Background
Methods
Search strategy
Article selection
Data extraction and critical appraisal
Study (first author) | Study design | Selection | Comparability | Outcome | |||||
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Representativeness of the sample | Sample size | Non-respondents | Ascertainment of exposure | Based on design and analysis | Assessment of outcome | Statistical test | |||
Gonik et al. (2000) [19] | Cross-sectional | + | + | + | |||||
Schupfner et al. (2002) [20] | Cross-sectional | + | + | + | ++ | + | + | ||
Taylor et al. (2002) [21] | Cross-sectional | + | ++ | ++ | + | ||||
Zimmerman et al. (2002) [22] | Cross-sectional | + | + | + | ++ | + | + | ||
Davis et al. (2003) [23] | Cross-sectional | + | + | + | ++ | + | + | ||
Milledge et al. (2003) [24] | Cross-sectional | + | + | + | + | ++ | + | + | |
Jungbauer-Gans et al. (2003) 1st part [25] | Cross-sectional | + | + | + | + | ||||
Jungbauer-Gans et al. (2003) 2nd part [25] | Cross-sectional | + | + | ++ | + | ||||
Wilson et al. (2004) [26] | Cross-sectional | + | + | + | + | ++ | + | + | |
Russell et al. (2004) [27] | Cross-sectional | + | + | + | + | ++ | + | + | |
Petousis-Harris et al. (2005) [28] | Cross-sectional | + | + | + | + | ||||
Clark et al. (2006) [29] | Cross-sectional | + | + | + | |||||
Davis et al. (2007) [30] | Cross-sectional | + | + | + | + | + | |||
Gust et al. (2008) [31] | Cross-sectional | + | + | ++ | + | + | |||
Goodyear-Smith et al. (2009) [32] | Cross-sectional | + | + | + | + | ++ | ++ | + | |
Study (first author)
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Study design
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Selection
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Comparability
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Exposure
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Case definition adequate?
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Representativeness of the cases
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Selection of controls
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Definition of controls
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Based on design and analysis
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Ascertainment of exposure
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Same method for cases and controls
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Non-response rate
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Salmon et al. (2008) [33] | Case–control | + | + | + | + | + | + |
Authors | Setting | Study population/response rate | Determinant (knowledge) | Intention to vaccinate | Measure of association | Adjustments |
---|---|---|---|---|---|---|
Taylor et al. (2002) [21] | USA | 112/? pediatricians | Knowledge in vaccine contraindications | Increase of record linked vaccine coverage per each contraindication less stated | At 8 months | 2B,1C,3E |
2.0% (95% CI 0.3-3.7) p < 0.05 | ||||||
At 19 months | ||||||
2.6% (95% CI 1.1 - 4.7) p < 0.05 | ||||||
Petousis-Harris et al. (2005) [28] | New Zealand | 150/89,3% family practice nurses | Knowledge in vaccine contraindications | Report of vaccination coverage | Significantly greater rate of correct responses in those reporting high coverage (>95) than in those reporting low coverage (<70%). p < 0.05 | None |
Goodyear-Smith et al. (2009) [32] | New Zealand | 106/58% general practitioners | Knowledge in vaccine contraindications | Record linked vaccine coverage | Results shown by region and practice governance: | 1A, 2B, 1C, 1D |
