PDF(Pubmed)
Abstract：
OBJECTIVE: Groups which are marginalised, disadvantaged or otherwise vulnerable have lower uptake of vaccinations. This differential has been amplified in COVID-19 vaccination compared to (e.g.) influenza vaccination. This overview assessed the effectiveness of interventions to increase vaccination in underserved, minority or vulnerable groups.
METHODS: In November 2022 we searched four databases for systematic reviews that included RCTs evaluating any intervention to increase vaccination in underserved, minority or vulnerable groups; our primary outcome was vaccination. We used rapid review methods to screen, extract data and assess risk of bias in identified reviews. We undertook narrative synthesis using an approach modified from SWiM guidance. We categorised interventions as being high, medium or low intensity, and as targeting vaccine demand, access, or providers.
RESULTS: We included 23 systematic reviews, including studies in high and low or middle income countries, focused on children, adolescents and adults. Groups were vulnerable based on socioeconomic status, minority ethnicity, migrant/refugee status, age, location or LGBTQ identity. Pregnancy/maternity sometimes intersected with vulnerabilities. Evidence supported interventions including: home visits to communicate/educate and to vaccinate, and facilitator visits to practices (high intensity); telephone calls to communicate/educate, remind/book appointments (medium intensity); letters, postcards or text messages to communicate/educate, remind/book appointments and reminder/recall interventions for practices (low intensity). Many studies used multiple interventions or components.
CONCLUSIONS: There was considerable evidence supporting the effectiveness of communication in person, by phone or in writing to increase vaccination. Both high and low intensity interventions targeting providers showed effectiveness. Limited evidence assessed additional clinics or targeted services for increasing access; only home visits had higher confidence evidence showing effectiveness. There was no evidence for interventions for some communities, such as religious minorities which may intersect with gaps in evidence for additional services. None of the evidence related to COVID-19 vaccination where inequalities of outcome are exacerbated.
UNASSIGNED: CRD42021293355.
METHODS: In November 2022 we searched four databases for systematic reviews that included RCTs evaluating any intervention to increase vaccination in underserved, minority or vulnerable groups; our primary outcome was vaccination. We used rapid review methods to screen, extract data and assess risk of bias in identified reviews. We undertook narrative synthesis using an approach modified from SWiM guidance. We categorised interventions as being high, medium or low intensity, and as targeting vaccine demand, access, or providers.
RESULTS: We included 23 systematic reviews, including studies in high and low or middle income countries, focused on children, adolescents and adults. Groups were vulnerable based on socioeconomic status, minority ethnicity, migrant/refugee status, age, location or LGBTQ identity. Pregnancy/maternity sometimes intersected with vulnerabilities. Evidence supported interventions including: home visits to communicate/educate and to vaccinate, and facilitator visits to practices (high intensity); telephone calls to communicate/educate, remind/book appointments (medium intensity); letters, postcards or text messages to communicate/educate, remind/book appointments and reminder/recall interventions for practices (low intensity). Many studies used multiple interventions or components.
CONCLUSIONS: There was considerable evidence supporting the effectiveness of communication in person, by phone or in writing to increase vaccination. Both high and low intensity interventions targeting providers showed effectiveness. Limited evidence assessed additional clinics or targeted services for increasing access; only home visits had higher confidence evidence showing effectiveness. There was no evidence for interventions for some communities, such as religious minorities which may intersect with gaps in evidence for additional services. None of the evidence related to COVID-19 vaccination where inequalities of outcome are exacerbated.
UNASSIGNED: CRD42021293355.
摘要：
目标：被边缘化的群体，处于不利地位或其他脆弱的人接种疫苗的比例较低。与(例如)流感疫苗接种相比，这种差异在COVID-19疫苗接种中得到了放大。本概述评估了在服务不足的情况下增加疫苗接种的干预措施的有效性，少数群体或弱势群体。
方法：2022年11月，我们搜索了四个数据库进行系统评价，其中包括评估任何干预措施以增加服务不足的疫苗接种的RCT，少数群体或弱势群体;我们的主要结果是疫苗接种。我们使用快速审查的方法来筛选，提取数据并评估已识别评论中的偏见风险。我们使用从SWiM指南修改的方法进行了叙事综合。我们将干预措施归类为高，中等或低强度，作为疫苗需求的目标，access,或提供者。
结果：我们纳入了23篇系统综述，包括在高、低收入或中等收入国家的研究，专注于儿童，青少年和成年人。基于社会经济地位的群体是脆弱的，少数民族,移民/难民身份，年龄,位置或LGBTQ身份。怀孕/产妇有时与脆弱性相交。证据支持的干预措施包括：家访沟通/教育和接种疫苗，和促进者访问实践(高强度)；电话沟通/教育，提醒/预订约会（中等强度）；信件，明信片或短信进行交流/教育，提醒/预约预约和提醒/回忆干预措施（低强度）。许多研究使用了多种干预措施或成分。
结论：有相当多的证据支持个人沟通的有效性，通过电话或书面增加疫苗接种。针对提供者的高强度和低强度干预均显示出有效性。有限的证据评估了额外的诊所或有针对性的服务，以增加访问;只有家访有更高的信心证据显示有效性。没有证据表明对某些社区进行干预，例如宗教少数群体，它们可能与额外服务的证据差距相交。没有与COVID-19疫苗接种相关的证据，这些证据加剧了结果的不平等。
■CRD42021293355。
方法：2022年11月，我们搜索了四个数据库进行系统评价，其中包括评估任何干预措施以增加服务不足的疫苗接种的RCT，少数群体或弱势群体;我们的主要结果是疫苗接种。我们使用快速审查的方法来筛选，提取数据并评估已识别评论中的偏见风险。我们使用从SWiM指南修改的方法进行了叙事综合。我们将干预措施归类为高，中等或低强度，作为疫苗需求的目标，access,或提供者。
结果：我们纳入了23篇系统综述，包括在高、低收入或中等收入国家的研究，专注于儿童，青少年和成年人。基于社会经济地位的群体是脆弱的，少数民族,移民/难民身份，年龄,位置或LGBTQ身份。怀孕/产妇有时与脆弱性相交。证据支持的干预措施包括：家访沟通/教育和接种疫苗，和促进者访问实践(高强度)；电话沟通/教育，提醒/预订约会（中等强度）；信件，明信片或短信进行交流/教育，提醒/预约预约和提醒/回忆干预措施（低强度）。许多研究使用了多种干预措施或成分。
结论：有相当多的证据支持个人沟通的有效性，通过电话或书面增加疫苗接种。针对提供者的高强度和低强度干预均显示出有效性。有限的证据评估了额外的诊所或有针对性的服务，以增加访问;只有家访有更高的信心证据显示有效性。没有证据表明对某些社区进行干预，例如宗教少数群体，它们可能与额外服务的证据差距相交。没有与COVID-19疫苗接种相关的证据，这些证据加剧了结果的不平等。
■CRD42021293355。
