Universally Recommended Vaccinations: Client Reminder & Recall Systems

Task Force Finding & Rationale Statement

Definition

Client reminder and recall interventions involve reminding members of a target population that vaccinations are due (reminders) or late (recall). Reminders and recalls differ in content and are delivered by various methods—telephone, letter, postcard, or other. Most reminder systems involve a specific notification for a specific client, and may be accompanied by educational messages regarding the importance of immunization for the targeted vaccine(s).

Task Force Finding

Client reminder and recall interventions are recommended based on strong evidence of effectiveness in improving vaccination coverage: (1) in children and adults; (2) in a range of settings and populations; (3) when applied at different levels of scale—from individual practice settings to entire communities; (4) across a range of intervention characteristics (e.g., reminder or recall, content, theoretical basis and method of delivery); and (5) whether used alone or with additional components.

Rationale

In 1997, the Task Force found strong evidence of effectiveness for client reminder and recall interventions. Based on the findings of this updated review, the Task Force reaffirms their original recommendation.

Our previous review (search period 1980–1997) included 54 study arms from 42 studies with a median absolute increase in vaccination coverage of 12.0 percentage points (interquartile interval [IQI]: 5.8 to 21.0 percentage points). Thirty-four study arms evaluated client reminder and recall when implemented alone (median absolute increase in vaccination coverage of 8.0 percentage points; IQI: 5.5 to 18.0 percentage points), and nine studies examined this intervention with additional components (median absolute increase in vaccination coverage of 16.0 percentage points; IQI: 7.5 to 23.0 percentage points).

Our updated review identified 20 additional studies from 19 papers (search period 1997–2007) with a median absolute increase in vaccination coverage of 6.1 percentage points (IQI: 3.3 to 13.0 percentage points). Twelve studies examined the impact of client reminder and recall alone and documented a median absolute increase of 5.1 percentage points (IQI: 1.6 to 7.2 percentage points). Eight studies evaluated client reminder and recall interventions with additional components, and documented a median absolute increase of 11.0 percentage points (IQI: 4.6 to 20.0 percentage points).

The reviewed studies evaluated the effectiveness of client reminder and recall in a wide range of client and provider populations and settings.

No evidence of harms regarding the use of client reminder and recall was identified in either the 1997 review or in our 2007 update.

The Task Force notes that the studies included in the 2007 review documented changes in vaccination coverage that are smaller in magnitude than those observed in the 1997 review. However, the findings from the 2007 review remain of sufficient magnitude of effect to support a conclusion of effectiveness and a recommendation for the use of these interventions to improve vaccination coverage.