Universally Recommended Vaccinations: Client or Family Incentive Rewards

Task Force Finding & Rationale Statement

Definition

Client or family incentive rewards are used to motivate people to obtain recommended vaccinations. Rewards may be monetary or non-monetary, and they may be given to clients or families for keeping an appointment, receiving a vaccination, returning for a vaccination series, or producing documentation of vaccination status. Rewards are typically small (e.g., food vouchers, gift cards, lottery prizes, baby products). Incentive reward programs are distinct from interventions that increase access to vaccination services (e.g., the provision of transportation or child care, the administration of vaccinations at no or reduced cost to clients).

Task Force Finding

The Community Preventive Services Task Force recommends client or family incentive rewards based on sufficient evidence of effectiveness in increasing vaccination rates in children and adults. Evidence on effectiveness is considered sufficient based on results from six studies that evaluated incentive awards alone or in combination with additional interventions.

Rationale

The Task Force considered evidence from six studies with seven study arms (search period January 1980-November 2009). Overall, the absolute median change in vaccination rates was an increase of 8.5 percentage points (interquartile interval: 6 to 18 percentage points). Two study arms that provided an assessment of the effectiveness of client incentive rewards alone showed similar changes in vaccination rates (8.5 and 9.0 percentage points). In the five remaining study arms, incentive rewards (most often small gifts or food vouchers) were combined with additional interventions, and the contribution of the incentive reward to the overall improvement in vaccination rates could not be determined.

The studies included in this review evaluated programs conducted primarily in public health settings, although several involved coordinated efforts with both public and private partners. Targeted client populations included adults as well as families of children. The vaccines delivered in these programs included seasonal influenza, and vaccines recommended as part of the childhood series. The Task Force considers the evidence to be applicable to the range of settings, and vaccines recommended for children and adults.

The type of incentive reward offered to clients included the following: government payments (i.e., of $208 AUD and childcare assistance), lottery prizes (i.e., $50 grocery voucher or $175 in monetary prizes), gift cards (i.e., $10 for baby products), baby products and food vouchers.

Incentive rewards may provide additional benefits, such as increasing contact between clients and their health care providers, thereby providing opportunities for other preventive care interactions. On the other hand, incentive rewards may be considered as coercive with the potential to influence the process of informed decision making by clients. Rewards also may have only a short term effect on motivations to obtain vaccinations or to maintain up-to-date status.

Additional implementation and evaluation research could focus on the independent effects of incentive rewards, and examine the relationship between the value of the reward and effectiveness. Most of the included studies examined the use of incentive rewards on vaccination rates for children, so additional research could examine the use of these interventions for vaccinations recommended for adolescents and adults.