Auckland: Maori with right response, median coverage (MC) 30%. Maori with missed response, no practice with these characteristics. Non-Maori right, MC 71%, Non-Maori missed, MC 64%. | ||||||
Midland: Maori right, MC 58%. Maori missed, MC 56%. Non-Maori right, MC 78%. Non-Maori missed, MC 73%. | ||||||
After multivariate analysis, the knowledge remained associated with the coverage (p < 0.05). |
Authors | Setting | Study population/response rate | Determinant (belief) | Intention to vaccinate | Measure of association | Adjustments |
---|---|---|---|---|---|---|
Zimmerman et al. (2002) [22] | USA | 281/72,4% general practitioners, family practice, pediatricians | Perception of: A) Efficacy of the vaccine. yes vs no | Would recommend vaccination | A) To children 12–18 months: 85% vs 70% (p < 0.05) | 1A, 1C, 1D, 3E, 1F |
To children 4–6 years: 85% vs 80% (p < 0.05) | ||||||
To children 11–12 years: 86% vs 83% (p > 0.05) | ||||||
B) Storing the vaccine being a major problem. Yes vs no | B) To children 12-18m: 62% vs 86% (p < 0.05) To Children 4–6 years: 73% vs 85% (p > 0.05) To children 11–12 years: 76% vs 87% (p > 0.05) | |||||
Schupfner et al. (2002) [20] | Germany | 97/73% pediatricians | Belief that: A) Official vaccination recommendations are influenced by the industry | Reported vaccine coverage rate | A) 60% of those reporting high coverage rate (>80%). 46% of those with low coverage rate (<80%). p > 0.05 | 2C, 4D, 4E |
B) Behavior in vaccination is mostly conditioned by physician's beliefs | B) 66% of those with high coverage and 59% of those with low coverage. p > 0.05 | |||||
Davis et al. (2003) [23] | USA | 694/60% family physicians | Believe the new 7-valent pneumococcal vaccine will effectively prevent meningitis | Reported habit of recommending the vaccine | OR 1.86 (95% CI 0.93, 3.73) p > 0.05 | 4E, 1F |
Milledge et al. (2003) [24] | Australia | 160/67% general practitioners | Agreement that the following are a deterrent to vaccination: A) Cost- to- parent | Would recommend universal varicella vaccination | A) OR 1.54 (95% CI:0.70-3.38) p > 0.05 | 1B, 1C, 7E, 2F |
B) Another needle | B) OR 0.79 (0.33–1.49) p > 0.05 | |||||
Jungbauer-Gans et al. (2003) [25] | Germany | 136/71% family physicians and pediatricians | Training in alternative medicine | Reported habit of recommending full vaccination | With training 63%, without training 78%. p > 0.05 for the difference | None |
94/71% family physicians and pediatricians | Training in alternative medicine | Record linked vaccine coverage | Beta: -0,121 (p < 0.05) | None | ||
Wilson et al. (2004) [26] | Canada | 312/59,4% naturopathic students | Belief that: A) Vaccines are beneficial | Willingness to advise full vaccination | A) OR: 16.4 (95% CI 5.15–73.6) p < 0.05 | 1D, 5E |
B) Vaccines are risky | B) OR: 0.30 ( 0.11–0.74) p < 0.05 | |||||
Russell et al. (2004) [27] | Canada | 503/78,2% chiropractors | Belief that: A) Vaccines are safe and efficacious | Reported habit of recommending vaccination | A) OR 25.2 [95% CI 8.7-72.7] p < 0.05 | 2D, 4E |
B) Social orientation of heath | B) OR 2.9 [95% CI 1.7-5.1] p < 0.05 | |||||
C) Broad view of chiropractic practice | C) OR 0.6 [95% CI 0.3-1.1] p > 0.05 | |||||
D) People are informed | D) OR 1.5 [IC95 % 0.9–2.5] p > 0.05 | |||||
E) Chiropractors should recommend vaccination | E) OR 0.9 [IC95 % 0.5–1.4] p > 0.05 | |||||
F) I believe in physicians who think I should recommend vaccination | F) OR 1.5 [IC95 % 1.0–2.4] p > 0.05 |
Authors | Setting | Study population/response rate | Determinant (attitude) | Intention to vaccinate | Measure of association | Adjustments |
