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{"sheet":"FULL MAP","index":2,"n_rows":821,"n_cols":5,"rows_kept":821,"cut":false,"hidden":false,"merged":[[820,1,878,1],[820,2,878,2],[820,3,879,3],[820,4,878,4],[744,1,775,1],[744,2,775,2],[744,3,776,3],[744,4,775,4],[777,1,819,1],[777,2,819,2],[777,3,819,3],[777,4,819,4],[471,1,502,1],[471,2,502,2],[471,3,502,3],[471,4,502,4],[713,1,740,1],[713,2,740,2],[713,3,743,3],[713,4,740,4],[644,4,670,4],[590,1,616,1],[590,2,616,2],[590,3,617,3],[590,4,616,4],[618,1,642,1],[618,2,642,2],[618,3,643,3],[618,4,643,4],[671,1,710,1],[671,2,710,2],[671,3,712,3],[671,4,712,4],[644,1,668,1],[644,2,668,2],[644,3,670,3],[503,1,540,1],[503,2,540,2],[503,3,540,3],[503,4,540,4],[541,1,565,1],[541,2,565,2],[541,3,565,3],[541,4,565,4],[566,1,588,1],[566,2,588,2],[566,4,588,4],[566,3,589,3],[287,1,316,1],[287,2,316,2],[229,3,286,3],[229,4,286,4],[287,3,316,3],[287,4,316,4],[209,1,228,1],[209,2,228,2],[414,1,436,1],[414,2,436,2],[414,3,436,3],[414,4,436,4],[82,1,96,1],[82,2,96,2],[82,3,96,4],[97,1,113,1],[97,2,113,2],[97,3,113,4],[118,2,133,2],[134,2,153,2],[134,3,153,3],[134,4,153,4],[116,1,116,4],[118,1,133,1],[118,3,133,3],[118,4,133,4],[134,1,153,1],[23,1,23,4],[25,2,53,2],[25,1,53,1],[25,3,53,4],[54,1,71,1],[54,2,71,2],[54,3,71,4],[72,1,81,1],[72,2,81,2],[72,3,81,4],[154,4,208,4],[154,1,208,1],[154,2,208,2],[154,3,208,3],[360,1,392,1],[360,2,392,2],[360,3,392,3],[360,4,392,4],[437,1,470,1],[437,2,470,2],[437,3,470,3],[437,4,470,4],[393,1,413,1],[393,2,413,2],[393,3,413,3],[393,4,413,4],[317,1,359,1],[317,2,359,2],[317,3,359,3],[317,4,359,4],[209,3,228,3],[209,4,228,4],[229,1,286,1],[229,2,286,2]]}
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[null,"ADRAN CANLLAWIAU - MAP LLAWN "]
[null,"Ffynhonnell:","Cynulleidfa:","Argymhellion:"]
[null,"National Institute for Health and Care Excellence. Flu vaccination: increasing uptake. NG103. London: NICE; 2018.\nAvailable here.","This guideline is for: \n- Commissioners and providers of primary and secondary healthcare services, including maternity providers and community pharmacies\n- All employers of staff who provide NHS or social-care funded services (including maternity care, domiciliary care and care homes)\n- Local authorities, and community and voluntary sector organisations that employ health and social care workers\n- Occupational health services and infection prevention and control teams\n- NHS England teams and Health Education England teams\n- People using services, their families, carers and other members of the public, in particular those eligible for flu vaccination","This guideline covers how to increase uptake of the free flu vaccination among people who are eligible. It describes ways to increase awareness and how to use all opportunities in primary and secondary care to identify people who should be encouraged to have the vaccination.\n\nIt includes recommendations on:\n- Using a multicomponent approach\n- Raising awareness\n- Offering vaccination\n- Increasing uptake among eligible groups in primary and secondary care\n- Audit, monitoring and feedback\n- Vaccination in carers\n- Increasing uptake in health and social care staff"]
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[null,"National Institute for Health and Care Excellence. Tuberculosis. NG33. London: NICE; 2016.\nAvailable here.\nLast updated in September 2019.","This guideline is for: \n- Healthcare professionals and TB multidisciplinary teams\n- Substance misuse services, prisons and immigration removal centres\n- Local government and commissioners\n- TB control boards, directors of public health and public health consultants\n- Public Health England and NHS England\n- Voluntary sector workers\n- People with TB and their carers","This guideline covers preventing, identifying and managing latent and active tuberculosis (TB) in children, young people and adults. It aims to improve ways of finding people who have TB in the community and recommends that everyone under 65 with latent TB should be treated. It describes how TB services should be organised, including the role of the TB control board.\n\nIt includes recommendations on:\n- Preventing TB, including in under-served groups\n- Diagnosing and managing latent TB, including recommendations specifically for children and young people\n- Diagnosing and managing active TB, including recommendations specifically for children and young people\n- Drug-resistant TB\n- Infection control\n- Case finding and adherence, treatment completion and follow-up, including in under-served groups\n- Service organisation"]
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[null,"National Institute for Health and Care Excellence. Hepatitis B and C testing: people at risk of infection. PH43. London: NICE; 2012.\nAvailable here.\nLast updated in March 2013.","This public health guidance is relevant to:\n- Commissioners and providers\n- People at increased risk of viral hepatitis\n- Members of the public","This guideline covers raising awareness of and testing for hepatitis B and C infection. It aims to ensure that people at increased risk of hepatitis B and C infection are tested.\n\nIt  includes recommendations on:\n- Raising awareness about hepatitis B and C among the general population and people at increased risk of infection\n- Education and training for professionals who provide services for people at increased risk of infection\n- Testing for hepatitis B and C in primary care, prisons and immigration removal centres, drugs services, and sexual health and genitourinary medicine clinics\n- Tracing close contacts of people with hepatitis B infection\n- Neonatal hepatitis B vaccination\n- Commissioning integrated services for testing and treatment and laboratory services for testing"]
