Vaccination Programs: Home Visits to Increase Vaccination Rates

Related Pages

Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends home visits to increase vaccination rates in children and adults.

The CPSTF notes, however, that economic evidence shows home visits can be resource-intensive and costly relative to other options.

The full CPSTF Finding and Rationale Statement and supporting documents for Vaccination Programs: Home Visits to Increase Vaccination Rates are available in The Community Guide Collection on CDC Stacks.

Intervention

Home visitors assess clients’ vaccination status, discuss the importance of recommended vaccinations, and either provide vaccinations in homes or refer clients to other services. Home visits may be conducted by vaccination providers (e.g., nurses) or others (e.g., social workers, community health workers).

Interventions may be directed to everyone in a designated population or to those who have not responded to other intervention efforts. Programs may be implemented alone or as part of a larger healthcare system or community-based program.

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.

Study Characteristics

  • 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)
  • Interventions addressed influenza vaccinations (7 studies) and childhood vaccinations (14 studies)

Summary of Results

Twenty-three studies were included. Twenty studies with 21 study arms used a common measure.

  • Overall vaccination rates increased by a median of 11 percentage points (20 studies with 21 study arms)
  • Home visits led to meaningful improvements when used:
    • 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 outside services (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

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 (search period 1980-2012). Monetary values in 2013 U.S. dollars.

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

Applicability

Findings applicable to:

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

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?

Implementation Considerations and Resources

Home visits serving multiple purposes may be logistically challenging. Timing for vaccinations and other services may be difficult. Clients may not open homes to strangers due to security or privacy concerns.

Resource-intensive interventions like home visits may be necessary to increase rates among populations with very low vaccination rates or where disparities persist. Interventions likely cost less if used as part of a stepped approach beginning with less resource-intensive options like client reminder and recall systems.

Included studies noted home visits give providers additional opportunities to assess clients’ undetected health risks or medical problems.

Potential harms described in literature include difficulties managing clients with adverse reactions and stigmatization of disadvantaged clients identified as needing special services.

Crosswalks

Healthy People 2030 icon Healthy People 2030 includes the following objectives related to this CPSTF recommendation.