---|---|---|---|---|---|---|
Gonik et al. (2000) [19] | USA | 313/43% Obstetrician-gynecologists | Assess routinely the patients for vaccine- preventable diseases | Reported habit to administer vaccines | Spearman rho correlation 0.30–0.70; p < 0.05 | None |
Zimmerman et al. (2002) [22] | USA | 281/72,4% general practitioners, family practice, pediatricians | Agreement with the national recommendations on varicella vaccination. Yes vs no | Would recommend the vaccination | In children 12–18 months: 98% | 1A,1C, 1D,3E, 1F |
vs 3%, p < 0.05 | ||||||
Children 4–6 years: 93% | ||||||
vs 19%, p < 0.05 | ||||||
Children 11–12 years: | ||||||
86% vs 68%, p < 0.05 | ||||||
Taylor et al. (2002) [21] | USA | 112/? pediatricians | A) Number of injections willing to give in one visit. Range 1 to 6 (>5) | Increase of record linked vaccine coverage | A) Per each injection more: Increase at 8 months of 3.6% (95% CI 0.4-6.8) p > 0.05, at 19 months 1.5% (95% CI −2.8 - 5.5) p > 0.05 | 2B, 1C, 3E |
B) Recommendation of inactivated polio vaccine (IPV) vs oral vaccine | B) Using IPV: Increase at 8 months of 8.9% (95% CI 3.3-15.4) p < 0.05, at 19 months 15.4% (95% CI 7.7 - 23.1) p < 0.05 | |||||
Schupfner et al. (2002) [20] | Germany | 97/73% pediatricians | Prefer to give combined vaccines than separate | Reported vaccine coverage rate | 100% in those with high reported coverage (>80%) vs 81% in low coverage (<80%) p > 0.05 | 2C,4D,4E |
Milledge et al. (2003) [24] | Australia | 160/67% general practitioners | Concerns about varicella vaccine: A) Immunity may not be life-long | Would recommend universal varicella vaccination | A) OR 0.60 (95%CI 0.33-1.21) p > 0.05 | 1B, 1C, 7E, 2F |
B) Increase in herpes zoster | B) OR 1.08 (0.33-3.6) p > 0.05 | |||||
C) More serious varicella disease in adults | C) OR 0.92 (0.37-2.27) p > 0.05 | |||||
D) Possible, unknown side effects | D) OR: 0.31 (0.15–0.63) p > 0.05 | |||||
Davis et al. (2003) [23] | USA | 694/60% family physicians | A) Considers giving 5 injections at 1 visit vs less | Reported habit of recommending the vaccine | A) OR 17.29 (95% CI 6.35, 47.05) p < 0.05 | 4E, 1F |
B) Considers giving 4 injections at 1 visit vs less | B) OR 8.69(95% CI 4.21, 17.94) p < 0.05 | |||||
Jungbauer-Gans et al. (2003) [25] | Germany | 136/71% family physicians and pediatricians | Importance of the officially recommended vaccinations (Index: 1 = not at all, 5 = very) | Reported habit of recommending full vaccination | Index of 4.8 in those recommending full vaccination vs 3.9 in those who did not. p < 0.05 | None |
94/71% family physicians and pediatricians | Importance of the officially recommended vaccinations (same Index) | Record linked vaccine coverage | One point increase in the Index was associated with an increase of 25.8% in the coverage. p < 0.05 | None | ||
Wilson et al. (2004) [26] | Canada | 312/59,4% naturopathic students | Trust in Public Health information | Willingness to advise full vaccination | OR 3.72 (95% CI 1.42–10.7) p < 0.05 | 1D, 5E |
Clark et al. (2006) [29] | USA | 183/54% obstetricians | Perceive to have a role in promote Tdap vaccination to other adults (not mothers) in contact with infants | Report to recommend Tdap vaccine to pregnant women | 77% perceive having a role in those recommending vaccine to pregnant women vs 50% in those who do not. p < 0.05 | None |
Davis et al. (2007) [30] | USA | 336/49% family physicians, general internists | Agree that pertoussis is serious enough to warrant using Tdap in adults. Yes vs no or neutral | Would recommend the vaccination if recommended | 93% vs 68%. p < 0.05 | None |