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[null,"National Institute for Health and Care Excellence. Immunisations: reducing differences in uptake in under 19s. PH21. London: NICE; 2009.\nAvailable here.\nLast updated in September 2017.","This public health guidance is relevant to:\n- Healthcare professionals\n- Commissioners and providers\n- People who work in children’s services and local authorities\n- People who work in schools, colleges and workplaces\n- People who work in the private, voluntary and community sectors\n- Parents, carers and young people","This guideline covers increasing immunisation uptake among children and young people aged under 19 years in groups and settings where immunisation coverage is low. It aims to improve access to immunisation services and increase timely immunisation of children and young people. It also aims to ensure babies born to mothers infected with hepatitis B are immunised.\n\nIt includes recommendations on:\n- Immunisation programmes\n- Information systems for recording immunisation status\n- Training for staff involved in immunisation services\n- Contribution of nurseries, schools and further education colleges\n- Targeting groups at risk of not being fully immunised\n- Hepatitis B immunisation for infants"]
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[null,"National Institute for Health and Care Excellence. Drug misuse in over 16s: psychosocial interventions. CG51. London: NICE; 2007.\nAvailable here.\nLast checked in July 2016.","This clinical guidance is relevant to:\n- Healthcare professionals\n- Commissioners and providers\n- People who work in specialist residential and community-based treatment settings\n- People who work in prisons and criminal justice settings\n- Adults and young people over 16 who misuse opioids, stimulants or cannabis and their families and carers","This guideline covers using psychosocial interventions to treat adults and young people over 16 who have a problem with or are dependent on opioids, stimulants or cannabis. It aims to reduce illicit drug use and improve people’s physical and mental health, relationships and employment.\n\nIt includes recommendations on:\n- Principles for supporting people who misuse drugs and their families and carers\n- Identification and assessment of drug misuse\n- Brief interventions and self-help\n- Formal psychosocial interventions\n- Residential, prison and inpatient care"]
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[null,"ADRAN ADOLYGIAD SYSTEMATIG - MAP LLAWN"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau'r awduron:"]
[null,"Jia  L et al. Payment methods for healthcare providers working in outpatient healthcare settings. Cochrane Database of Systematic Reviews 2021, Issue 1. Art. No.: CD011865. DOI: 10.1002/14651858.CD011865.pub2. \nAvailable here.","Adults (65 years+)","This Cochrane review aimed to assess the impact of different payment methods for healthcare providers working in outpatient healthcare settings on the quantity and quality of health service provision, patient outcomes, healthcare provider outcomes, cost of service provision, and adverse effects.\n\nThe reviewers' included 27 studies in the review: 12 randomised trials, 13 controlled before‐and‐after studies, one interrupted time series, and one repeated measure study. Only one randomised controlled trial (RCT; Kouides et al. 1998) based in USA fulfilled the inclusion criteria of this evidence map. \nPrimary care physicians in the intervention group received a fee for each immunisation of USD 8 and an additional 10% (USD 0.8) or 20% (USD 1.6) reimbursement per shot according to whether they immunised 70% or 85% (respectively) of the eligible population. The primary care physicians in the control group received only the fee for each immunisation of USD 8. The mean immunisation rate with payment for performance plus existing payment methods was 0.34 per cent points higher (0.2 per cent points lower to 0.87 points higher) compared to existing payment methods [MD 0.34 (−0.20 to 0.87)].\n\n\n\n\n\n","Based on the evidence from one study, the authors were uncertain of the effect of payment for performance added to existing payment methods on immunisation rates for the elderly.\n\nThere is a need for further well‐conducted research on payment methods for healthcare providers working in outpatient healthcare settings in low‐ and middle‐income countries; more studies comparing the impacts of different designs of the same payment method; and studies that consider the unintended consequences of payment interventions."]
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[null,"Palmer  MJ et al. Free  C. Targeted client communication via mobile devices for improving maternal, neonatal, and child health. Cochrane Database of Systematic Reviews 2020, Issue 8. Art. No.: CD013679. DOI: 10.1002/14651858.CD013679.\nAvailable here.","High risk groups (pregnant women)","This Cochrane review aimed to assess the effects of TCC via MD on health behaviour, service use, health, and well‐being for maternal, neonatal and child health (MNCH).\n\nThe reviewers'  included 27 trials (17,463 participants). Trial populations were: pregnant and postpartum women (11 trials conducted in low‐, middle‐ or high‐income countries; pregnant and postpartum women living with HIV (three trials carried out in one lower middle‐income country); and parents of children under the age of five years (13 trials conducted in LMHIC). \n\nOnly two studies within the targeted client communication via mobile device versus digital non-targeted communication fulfilled the criteria of this review:\nOne RCT (Yudin et al. 2017) found that a mobile phone text message reinforcing that the influenza vaccine is recommended for all pregnant women and safe during pregnancy and breastfeeding compared to standard care/ no intervention, may make little or no difference to attendance for antenatal influenza vaccination (risk ratio (RR) 1.05, 95% confidence interval (CI) 0.71 to 1.58), though the CI encompasses both benefit and harm (low‐certainty evidence). \nOne cluster-RCT (Lund et al. 2012) found that a multi-component approach combining mobile phone text message with voucher compared to simple health education and appointment reminders to encourage attendance to routine antenatal classes, make little or no difference to attendance for antenatal tetanus vaccine (OR 1.67, 95% CI 0.84 to 3.33). ","The authors conclude that the effect of targeted client communication via mobile devices for most outcomes is uncertain. There may be improvements for some outcomes using targeted communication but these findings were of low certainty. \n\nHigh‐quality, adequately powered trials and cost‐effectiveness analyses are required to reliably ascertain the effects and relative benefits of TCCMD. Future studies should measure potential unintended consequences, such as partner violence or breaches of confidentiality."]
