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Vaccination Programs: Community-Based Interventions Implemented in Combination


What the CPSTF Found

About The Systematic Review

This CPSTF finding is based on evidence from a Community Guide systematic review completed in 2010 (17 studies; search period 1980 - 2010) combined with more recent evidence (1 study, search period 2010 - February 2012). It updates and replaces the 2010 finding for Community Based Interventions Implemented in Combination pdf icon [PDF - 181 KB].

This review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to increasing appropriate vaccination.


The CPSTF notes that implementing manual outreach and tracking or home visits can be resource-intensive and costly, relative to other options for increasing vaccination rates. Such interventions should be used only when there is demonstrated need, and when resources are available.

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement pdf icon [PDF - 172 KB].

The systematic review included 18 studies with 21 study arms.

  • Overall vaccination rates: median increase of 14 percentage points (18 studies)
    • Older adults (65 years and older): median increase of 30.8 percentage points (4 studies)
    • Children (12 years and younger): median increase of 12 percentage points (14 studies)
  • Studies that combined one or more interventions to increase client and community demand with one or more interventions to enhance access to vaccination services saw a median increase in vaccination rates of 16 percentage points (14 studies).
  • Intervention combinations that included client reminders reported a median increase in vaccination rates of 13 percentage points (15 study arms).

Summary of Economic Evidence

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement pdf icon [PDF - 172 KB].

Twenty-two studies that qualified for the economic review evaluated combinations of community-based interventions, such as client reminders, mass media, home visits, and client incentives. All monetary values provided are in 2012 U.S. dollars.

  • Estimates of cost and cost-effectiveness varied between studies.
    • The median intervention cost per person per year was $54 (19 studies).
    • The median cost per additional vaccinated person was $461 (19 studies)
    • Estimates were higher for combined interventions that included intensive outreach and home visits.
    • Estimates were lower for combined interventions that were mostly based on mail or telephone reminders.


Based on the evidence, the CPSTF finding should be applicable to the following.

  • Populations with low vaccination rates
    • Children ages 12 years and younger
    • Older adults ages 65 years and older
    • Groups with low socioeconomic status
    • Racial and ethnic minorities
  • Different vaccines, including
    • Recommended childhood series
    • Pneumococcal – adults
    • Influenza – adults
  • Urban areas

Evidence Gaps

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

  • How effective are these programs when applied to adolescents, or in rural settings?
  • What are the economic efficiencies of the more resource-intensive components (i.e., manual outreach and tracking, home visits)?
  • How does program effectiveness differ based on included component interventions and strategic combinations?
  • What are the most efficient ways to sustain these programs, especially for existing community-based organizations?

Study Characteristics

  • In 13 of the 18 studies, the community-based effort combined one or more interventions to increase community demand for vaccinations with one or more interventions to enhance access to vaccination services.
  • Interventions were conducted in urban (21 study arms) and rural (1 study arm) settings.
  • Interventions targeted children (21 study arms), adolescents (1 study arm) and adults (4 study arms).
  • Studies evaluated the following vaccines:
    • Recommended childhood series (15 study arms)
    • Influenza—adults (4 study arms)
    • Pneumococcal—adults (2 study arms)
    • Hepatitis B—child (1 study arm)
  • Majority of the studies evaluated interventions that targeted populations with low socioeconomic status (10 study arms).