背景:社区参与在全球免疫策略中占主导地位,能够消除疫苗接种犹豫并提高疫苗接种信心。尽管大力支持社区参与促进健康,社区参与疫苗接种推广的证据出现在质量不确定的片段中。
目的:本综述旨在系统研究不同内容和程度的社区参与对提高疫苗接种率的有效性。
方法:本研究按照系统评价和荟萃分析(PRISMA)的首选报告项目进行。在四个英语数据库中进行了全面而详尽的文献检索(PubMed,Embase,WebofScience,和CochraneLibrary)和两个中文数据库(CNKI和万方),以查找所有可能的文章。具有实验研究设计的原始研究文章检查了社区参与疫苗接种促进的有效性。两名审稿人独立进行文献检索,研究选择,质量评估和数据提取。通过讨论解决了差异,在必要时由第三审稿人仲裁。
结果:在2006年至2021年期间的11,404条记录中,总共检索了20篇文章,作为样本集,以量化社区参与疫苗接种促进的有效性。这些包括的研究以各种设计进行,12个使用单组研究前设计,5项使用集群随机对照试验,3项使用非随机对照试验。其中包括针对多种疫苗的研究,8项研究侧重于儿童免疫接种,8项研究集中在HPV疫苗上,3研究集中在乙肝疫苗,1项研究集中在COVID-19疫苗上。荟萃分析报告了在前后比较((率差异)RD:0.34;95%CI:0.21-0.47)和组间比较(RD:0.18;95%CI:0.07-0.29)中疫苗接种率均显着增加。关于社区参与内容的荟萃分析发现,参与者招募产生的效应大小最大(RD:0.51;95%CI:0.37-0.67;I2=99.5%)。其次是干预发展(RD:0.36;95%CI:0.23-0.50;I2=99.7%),干预实施(RD:0.35;95%CI:0.22-0.47;I2=99.8%),和数据收集(RD:0.34;95%CI:0.19-0.50;I2=99.8%)。关于社区参与程度的荟萃分析发现,高社区参与程度产生的效应大小最大(RD:0.49;95%CI:0.17-0.82;I2=99.5%)。其次是中等社区参与度(RD:0.45;95%CI:0.33-0.58;I2=99.4%),社区参与程度低(RD:0.15;95%CI:0.05-0.25;I2=98.6%)。关于干预策略类型的荟萃分析发现,“卫生服务支持”认可了最大的效应大小(RD:0.45;95%CI:0.25-0.65;I2=99.9%),其次是“健康教育和讨论”(RD:0.39;95%CI:0.20-0.58;I2=99.7%),“随访和提醒”(RD:0.33;95%CI:0.23-0.42;I2=99.3%),和“社会营销活动(SMC)和社区动员(CM)”(RD:0.24;95%CI:0.06-0.41;I2=99.9%)。
结论:这项荟萃分析的结果支持社区参与疫苗接种促进的有效性,但参与内容和程度不同。社区参与需要“适合目的”的方法,而不是“一刀切”的方法,以最大限度地提高疫苗推广的有效性。
背景:该审查协议已在PROSPERO数据库(CRD42022339081)中注册。
BACKGROUND: Community engagement plays a vital role in global immunization strategies, offering the potential to overcome vaccination hesitancy and enhance vaccination confidence. Although there is significant backing for community engagement in health promotion, the evidence supporting its effectiveness in vaccination promotion is fragmented and of uncertain quality.
OBJECTIVE: This review aims to systematically examine the effectiveness of different contents and extent of community engagement for promoting vaccination rates.
METHODS: This study was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive and exhaustive literature search was performed in 4 English databases (PubMed, Embase, Web of Science, and Cochrane Library) and 2 Chinese databases (CNKI and Wan Fang) to identify all possible articles. Original research articles applying an experimental study design that investigated the effectiveness of community engagement in vaccination promotion were eligible for inclusion. Two reviewers independently performed the literature search, study selection, quality assessment, and data extraction. Discrepancies were resolved through discussion, with the arbitration of a third reviewer where necessary.
RESULTS: A total of 20 articles out of 11,404 records from 2006 to 2021 were retrieved. The studies used various designs: 12 applied single-group pre-post study designs, 5 were cluster randomized controlled trials (RCTs), and 3 were non-RCTs. These studies targeted multiple vaccines, with 8 focusing on children\'s immunization, 8 on human papillomavirus vaccine, 3 on hepatitis B virus vaccine, and 1 on COVID-19 vaccine. The meta-analysis revealed significant increases in vaccination rates both in pre-post comparison (rate difference [RD] 0.34, 95% CI 0.21-0.47, I2=99.9%, P<.001) and between-group comparison (RD 0.18, 95% CI 0.07-0.29, I2=98.4%, P<.001). The meta-analysis revealed that participant recruitment had the largest effect size (RD 0.51, 95% CI 0.36-0.67, I2=99.9%, P<.001), followed by intervention development (RD 0.36, 95% CI 0.23-0.50, I2=100.0%, P<.001), intervention implementation (RD 0.35, 95% CI 0.22-0.47, I2=99.8%, P<.001), and data collection (RD 0.34, 95% CI 0.19-0.50, I2=99.8%, P<.001). The meta-analysis indicated that high community engagement extent yielded the largest effect size (RD 0.49, 95% CI 0.17-0.82, I2=100.0%, P<.001), followed by moderate community engagement extent (RD 0.45, 95% CI 0.33-0.58, I2=99.6%, P<.001) and low community engagement extent (RD 0.15, 95% CI 0.05-0.25, I2=99.2%, P<.001). The meta-analysis revealed that \"health service support\" demonstrated the largest effect sizes (RD 0.45, 95% CI 0.25-0.65, I2=99.9%, P<.001), followed by \"health education and discussion\" (RD 0.39, 95% CI 0.20-0.58, I2=99.7%, P<.001), \"follow-up and reminder\" (RD 0.33, 95% CI 0.23-0.42, I2=99.3%, P<.001), and \"social marketing campaigns and community mobilization\" (RD 0.24, 95% CI 0.06-0.41, I2=99.9%, P<.001).
CONCLUSIONS: The results of this meta-analysis supported the effectiveness of community engagement in vaccination promotion with variations in terms of engagement contents and extent. Community engagement required a \"fit-for-purpose\" approach rather than a \"one-size-fits-all\" approach to maximize the effectiveness of vaccine promotion.
BACKGROUND: PROSPERO CRD42022339081; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=339081.