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[null,"Abdullahi  LH et al. Improving vaccination uptake among adolescents. Cochrane Database of Systematic Reviews 2020, Issue 1. Art. No.: CD011895. DOI: 10.1002/14651858.CD011895.pub2.\nAvailable here.","Adults (under 19s)","This Cochrane review aimed to evaluate the effects of interventions to improve vaccine uptake among adolescents.\n\nThe reviewers' included 16 studies (eight individually randomised trials, four cluster randomised trials, three non‐randomised trials, and one controlled before‐after study). Twelve studies were conducted in the USA, while there was one study each from: Australia, Sweden, Tanzania, and the UK. Ten studies had unclear or high risk of bias. They categorised interventions as recipient‐oriented, provider‐oriented, or health systems‐oriented.\n\nThe interventions targeted adolescent boys or girls or both (seven studies), parents (four studies), and providers (two studies). Five studies had mixed participants that included adolescents and parents, adolescents and healthcare providers, and parents and healthcare providers. The outcomes included uptake of human papillomavirus (HPV) (11 studies); hepatitis B (three studies); and tetanus–diphtheria–acellular–pertussis (Tdap), meningococcal, HPV, and influenza (three studies) vaccines among adolescents.\n\nHealth education improves HPV vaccine uptake compared to usual practice (RR 1.43, 95% CI 1.16 to 1.76; I² = 0%; 3 studies, 1054 participants; high‐certainty evidence). In addition, one large study provided evidence that a complex multi‐component health education intervention probably results in little to no difference in hepatitis B vaccine uptake compared to simplified information leaflets on the vaccine (RR 0.98, 95% CI 0.97 to 0.99; 17,411 participants; moderate‐certainty evidence).\n\nFinancial incentives may improve HPV vaccine uptake compared to usual practice (RR 1.45, 95% CI 1.05 to 1.99; 1 study, 500 participants; low‐certainty evidence). However, we are uncertain whether combining health education and financial incentives has an effect on hepatitis B vaccine uptake, compared to usual practice (RR 1.38, 95% CI 0.96 to 2.00; 1 study, 104 participants; very low certainty evidence).\n\nMandatory vaccination probably leads to a large increase in hepatitis B vaccine uptake compared to usual practice (RR 3.92, 95% CI 3.65 to 4.20; 1 study, 6462 participants; moderate‐certainty evidence).\n\nProvider prompts probably make little or no difference compared to usual practice, on completion of Tdap (OR 1.28, 95% CI 0.59 to 2.80; 2 studies, 3296 participants), meningococcal (OR 1.09, 95% CI 0.67 to 1.79; 2 studies, 3219 participants), HPV (OR 0.99, 95% CI 0.55 to 1.81; 2 studies, 859 participants), and influenza (OR 0.91, 95% CI 0.61 to 1.34; 2 studies, 1439 participants) vaccination schedules (moderate‐certainty evidence).\n\nProvider education with performance feedback may increase the proportion of adolescents who are offered and accept HPV vaccination by clinicians, compared to usual practice. Compared to adolescents visiting non‐participating clinicians (in the usual practice group), the adolescents visiting clinicians in the intervention group were more likely to receive the first dose of HPV during preventive visits (5.7 percentage points increase) and during acute visits (0.7 percentage points for the first and 5.6 percentage points for the second doses of HPV) (227 clinicians and more than 200,000 children; low‐certainty evidence).\n\nA class‐based school vaccination strategy probably leads to slightly higher HPV vaccine uptake than an age‐based school vaccination strategy (RR 1.09, 95% CI 1.06 to 1.13; 1 study, 5537 participants; moderate‐certainty evidence).\n\nA multi‐component provider intervention (including an education session, repeated contacts, individualised feedback, and incentives) probably improves uptake of HPV vaccine compared to usual practice (moderate‐certainty evidence).\n\nA multi‐component intervention targeting providers and parents involving social marketing and health education may improve HPV vaccine uptake compared to usual practice (RR 1.41, 95% CI 1.25 to 1.59; 1 study, 25,869 participants; low‐certainty evidence).","The authors conclude that various strategies have been evaluated to improve adolescent vaccination including health education, financial incentives, mandatory vaccination, and class‐based school vaccine delivery. However, most of the evidence is of low to moderate certainty. This implies that while this research provides some indication of the likely effect of these interventions, the likelihood that the effects will be substantially different is high. \n\nTherefore, additional research is needed to further enhance adolescent immunisation strategies, especially in low‐ and middle‐income countries where there are limited adolescent vaccination programmes. In addition, it is critical to understand the factors that influence hesitancy, acceptance, and demand for adolescent vaccination in different settings. This is the topic of an ongoing Cochrane qualitative evidence synthesis, which may help to explain why and how some interventions were more effective than others in increasing adolescent HPV vaccination coverage."]