Gust et al. (2008) [31] | USA | 733/65% family physicians, pediatricians | Have some concerns about immunization | Recommend full immunization | OR 0.32 (95% CI 0.56-0.19) p < 0.05 | 1C, 1D, 1E |
Authors | Setting | Study population/respnse rate | Determinant | Intention to vaccinate | Measure of association | Adjustments |
---|---|---|---|---|---|---|
Salmon et al. (2008) [33] | USA | Sample size 551 (55 cases/432 controls/64 mixed c ). Primary healthcare professionals |
Beliefs
| Cases: Primary healthcare professionals of unvaccinated | Medical doctors or doctors in osteopathy | |
A1) Disease susceptibility | A1) OR 1.39 (95%CI:0.68–2.85) p < 0.05 | |||||
A2) Disease severity | children at school entry. vs Controls: Primary healthcare professionals only of vaccinated children. | A2) OR 0.90 (0.59–1.38) p < 0.05 | ||||
A3) Vaccine efficacy | A3) OR 1.37(0.65–2.86) p < 0.05 | |||||
A4) Vaccine security | A4) OR 0.37 (0.19-0.72) p < 0.05 | |||||
B) Benefit when a child is fully vaccinated for: B1) Child | B1) OR 0.30 (0.10–0.85) p < 0.05 | |||||
B2) Community | B2) OR 0.28 (0.09–0.88) p < 0.05 | |||||
B3) Primary care practitioner | B3) OR 0.59 (0.39–0.90) p < 0.05 | |||||
B4) Insurance company | B4) OR 0.56 (0.32–0.99) p < 0.05 | |||||
B5) Government | B5) OR 0.55 (0.32–0.96) p < 0.05 | |||||
B6) Vaccine companies | B6) OR 0.57 (0.30–1.10) p < 0.05 | |||||
C) Agree or completely agree with the following statements: C1) Children get more immunizations than are good for them | C1) OR 2.28 (1.56-5.10) p < 0.05 | |||||
C2) A good diet is more important | C2)OR 3.68 (1.61-8.38) p < 0.05 | |||||
C3) Child’s immune system could be weakened | C3) OR 4.03 (2.06-7.86) p < 0.05 | |||||
C4) Better to develop immunity by getting sick | C4) OR 4.08 (1.9-8.76) p < 0.05 | |||||
Attitudes
| ||||||
A) Should be allowed to send unvaccinated children to school | A) 1.72 (1.13-2.6) p < 0.05 | |||||
B) Worry that many of the reports of serious side effects from vaccines are accurate | B) 2.03 (1.05-3,91) p < 0.05 | |||||
C) Concerned the CDC/ACIP underestimates the frequency of vaccine side effects | C) 2.86 (1.65-4.97) p < 0.05 |
Factor | Negative associations | Null associations | Positive associations | ||||||
---|---|---|---|---|---|---|---|---|---|
Logistic regression | Other analysis | Logistic regression | Other analysis | Logistic regression | Other analysis | ||||
N | Range OR | N | N | Range OR | N | N | Range OR | N | |
1. Knowledge
| |||||||||
a. Vaccine contraindications. | 0 | 0 | 0 | 1 | 0 | 2 | |||
2. Beliefs
| |||||||||
a. Vaccines are more risky than beneficial. | 3 | 0,04-0,37* | 0 | 0 | 0 | 0 | 0 | ||
b. Vaccine low efficacy and benefit and low susceptibility and severity of the disease. | 2 | 0,04-0,06 | 1 | 2 | 0,54-1,39* | 0 | 0 | 0 | |
c. Use of alternative medicine theories | 1 | 0,24*-0,44* | 1 | 1 | 0,6 | 0 | 0 | 0 | |
d. More individualist than social orientation of the health care. | 2 | 0,28*-0,59* | 0 | 0 | 0 | 0 | 0 | ||
e. Cost-to-parent is a deterrent to vaccination. | 0 | 0 | 1 | 1,54 | 0 | 0 | 0 | ||
f. Another needle is a deterrent to vaccination. | 0 | 0 | 1 | 0,79 | 0 | 0 | 0 | ||
g. Stocking the vaccine is a problem. | 0 | 1 | 0 | 0 | 0 | 0 | |||
h. People are adequately informed about vaccine. | 0 | 0 | 1 | 1,5 | 0 | 0 | 0 | ||
i. Theories of conspiration, influence of the farmaceutical industry on the policy makers in immunization. | 0 | 0 | 0 | 1 | 0 | 0 | |||
j. Behavior in vaccination is mostly conditioned by physician's beliefs | 0 | 0 | 0 | 1 | 0 | 0 | |||
k. Chiropractors should counsel about immunization. | 0 | 0 | 0 | 1 | 0 | 0 | |||
