Strategies to improve vaccination uptake in Australia, a systematic review of types and effectiveness

Objective: To identify and critique interventions to improve vaccination uptake in Australia. Methods: Peer-reviewed and grey literature from 1997 to May 2011 was searched to identify evaluations of one or more interventions to improve vaccination uptake among any target group in Australia. Studies were categorised by intervention type and target group. Recommended tools for assessing quality in public health interventions were used in the methodological critique of included studies. Results: Forty-nine studies met the inclusion criteria, two-thirds of which were published in peer-reviewed journals. Evidence for strategies that increase community demand for vaccination was most common. Multi-component strategies, patient and provider reminders, plans for catch-up vaccination and accelerated schedules were identified as most effective. There was a lack of evidence for strategies to improve coverage in Aboriginal and Torres Strait Islander peoples, behaviourally at-risk groups and pregnant women. Major limitations of identified studies were the lack of baseline coverage for comparison, limited use of controlled designs and measurement biases. Conclusion: The evidence, while limited, suggests that the most effective strategies are those which increase community demand for and enhance access to vaccines. Strategies to increase vaccination uptake are infrequently and often inadequately evaluated, despite the need for evidence to support their use. Implications: The results of this review, used in conjunction with international evidence, can guide those desiring to improve the performance of vaccination programs and suggest priorities for future evaluation of strategies to improve vaccination uptake.