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[null,"Stormacq C et al. Effects of health literacy interventions on health-related outcomes in socioeconomically disadvantaged adults living in the community: a systematic review. JBI evidence synthesis 2020, Issue 18(7). pp.1389-1469. doi: 10.11124/JBISRIR-D-18-00023.\nAvailable here.","High risk groups (pregnant women)","The objectives of this JBI review were: i) to identify and synthesize the best available evidence on the effectiveness on health-related outcomes of health literacy interventions for enabling socioeconomically disadvantaged people living in the community to access, understand, appraise and apply health information; and ii) to identify components of health literacy interventions associated with improved health-related outcomes.\n\nTwenty-one studies were included in the review. Only one randomised controlled trial fulfilled the criteria of this evidence map (Stockwell et al. 2014). It included 1153 low-income women initiating prenatal care, 576 of whom participated in the experimental group and 577 in the control group. Participants in the experimental group received health information and health education about influenza during pregnancy through five weekly text messages. The text messages covered various topics such as risk of influenza for the pregnant woman and fetus, vaccine safety and vaccine recommendations. Participants in the control group received usual care. At four months follow-up, there was a higher rate of vaccination in the experimental group than in the control group (P = 0.048). Text messages are a simple, convenient and cost-effective tool to send specific health information to a large number of people simultaneously. Text messages can be an effective tool for delivering health information and encouraging the adoption of positive health behaviors within a population with limited access to health information.","The review concluded that mostly, health literacy interventions in the Disease Prevention domain of the health continuum were effective for improving preventive health behaviors and practices such as vaccination and screenings."]
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[null,"Thomas  RE and Lorenzetti  DL. Interventions to increase influenza vaccination rates of those 60 years and older in the community. Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD005188. DOI: 10.1002/14651858.CD005188.pub4. \nAvailable here.","Adults (60 years+)","This Cochrane review aimed to assess access, provider, system, and societal interventions to increase the uptake of influenza vaccination in people aged 60 years and older in the community.\n\nThe reviewers' included 3 new RCTs for this update (total 61 RCTs; 1,055,337 participants). Trials involved people aged 60 years and older living in the community in high‐income countries. Heterogeneity limited some meta‐analyses. They assessed studies as at low risk of bias for randomisation (38%), allocation concealment (11%), blinding (44%), and selective reporting (100%). Half (51%) had missing data. We assessed the evidence as low‐quality. They identified three levels of intervention intensity: low (e.g. postcards), medium (e.g. personalised phone calls), and high (e.g. home visits, facilitators).\n\nIncreasing community demand (12 strategies, 41 trials, 53 study arms, 767,460 participants): One successful intervention that could be meta‐analysed was client reminders or recalls by letter plus leaflet or postcard compared to reminder (OR 1.11, 95% CI 1.07 to 1.15; 3 studies; 64,200 participants). Successful interventions tested by single studies were patient outreach by retired teachers (OR 3.33, 95% CI 1.79 to 6.22); invitations by clinic receptionists (OR 2.72, 95% CI 1.55 to 4.76); nurses or pharmacists educating and nurses vaccinating patients (OR 152.95, 95% CI 9.39 to 2490.67); medical students counselling patients (OR 1.62, 95% CI 1.11 to 2.35); and multiple recall questionnaires (OR 1.13, 95% CI 1.03 to 1.24).\n\nSome interventions could not be meta‐analysed due to significant heterogeneity: 17 studies tested simple reminders (the 95% CI was entirely above unity in 11 trials implying all 11 interventions increased vaccination rates); 16 tested personalised reminders (the 95% CI was entirely above unity in 12 trials implying all 12 interventions increased vaccination rates ); 2 investigated customised compared to form letters (the 95% CI was above unity in both trials implying both interventions increased vaccination rates); and 4 studies examined the impact of health risk appraisals (the 95% CI was above unity in all 4 trials implying all 4 interventions increased vaccination rates). One study of a lottery for free groceries was not effective.\n\nEnhancing vaccination access (6 strategies, 8 trials, 10 arms, 9353 participants): The reviewers meta‐analysed results from 2 studies of home visits (OR 1.30, 95% CI 1.05 to 1.61), and 2 studies that tested free vaccine compared to patient payment for vaccine (OR 2.36, 95% CI 1.98 to 2.82). They were unable to conduct meta‐analyses of 2 studies of home visits by nurses plus a physician care plan (the 95% CI was entirely above unity in both trials implying both interventions increased vaccination rates) and 2 studies of free vaccine compared to no intervention (the 95% CI was entirely above unity in both trials implying both interventions increased vaccination rates). One study of group visits (OR 27.2, 95% CI 1.60 to 463.3) was effective, and 1 study of home visits compared to safety interventions was not.\n\nProvider‐ or system‐based interventions (11 strategies, 15 trials, 17 arms, 278,524 participants): One successful intervention that could be meta‐analysed focused on payments to physicians (OR 2.22, 95% CI 1.77 to 2.77). Successful interventions tested by individual studies were: reminding physicians to vaccinate all patients (OR 2.47, 95% CI 1.53 to 3.99); posters in clinics presenting vaccination rates and encouraging competition between doctors (OR 2.03, 95% CI 1.86 to 2.22); and chart reviews and benchmarking to the rates achieved by the top 10% of physicians (OR 3.43, 95% CI 2.37 to 4.97).\n\nThe reviewers were unable to meta‐analyse 4 studies that looked at physician reminders (the 95% CI was entirely above unity in 3 trials implying all 3 interventions increased vaccination rates) and 3 studies of facilitator encouragement of vaccination (the 95% CI was entirely above unity in 2 trials implying both interventions increased vaccination rates). Interventions that were not effective were: comparing letters on discharge from hospital to letters to general practitioners; posters plus postcards versus posters alone; educational reminders, academic detailing, and peer comparisons compared to mailed educational materials; educational outreach plus feedback to teams versus written feedback; and an intervention to increase staff vaccination rates.\n\nInterventions at the societal level: No studies reported on societal‐level interventions.","The reviewers identified interventions that demonstrated significant positive effects of low (postcards), medium (personalised phone calls), and high (home visits, facilitators) intensity that increase community demand for vaccination, enhance access, and improve provider/system response. The overall GRADE assessment of the evidence was moderate quality. Conclusions are unchanged from the 2014 review."]
