Evidence-based Interventions

The Individually Tailored Calendar¹³

Behavior Change Intervention: “Patient-oriented” approaches such as creating individually tailored calendars for parents of new babies have been shown to be effective among populations that are at risk for having low child immunization rates.

Description: The individually tailored calendar intervention involves offering free enrollment to new mothers of children under the age of one at free community health clinics. Using a digital camera and user-friendly computer software, pictures of the baby are taken, uploaded, and printed out in the format of a personalized immunization calendar. Parents only receive a calendar for the month leading up to their baby’s next appointment.

In addition to providing as a reminder to the next vaccination date, the calendars also provide information regarding

• how to prevent childhood injuries
• developmental milestones
• tips on parenting skills
• information regarding other preventative services that the health center offers.

Theoretical Basis: “Exchange Theory” states that individuals, groups, or organization may have a resource to exchange for a perceived benefit. Those resources in regards to health promotion may include money, time, physical and cognitive effort, or lifestyle changes. The perceived benefit provided to these individuals may be money, technical expertise, ideas, products, or services (Kotler, 1975).

In regards to the Individually Tailored Calendar, parents of limited economic means received informative calendars that they found useful and had free pictures of their new baby. The calendar included tailored personal messages and images for the parents. They only received calendars up to their next immunization, so in order to receive another calendar, they had to take their child back to the health center to be immunized.

Benefited Groups:  It is particularly effective among low-income/education communities, minorities, and inner-city areas. Certain evidence based interventions such as mail or phone reminders have not been shown as effective among high risk groups living in urban areas who are also of low social economic status.

A pilot project  carried out with new parents at two urban health centers in St. Louis, Missouri,  found that children enrolled in the tailored calendar program had 91% immunization rates at their 4 month check ups- more than double the vaccination rate of the entire city during the time of the study (Kreuter et al. 1996).

A subsequent follow-up case-control study found that a higher proportion of intervention than of control babies were up to date at the end of a 9-month enrollment period (82% vs 65%, P < .001) and at age 24 months (66% vs 47%, P < .001) (Kreuter et al. 2004).

A more current personalized immunization calendar study carried out with Aboriginal children in 2008-2009 ( Abbott et al. 2013) also found that this style of vaccination intervention to be effective in increasing vaccination rates and timeliness of vaccinations that were received.

 

Vaccine For Children Program¹⁴ (VFC)

Behavior Change Intervention:  The affordability, availability and access to vaccines serve as an impediment of vaccine uptake in a given population. Policy interventions that make vaccines affordable increases access and encourages parents to immunize their children.

Description: Vaccine For Children Program is a vaccination program funded by the federal government to expand vaccine coverage for children who would otherwise be unable to afford the cost of the vaccine. It involves the Center for Disease Prevention (CDC) purchasing vaccines at discounted prices and distributing them to institutions such as the state health department. These institutions in turn make these vaccines available at no cost to providers office and public health offices where the vaccines will be administered. This is an ongoing program that has expanded its coverage over the years to even include second doses of vaccines such as measles to children that are eligible.

This pretest-posttest study carried out in 1993, took a random sample of 30 physicians from from 8 New York City neighborhoods. These neighborhoods were identified as having the highest proportions of Medicaid-eligible individuals. The VFC program was implemented in October 1994. In 1995-1996, all 30 physicians were contacted again and only 23 were eligible to complete the interview and consent to a review of medical records. The inclusion criteria for selected medical records reviewed:

• Were of pre-school age i.e between 3-35 months old
• Contained 3 or more recorded visits
• Visits that spanned a period of more than 3 months

Theoretical Basis: The Health Belief Model described in the 1950s and has been used to identify specific beliefs and thoughts that are important. The constructs of this model are the: belief in personal risk of disease (susceptibility); belief that consequences would be serious (severity); belief in positive results of preventive action (perceived benefits); belief in negative results (perceived barriers); and a belief in own ability to take action (self-efficacy).

This study really highlighted the perceived barriers in receiving immunizations which happened to be the cost in obtaining a vaccine. In this study cues for parents to make use of this program were done by use of media such as posters at the community level. Parent’s of children in need of this vaccine recognized the perceived benefits of vaccinating their children, ensuring that their children attended well-child visits and were updated on vaccines. They were also able to recognize that their children were susceptible to diseases that could be easily preventable by vaccine uptake, hence, the need to immunize their children. The physicians that were interviewed perceived the benefits in increasing immunization coverage as the vaccines had been supplied for free. Additionally, physicians were less likely to refer patients to another facility to receive their vaccines as they were now able to administer these vaccines.

Benefitted Groups: The children that were included in this study were identified as “needy” according to the high proportion of Medicaid claims submitted in the randomly selected 8 neighborhoods. Removing the barrier of vaccine cost, there was an overall significant increase in immunization rates in 1995-1996 as compared to 1993 by 24.3% (p<0.05). The vaccines that were considered were: DTP (diptheria toxoid, tetanus toxoid and pertussis vaccine); OPV (oral poliovirus vaccine); MMR (measles, mumps and rubella vaccine); and Hepatitis B vaccine. There was a general increase in coverage across board with the largest increase seen in Hepatitis B vaccine (which had the lowest coverage in 1993).

Since the providers received the vaccines at no cost, their administrative fees received from the state increased from $2 to $17.85.

Other Interventions to Improve Vaccination Coverage

• Client reminder/ recall: allows clients to know when vaccinations are due or overdue. It provides time to contact their vaccination provider to determine if vaccinations are needed.
• Vaccination program in WIC settings: provides assessment of the children’s immunization status and refers the under immunized children to healthcare providers
• Home visits: Provides face to face services to people in their home. Services include
  • education
  • assessment of need
  • referral
  • provision of vaccination
• For more information on other interventions click here

Mumps

Mumps vaccine uptake in the measles, mumps, rubella (MMR) vaccine was among one of the vaccines considered in the inner-city study in New York.  With the implementation of VFC, there was a 23.5% increase in children considered up-to-date for receiving measles, mumps and rubella vaccine.

With programs such as VFC, increased public health awareness and increased immunization coverage in the United States, vaccine-preventable diseases such as mumps and measles should not be an issue. However, there is an ongoing mumps outbreak in Columbus, OH.

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