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Vaccination Programs: Home Visits to Increase Vaccination Rates

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What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a Community Guide systematic review completed in 2009 (19 studies, search period 1980-2009) combined with more recent evidence (4 studies, search period 2009-2012). This finding updates and replaces the 2009 finding for Home Visits to Increase Vaccination Rates pdf icon [PDF - 521 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.

Context

Home visiting interventions may be effective in addressing a wide range of public health problems. The focus of this review is the subset of interventions focused on increasing vaccination rates.

Summary of Results

More details about study results are available in the CPSTF Finding and Rationale Statement pdf icon [PDF - 507 kB].

The systematic review included 23 studies. Of these, 20 studies with 21 study arms used a common measure of change in vaccination rates.

  • Overall vaccination rates increased by a median of 11 percentage points (20 studies with 21 study arms).
  • Home visits led to meaningful improvements in vaccination rates when used in the following ways:
    • With all clients in a designated population (12 study arms)
    • With only clients who did not respond to other interventions (9 study arms)
    • When focused on vaccinations alone (12 study arms)
    • When used to address vaccinations and other health concerns (9 study arms)
    • When vaccinations were provided on-site (8 study arms)
    • When clients were referred to vaccination services outside the home (13 study arms)
    • As the sole intervention (8 study arms)
    • As part of a larger healthcare system or community-based program (13 study arms)

Summary of Economic Evidence

More details about study results are available in the CPSTF Finding and Rationale Statement pdf icon [PDF - 507 kB].

Findings from the economic review show that home visits are resource-intensive and high-cost interventions relative to other available options.

Nine studies were included in the review (search period: 1980 - 2012). Monetary values are in reported in 2013 US dollars.

  • The median for intervention group size was 575 (9 studies)
  • Median cost per person was $56.30 (9 studies)
  • Median cost per additional vaccinated person was $786.79 (9 studies)
  • Studies were conducted in the United States (5 studies), the United Kingdom (2 studies), Australia (1 study), and Canada (1 study).
  • One study looked at adolescent vaccines; eight studies evaluated interventions focused on the childhood vaccination series.

Applicability

Based on results of the review, CPSTF findings should be applicable to the following:

  • Urban settings
  • Lower income populations
  • Children and adults
  • Influenza and childhood vaccinations

Evidence Gaps

Additional research and evaluation are needed to answer the following questions and fill existing gaps in the evidence base. (What are evidence gaps?)

  • What are the effectiveness and economic benefits of this intervention among adolescent populations or when used in rural settings?
  • What portion of home visits can be attributed solely to improving vaccination rates when home visits include other activities and objectives?

Study Characteristics

  • Included studies were conducted primarily in urban settings (15 studies) and among lower income populations (10 studies).
  • Studies were directed at children (15 studies) and adults (7 studies)
  • Evaluated interventions addressed influenza vaccinations (7 studies) and childhood vaccinations (14 studies).

Publications