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[null,"Jacobson Vann  JC et al. Patient reminder and recall interventions to improve immunization rates. Cochrane Database of Systematic Reviews 2018, Issue 1. Art. No.: CD003941. DOI: 10.1002/14651858.CD003941.pub3. \nAvailable here.","Adults","This Cochrane review aimed to evaluate and compare the effectiveness of various types of patient reminder and recall interventions to improve receipt of immunizations.\n\nThe 75 included studies involved child, adolescent, and adult participants in outpatient, community‐based, primary care, and other settings in 10 countries.\n\nPatient reminder or recall interventions, including telephone and autodialer calls, letters, postcards, text messages, combination of mail or telephone, or a combination of patient reminder or recall with outreach, probably improve the proportion of participants who receive immunization (RR of 1.28, 95% CI 1.23 to 1.35; risk difference of 8%) based on moderate certainty evidence from 55 studies with 138,625 participants.\n\nThree types of single‐method reminders improve receipt of immunizations based on high certainty evidence: the use of postcards (RR 1.18, 95% CI 1.08 to 1.30; eight studies; 27,734 participants), text messages (RR 1.29, 95% CI 1.15 to 1.44; six studies; 7772 participants), and autodialer (RR 1.17, 95% CI 1.03 to 1.32; five studies; 11,947 participants). Two types of single‐method reminders probably improve receipt of immunizations based on moderate certainty evidence: the use of telephone calls (RR 1.75, 95% CI 1.20 to 2.54; seven studies; 9120 participants) and letters to patients (RR 1.29, 95% CI 1.21 to 1.38; 27 studies; 81,100 participants).\n\nBased on high certainty evidence, reminders improve receipt of immunizations for childhood (RR 1.22, 95% CI 1.15 to 1.29; risk difference of 8%; 23 studies; 31,099 participants) and adolescent vaccinations (RR 1.29, 95% CI 1.17 to 1.42; risk difference of 7%; 10 studies; 30,868 participants). Reminders probably improve receipt of vaccinations for childhood influenza (RR 1.51, 95% CI 1.14 to 1.99; risk difference of 22%; five studies; 9265 participants) and adult influenza (RR 1.29, 95% CI 1.17 to 1.43; risk difference of 9%; 15 studies; 59,328 participants) based on moderate certainty evidence. They may improve receipt of vaccinations for adult pneumococcus, tetanus, hepatitis B, and other non‐influenza vaccinations based on low certainty evidence although the confidence interval includes no effect of these interventions (RR 2.08, 95% CI 0.91 to 4.78; four studies; 8065 participants).","The reviewers conclude that patient reminder and recall systems, in primary care settings, are likely to be effective at improving the proportion of the target population who receive immunizations."]
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[null,"Lorenc T, Marshall D, Wright K, Sutcliffe K, Sowden A (2018). Seasonal influenza vaccination of healthcare workers: evidence synthesis. London: EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London. \nAvailable here.","Occupational groups (healthcare workers)","This report by EPPI-centre presents the findings from: (1) a synthesis of evidence about seasonal flu vaccination interventions: content and components, processes, and implementation; and (2) a systematic review of qualitative studies investigating HCWs’ views, attitudes and perceptions about seasonal flu vaccination. \n\nThe reviewers identified 60 studies evaluating interventions to promote seasonal flu vaccination among HCWs. Of these, only 13 used an RCT design. The types of strategy, number of studies, strength of evidence and likely effectiveness are presented in the summary table, overleaf. Most of the RCTs focused on increasing awareness, or on education. Few RCTs evaluated strategies to increase access, or incentives, and none assessed mandatory vaccination programmes. Most interventions combined several different elements and this is likely to be the most promising approach, as components are likely to work in different ways, and for different people. Most RCTs were conducted either in hospitals or in long-term care (e.g., nursing homes).\n\nThree studies were conducted in the UK (two RCTs), mainly focusing on increasing awareness or education. Most interventions appear not to have been based on any clear theoretical framework, or on any formative research or substantive engagement with HCWs themselves. Most non-mandatory interventions focused on individual beliefs, rather than on the social or institutional factors which may affect vaccination uptake. Data on implementation indicate that it is important to ensure adequate resources and management support; to address HCWs’ beliefs about vaccination; and to collect accurate data on vaccination coverage.\n\nThe findings from 25 qualitative studies. The data indicated a number of personal beliefs which may be barriers to vaccination, including perceived low risk of influenza, fear of side-effects of the vaccine, and scepticism about vaccine effectiveness. There were serious barriers to the acceptability of some interventions, particularly coercive mandatory policies, but also some educational or awareness-raising strategies.\n","The review concluded that bringing together the findings from the quantitative and qualitative studies, it appears that HCWs have clear views about their needs and priorities in relation to seasonal flu\nvaccination, which were mostly not addressed by the evaluated interventions. \n\nThe key messages were:\n- Promising interventions combine several components, including individual, social and environmental elements\n- Education alone is probably ineffective, but broader awareness-raising strategies appear promising\n- Increasing access to vaccination may be effective, but the evidence is weak with few RCTs\n- Both “soft” and “hard” mandates appear promising, but have yet to be evaluated using robust study designs, and may have limited acceptability\n- Interventions should ideally target everyone working in a healthcare context, but this may be practically difficult\n- The culture and context of the organisation(s), within which interventions are implemented, may have an important influence on outcomes. Evaluators should seek\nto understand interventions within an organisational system\n- Very few interventions engaged with HCWs to understand their needs and priorities\n- Intervention developers/implementers should engage with HCWs to understand their views, conduct formative research and pilot interventions before full-scale evaluation\n- Mixed-methods research to understand the context, in which an intervention will be implemented, and HCWs’ likely responses to an intervention, may be valuable"]
