-outs | 2 | 4.4% |
Total
|
45
|
100.0%
|
Barrier | Proposed solution | |
---|---|---|
1 | Insufficient knowledge of vaccines and immunisation | Training, supportive supervision, and audit and feedback |
2 | Financial constraints | Government should make appropriate financial arrangements for financing the EPI |
3 | Staff shortages and high staff turn-over | Government should put in place appropriate strategies for recruitment and retention of staff |
4 | Poor communication among stakeholders | Use best available evidence for vaccine advocacy and social mobilisation |
5. | Resistance from parents and anti-immunisation rumours | Strengthen social mobilisation and provide timely evidence-based response to rumours |
Review question / objective | Data sources | Interventions | Data collection and analysis | |
---|---|---|---|---|
Reference [16] | ||||
What are the most effective communication tools to improve patient understanding of ‘evidence’? | Cochrane Library, Medline, Psychinfo, Embase, Cancerlit, authors’ personal files. | 10 SRs and 17 RCTs on tailored print information, decision aids, consultation summaries or instructions (audiotapes, written and verbal), provider training in a patient-centred approach with or without risk communication, video, interactive computer aids/touch screens, evidence-based leaflets, and question prompts. | Conducted duplicate study selection, critical appraisal (of RCTs and SRs using validated checklists) and data extraction; and narrative synthesis and meta-analysis, as appropriate. | |
Last search: June 2004 | ||||
Reference [17] | ||||
Are educational meetings and workshops effective in improving professional practice or healthcare outcomes? | EPOC trials register, EMBASE, reference lists | 81 RCTs of educational meetings (alone or as part of multifaceted interventions); conducted in North America (31 studies), Europe (34), Australia and New Zealand (4), South East Asia (4), Latin America (3), and sub-Saharan Africa (4). | Conducted duplicate study selection, critical appraisal (of RCTs and SRs using validated checklists) and data extraction; and narrative synthesis and meta-analysis, as appropriate. | |
Last search: March 2006. | ||||
Reference [18] | ||||
Are educational outreach visits effective in improving health professional practice and healthcare outcomes? | EPOC register, Medline, EMBASE, reference lists | 69 RCTs of educational outreach visits (alone or as part of multifaceted interventions); conducted in North America (23 RCTs), Europe (36), Australia (8), and South East Asia (3). | Conducted duplicate study selection, critical appraisal (of RCTs and SRs using validated checklists) and data extraction; and narrative synthesis and meta-analysis, as appropriate. | |
Last search: March 2007. | ||||
Reference [19] | ||||
Is audit and feedback effective in improving professional practice and health care outcomes? | EPOC register, Medline, EMBASE, reference lists | 118 RCTs of audit and feedback (alone or as part of multifaceted interventions); conducted in North America (67), Europe (30), Australia (9), South East Asia (3), and sub-Saharan Africa (1). | Conducted duplicate study selection, critical appraisal (of RCTs and SRs using validated checklists) and data extraction; and narrative synthesis and meta-analysis, as appropriate. | |
Last search: February 2006 | ||||
Reference [20] | ||||
To determine the effectiveness of printed educational materials in improving process outcomes and patient outcomes. | EPOC register, Medline, EMBASE, CENTRAL, DARE, CINAHL, CAB Health, reference lists. | 12 RCTs, 1 CBA, and 10 ITS of printed educational materials; conducted in North America (14) and Europe (9). | Conducted duplicate study selection, critical appraisal (of RCTs and SRs using validated checklists) and data extraction; and narrative synthesis and meta-analysis, as appropriate. | |
Last search: March 2007 | ||||
Reference [21] | ||||
To assess the overall effectiveness of patient reminder or recall systems, or both, in improving immunisation coverage | EPOC register, Medline, EMBASE, CENTRAL, PsychINFO, CINAHL, Sociological Abstracts, CAB Abstracts, reference lists. | 40 RCTs and 3CBAs of of patient reminder or recall systems; conducted in North America (37), Europe (2) and Australia and New Zealand (4) | Conducted duplicate study selection, critical appraisal (of RCTs and SRs using validated checklists) and data extraction; and narrative synthesis and meta-analysis, as appropriate. | |
Last search: May 2007 | ||||
Reference [22] | ||||
To assess the effects of lay health worker interventions in primary and community health care on maternal and child health and the management of infectious diseases. | Medline, EMBASE, CENTRAL, PsychINFO, CINAHL, Sociological Abstracts, CAB Abstracts, British Nursing Index and Archive, POPLINE, WHOLIS, ISI Web of Science, Healthstar, reference lists. | 82 RCTs on use of lay health worker interventions; conducted in high-income countries (55), middle-income countries (12), and low-income countries (15). | Conducted duplicate study selection, critical appraisal (of RCTs and SRs using validated checklists) and data extraction; and narrative synthesis and meta-analysis, as appropriate. | |
Last search: February 2010 | ||||
Reference [23] | ||||
To assess the effect mass media interventions on utilisation of health services. | EPOC register, Medline, EMBASE, Eric, PsycLit, hand search of relevant journals, reference lists. | 20 ITS and 1 CBA of mass media campaigns (using radio, television, newspapers, posters and leaflets); conducted in Europe (10), North America (5), Australia (4), and Latin America (1). | Conducted duplicate study selection, critical appraisal (of RCTs and SRs using validated checklists) and data extraction; and narrative synthesis and meta-analysis, as appropriate. | |
Last search: 1999 | ||||
Reference [24] | ||||
To assess the effectiveness of conditional monetary transfers in improving access to care and health outcomes, in particular for poorer populations in LMICs. | EPOC register, CENTRAL, Medline, EMBASE, Popline, CAB-Direct, WHOLIS, LILACS, many other databases and websites/online resources, reference lists. | 4 RCTs and 2 CBAs of conditional cash transfer programmes; conducted in Latin America (5) and sub-Saharan Africa (1). | Conducted duplicate study selection, critical appraisal (of RCTs and SRs using validated checklists) and data extraction; and narrative synthesis and meta-analysis, as appropriate. | |
Last search: May 2009. | ||||
Reference [25] | ||||
To assess the effectiveness of risk protection mechanisms in improving access to care in LMICs | EPOC register, CENTRAL, Medline, EMBASE, Popline, CAB-Direct, WHOLIS, LILACS, many other databases and websites/online resources, reference lists. | Authors found few reports of social health insurance schemes operating at national level in LMICs; but none of these studies was an RCT, CBA, or ITS. | Duplicate screening of search output and assessment of potentially eligible studies for inclusion. | |
Last search: May 2009. |
Challenges identified by EPI managers | Remedial strategies suggested by EPI managers | GRADE quality of evidence* |
---|---|---|
Insufficient knowledge of vaccines and immunisation issues among health workers | Regular education | High |
Supportive supervision/educational outreach | High | |
Audit and feedback | High | |
Printed educational materials. | Low | |
Anti-immunisation rumours and resistance from parents | Parent reminder and recall systems | Moderate |
Community health workers | Moderate | |
Mass media | Moderate | |
Structured, tailored, or interactive communication tools | Moderate | |
Conditional cash transfers | Moderate | |
Insufficient financial and human resources | Tax-funded financing of immunisation programmes | No systematic review of effects |
Social health insurance scheme for financing of EPI | Low |