3.Attitudes
| |||||||||
a. Have some concerns about immunization. | 1 | 0,32 | 0 | 0 | 0 | 0 | 0 | ||
b. Concerned about vaccine’s side effects. | 1 | 0,49* | 0 | 1 | 0,31 | 0 | 0 | 0 | |
c. Low confidence in Public Healthcare information or national recommendations. | 2 | 0,27-0,35* | 1 | 0 | 0 | 0 | 0 | ||
d. Consider the disease serious enough to warrant using a vaccine or give importance to the vaccination. | 0 | 0 | 0 | 0 | 0 | 2 | |||
e. Number of injections the physician considers giving at one visit (4 vs less and 5 vs less). | 0 | 0 | 0 | 1 | 1 | 8,69 and 17,29 | 0 | ||
f. Perceive to have a role in vaccination. | 0 | 0 | 0 | 1 | 0 | 1 | |||
g. Preference for combined vaccine than for separate. | 0 | 0 | 0 | 1 | 0 | 0 | |||
h. Concerned about (A) vaccine immunity may not be life-long (B) will lead to more serious disease in adults. | 0 | 0 | 1 | A) 0,6 B)1,08 | 0 | 0 | 0 | ||
i. Not having adopted the new recommendations in use of polio vaccine (still using Sabin vs Salk). | 0 | 1 | 0 | 0 | 0 | 0 | |||
j. It should be allowed to send unvaccinated children to school. | 1 | 0,58* | 0 | 0 | 0 | 0 | 0 |
Authors | Knowledge, beliefs, attitudes | Measure of intention to vaccinateA
| Design | Type of tool | Mean to collect data | Anonymity | Questionnaire: new, previously used, validated | Target populationB
| Vaccine studiedC
|
---|---|---|---|---|---|---|---|---|---|
Clark et al. [29] | attitude | 2 | cross-sectional | survey | mail | not specified | new | Obst./Gyn. | DTP |
Petousis-Harris et al. [28] | knowledge | 4 | cross-sectional | survey | telephone | not anonymous | new | Nurses | P,MMR |
Wilson et al. [26] | beliefs and attitude | 2 | cross-sectional | survey | working place or similar | not specified | new | Nat. stu. | PedV |
Jungbauer-Gans et al. [25] | beliefs and attitude | 1 and 3 | cross-sectional | survey and record linked | not specified and record linked | not specified | not specified | FP/GP, Ped. | PedV |
Milledge et al. [24] | beliefs and attitude | 2 | cross-sectional | survey | mail | not specified | not specified | FP/GP | Var. |
Zimmerman et al. [22] | beliefs and attitude | 2 | cross-sectional | survey | mail, e-mail or web, telephone | not anonymous | new | FP/GP, Ped. | Var. |
Davis et al. [30] | attitude | 2 | cross-sectional | survey | mail | not specified | not specified | FP/GP, Int. | DTP |
Davis et al. [23] | beliefs and attitude | 1 | cross-sectional | survey | mail | not specified | new | FP/GP, Ped. | Pn. |
Russell et al. [27] | beliefs | 1 | cross-sectional | survey | mail | not specified | new | Chiropractors | GenV |
Taylor et al. [21] | knowledge and attitude | 3 | cross-sectional | survey and record linked | working place and record linked | not anonymous | not specified | Ped. | DTP,MMR, Hep. B,HiB,Pol. |
Gust et al. [31] | attitude | 1 | cross-sectional | survey and record linked | e-mail or web | anonymous | previously used | FP/GP, Ped. | PedV |
Gonik et al. [19] | attitude | 1 | cross-sectional | survey | mail | anonymous | new | Obst./Gyn. | DT, MMR, Hep.B, Var. |
Schupfner et al. [20] | beliefs and attitude | 4 | cross-sectional | survey | mail | anonymous | new | Ped. | PedV |
Goodyear-Smith et al. [32] | knowledge | 3 | cross-sectional | survey and record linked | telephone and record linked | not anonymous | previously used, modified | FP/GP | PedV |
Salmon et al. [33] | beliefs and attitude | 1 | case and control | survey and record linked | mail | not anonymous | not specified | PHCP, DO | SchV |
Kappa index
| 0,65 | 0,71 | 1 | 0,72 | 0,9 | 0,89 | 0,9 | 0,92 | 0,83 |