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[null,"Arditi  C et al. Computer‐generated reminders delivered on paper to healthcare professionals: effects on professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD001175. DOI: 10.1002/14651858.CD001175.pub4.\nAvailable here.","Adults","This Cochrane review aimed to evaluate the effects of reminders automatically generated through a computerized system (computer‐generated) and delivered on paper to healthcare professionals on quality of care (outcomes related to healthcare professionals' practice) and patient outcomes (outcomes related to patients' health condition).\n\nReview authors identified 35 studies (30 RCTs trials and five non‐RCTs) and analyzed 34 studies (40 comparisons). Twenty‐nine studies took place in the USA and six studies took place in Canada, France, Israel, and Kenya. All studies except two took place in outpatient care. Reminders were aimed at enhancing compliance with preventive guidelines (e.g. cancer screening tests, vaccination) in half the studies and at enhancing compliance with disease management guidelines for acute or chronic conditions (e.g. annual follow‐ups, laboratory tests, medication adjustment, counseling) in the other half.\n\nComputer‐generated reminders delivered on paper to healthcare professionals, alone or in addition to co‐intervention(s), probably improves quality of care slightly compared with usual care or the co‐intervention(s) without the reminder component (median improvement 6.8% : 3.8% to 17.5%]; 34 studies (40 comparisons); moderate‐certainty evidence).\n\nComputer‐generated reminders delivered on paper to healthcare professionals alone (single‐component intervention) probably improves quality of care compared with usual care (median improvement 11.0% (IQR 5.4% to 20.0%); 27 studies (27 comparisons); moderate‐certainty evidence). Adding computer‐generated reminders delivered on paper to healthcare professionals to one or more co‐interventions (multi‐component intervention) probably improves quality of care slightly compared with the co‐intervention(s) without the reminder component (median improvement 4.0% (IQR 3.0% to 6.0%); 11 studies (13 comparisons); moderate‐certainty evidence). \n\nSub-group analyses revealed largest improvement seen in vaccination, with a median improvement of 13.1% [Interquartile range (IQR) 12.2% to 20.7%].\n\nThe authors are uncertain whether reminders, alone or in addition to co‐intervention(s), improve patient outcomes as the certainty of the evidence is very low (n = 6 studies (seven comparisons)). None of the included studies reported outcomes related to harms or adverse effects of the intervention.","The review concludes that there is moderate‐certainty evidence that computer‐generated reminders delivered on paper to healthcare professionals probably slightly improves quality of care, in terms of compliance with preventive guidelines and compliance with disease management guidelines. It is uncertain whether reminders improve patient outcomes because the certainty of the evidence is very low. The heterogeneity of the reminder interventions included in this review also suggests that reminders can probably improve quality of care in various settings under various conditions."]
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[null,"Posadzki  P et al. Automated telephone communication systems for preventive healthcare and management of long‐term conditions. Cochrane Database of Systematic Reviews 2016, Issue 12. Art. No.: CD009921. DOI: 10.1002/14651858.CD009921.pub2.\nAvailable here.","Adults\n\nHigh risk groups (long-term health conditions) \n","This Cochrane review aimed to assess the effects of automated telephone communication system (ATCS) for preventing disease and managing long‐term conditions on behavioural change, clinical, process, cognitive, patient‐centred and adverse outcomes.\n\nThe review authors found 132 trials with over 4 million participants across preventive healthcare areas and for the management of long‐term conditions.\n\nStudies compared ATCS types in many ways. Some studies reported findings across diseases. For prevention, ATCS probably increase immunisation uptake in children, and slightly in adolescents, but in adults effects are uncertain. \n\nTen studies, all in the USA, evaluated ATCS for promoting immunisation uptake. For preventive healthcare, ATCS (ATCS Plus, IVR, unidirectional) probably increase immunisation uptake in children (risk ratio (RR) 1.25, 95% confidence interval (CI) 1.18 to 1.32; 5 studies, N = 10,454; moderate certainty) and to a lesser extent in adolescents (RR 1.06, 95% CI 1.02 to 1.11; 2 studies, N = 5725; moderate certainty). Based on evidence from 2 studies the effects of ATCS in adults are unclear (RR 2.18, 95% CI 0.53 to 9.02; 2 studies, N = 1743; very low certainty).","The review authors concluded that ATCS interventions can change patients' health behaviours, improve clinical outcomes and increase healthcare uptake with positive effects in several important areas including immunisation, screening, appointment attendance, and adherence to medications or tests. The decision to integrate ATCS interventions in routine healthcare delivery should reflect variations in the certainty of the evidence available and the size of effects across different conditions, together with the varied nature of ATCS interventions assessed. Future research should investigate both the content of ATCS interventions and the mode of delivery; users' experiences, particularly with regard to acceptability; and clarify which ATCS types are most effective and cost‐effective."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Vaccination Programs: Home Visits to Increase Vaccination Rates. The Community Guide; 2016. \nAvailable here.","Adults","This report examines home visits to increase vaccination rates in children and adults, leading to a Community Preventive Services Task Force (CPSTF) recommendation on the subject. 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). \n\nThe Task Force considered evidence from 23 studies of home visits, with 20 studies and 21 study arms using a common measure of change in vaccination rates. The overall effect was a median increase of 11 percentage points (IQR: 5 to 15 percentage points). Meaningful improvements were observed as a result of home visits delivered to all clients (12 study arms) and to only those clients unresponsive to other interventions (9 study arms), home visits focused on vaccination alone (12 study arms) and in combination with other health concerns (9 study arms), and home visits providing on-site vaccinations (8 study arms) and referring clients to vaccination services outside the home (13 study arms). Home visits delivered as the sole intervention (8 study arms) and home visits delivered as part of a larger healthcare system or community-based program (13 study arms) also produced meaningful change in vaccination rates.","The CPSTF report recommends home visits based on strong evidence of their effectiveness in increasing vaccination rates. Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness. The Task Force notes that home visiting interventions are potentially effective in addressing a wide range of public health problems and that the focus of this review is the subset of interventions specifically addressing vaccination rates.\n\nThe report identified that more research is needed on the effectiveness and economic benefits of home visits to increase vaccination rates among adolescents and in rural settings. Additional economic research is needed to estimate the portion of home visits that can be attributed solely to improving vaccination rates when home visits include other activities and objectives."]
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[null,"Till  SR et al. Incentives for increasing prenatal care use by women in order to improve maternal and neonatal outcomes. Cochrane Database of Systematic Reviews 2015, Issue 12. Art. No.: CD009916. DOI: 10.1002/14651858.CD009916.pub2.\nAvailable here.","High risk groups (pregnant women)","This Cochrane review aimed to determine whether incentives are an effective tool to increase utilization of timely prenatal care among women.\n\nThe review authors identified 11 studies (19 reports), six of which we excluded. Five studies, involving 11,935 pregnancies were included, but only 1893 pregnancies contributed data regarding our specified outcomes. Incentives in the studies included cash, gift card, baby carrier, baby blanket or taxicab voucher and were compared with no incentives. Meta‐analysis was performed for only one outcome 'Return for postpartum care' and this outcome was not pre‐specified in their protocol. Other analyses were restricted to data from single studies.\n\nThe five included studies of incentive programs did not report any of this review's primary outcomes: preterm birth, small‐for‐gestational age, or perinatal death.\n\nIn terms of this review's secondary outcomes, pregnant women receiving incentives were no more likely to initiate prenatal care (risk ratio (RR) 1.04, 95% confidence interval (CI) 0.78 to 1.38, one study, 104 pregnancies). Pregnant women receiving incentives were more likely to attend prenatal visits on a frequent basis (RR 1.18, 95% CI 1.01 to 1.38, one study, 606 pregnancies) and obtain adequate prenatal care defined by number of “procedures” such as testing blood sugar or blood pressure, vaccinations and counselling about breastfeeding and birth control (mean difference (MD) 5.84, 95% CI 1.88 to 9.80, one study, 892 pregnancies). In contrast, women who received incentives were more likely to deliver by cesarean section (RR 1.97, 95% CI 1.18 to 3.30, one study, 979 pregnancies) compared to those women who did not receive incentives.","The included studies did not report on this review's main outcomes: preterm birth, small‐for‐gestational age, or perinatal death. There is limited evidence that incentives may increase utilization and quality of prenatal care, but may also increase cesarean rate. Overall, there is insufficient evidence to fully evaluate the impact of incentives on prenatal care initiation. \n\nThere is a need for high‐quality RCTs to determine whether incentive program increase prenatal care use and improve maternal and neonatal outcomes. Incentive programs, in particular cash‐based programs, as suggested in this review and in several observational studies may improve the frequency and ensure adequate quality of prenatal care. No peer‐reviewed data have been made publicly available for one of the largest incentive‐based prenatal programs – the statewide Medicaid‐based programs within the United States. These observational data represent an important starting point for future research with significant implications for policy development and allocation of healthcare resources. The disparate findings related to attending postpartum care should also be further explored as the findings were limited by the number of studies. Future large RCTs are needed to focus on the outcomes of preterm birth, small‐for‐gestational age and perinatal outcomes."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Clinic-based Client Education\nWhen Used Alone. The Community Guide; 2015. \nAvailable here.","Adults (older: age not specified)","This report aimed to determine the effectiveness of clinic-based client education interventions when implemented alone in increasing vaccination rates or reducing rates of vaccine preventable illness and found insufficient evidence. Four of the included studies provided sufficient evidence of effectiveness but were limited to immunizations for pneumococcal polysaccharide vaccine among older adults with very low baseline coverage. The Task Force finding reflects concerns about the intervention's applicability to a broader range vaccinations, populations, and clinic-based settings.\n\nThis Task Force finding is based on evidence from a Community Guide systematic review completed in 2011 (4 studies with 6 study arms, search period 1980-2009) combined with more recent evidence (1 study, search period 2009-2012). Based on the combined evidence, the Task Force reaffirms its finding of insufficient evidence. The combined Task Force review included five studies. Four studies with six study arms providing a common measurement of change in vaccination rates. Although the median change in vaccination rates was an increase of 10 percentage points (IQR: 3 to 19 percentage points), results were dominated by findings from three related study arms focused on increasing pneumococcal polysaccharide vaccinations among older adult patients in one clinical setting. Changes in vaccination rates from the other three study arms were inconsistent and smaller in magnitude. The final study did not evaluate changes in vaccination rates, and found only a very small change in the proportion of tetanus booster doses administered with the use of an audiovisual message in clinic waiting areas.\n\nTwo studies included in this review implemented a potentially useful educational approach to increase vaccination rates by prompting discussions between the client and their vaccination provider. In these studies, an educational brochure distributed to patients in the waiting area included a specific request for a discussion with their provider about the pneumococcal polysaccharide vaccine. In both studies, use of the brochure increased vaccination rates by 16 percentage points in a client population with very low baseline rates. \n\nClinic-based client education can be one component of an effective combined approach to increase vaccination rates. The Task Force finds strong evidence to recommend health care system-based interventions implemented in combination and community-based interventions implemented in combination.","This CPSTF report states that although the evidence identified in this systematic review is small and inconsistent, at least one format demonstrates sufficient evidence of effectiveness. The Task Force considers the applicability of this educational approach to other vaccines and populations an important question for further study.\n\n"]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Community-Wide Education When Used Alone. The Community Guide; 2015. \nAvailable here.","Adults (older: age not specified)","This report aimed to determine the effectiveness of community-wide education interventions when implemented alone in increasing vaccination rates or reducing rates of vaccine preventable illness and found insufficient evidence. Evidence is considered insufficient due to inconsistent results and concerns about the applicability of evidence to more diverse communities in the United States where improvements in vaccination rates are needed.\n\nThis Task Force finding is based on evidence from a Community Guide systematic review completed in 2010 (6 studies with 8 study arms, search period 1980-2009) combined with more recent evidence (1 study, search period 2009- February 2012). Based on the combined evidence, the Task Force reaffirms its finding of insufficient evidence.\n\nThe Task Force considered evidence from 7 studies with 9 study arms. Among the studies providing a common measure of change in vaccination rates (4 studies with 6 arms) there was a median increase of 6 percentage points (range of values: 0.4 to 12.2 percentage points).\n\nThree studies evaluated mass media activities using different measures of change. In a targeted community in Australia, pneumococcal vaccines dispatched to service providers increased during the period of a mass media campaign. In Finland, a mass media campaign briefly increased MMR vaccine receipt for children 6 years of age, though changes were not reported for younger children. In the U.S., a mass media campaign addressing flu-related topics among a nationally representative population of older adults found a positive association between flu-related media reports and influenza vaccination rates in the weeks following the campaign (annual vaccination rates increased by 2.3-7.9 percentage points, p<0.001).\n\nOne U.S. study observed moderate increases in vaccination rates for hepatitis B vaccine following intensive communitywide educational efforts in two Vietnamese-American communities. Characteristics of the study communities that may have contributed to intervention effectiveness included: (1) popular Vietnamese-language media, (2) established Vietnamese service organizations, and (3) culturally appropriate strategies and materials.\n\nCommunity-wide education is commonly implemented in combination with additional interventions (such as efforts to expand and enhance access to vaccinations). In another review, the Task Force found strong evidence of effectiveness for community-based interventions implemented in combination to increase vaccination rates, and five of the included studies used community-wide education in the combination of interventions.","This CPSTF report states that although the evidence identified in this systematic review is insufficient to determine the effectiveness of community-wide education when implemented alone, two studies suggest that these interventions may be useful with certain communities. More research is needed to understand the potential applicability of these interventions to other populations, and for other vaccines.\n\nThe Task Force acknowledges an important role for mass media (and the potential role of social media) in disseminating\ninformation to large audiences and shaping public attitudes and behaviours.\n\nVaccine manufacturers have been increasing direct-to-consumer mass and small media advertising to promote new vaccines. While evidence from private sector marketing campaigns on vaccine uptake was not included in this review, the Task Force considered the applicability of these marketing experiences to public health efforts. They determined that community-wide educational efforts may have greater impact when used to inform members of the community about new vaccines (such as HPV), or new recommendations (such as the universal recommendation for seasonal influenza), and in situations of public health urgency (such as the H1N1 pandemic). The effectiveness of community-wide education to increase vaccination rates in these circumstances remains an important issue for further evaluation research.\n"]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Provider Reminders. The Community Guide; 2015. \nAvailable here.","Adults","The CPSTF recommends provider reminders on the basis of strong evidence of effectiveness in increasing vaccination rates: (1) among adults, adolescents and children; (2) when used alone or with additional interventions; (3) across a range of intervention characteristics (e.g., computerized or simple reminders, checklists, flowcharts); and (4) in a range of settings and populations.\n\nThe Task Force finding is based on evidence from a Community Guide systematic review completed in 2008 (23 studies, search period 1997–2007) combined with more recent evidence (5 studies, search period 2007–February 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\nThe Task Force considered evidence from 28 studies. Twenty-two studies provided a measurement of change in vaccination rates, with an overall median increase of 10 percentage points (IQI: 6 to 25 percentage points). Of these, seven studies examined provider reminders alone with a median increase of 12 percentage points (IQI: 6 percentage point to 25 percentage points). Fifteen studies examined the impact of provider reminders with additional interventions and observed a median increase of 9 percentage points (IQI: 5 to 25 percentage points). Six additional studies did not provide a common measurement of change in vaccination rates; however, five of the studies provided additional support for the use of provider reminders.\n\nEvidence indicates that provider reminders remain an effective option for consideration in a wide range of clinical settings and populations. A subset of the included evidence, however, suggests that standing orders may be more effective in improving vaccination rates in both inpatient and outpatient settings than provider reminder systems.","Evidence in this CPSTF report indicates that provider reminders are effective in a wide range of contexts. Additional research should focus on system-level implementation of reminder systems, and identify strategies to encourage regular and sustained use. In addition, future research could examine or compare the effectiveness of specific reminder prompts provided as a capability of regional or state-level immunization information systems."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Client or Family Incentive Rewards. The Community Guide; 2015. \nAvailable here.","Adults","The CPSTF recommends client or family incentive rewards, used alone or in combination with additional interventions, based on sufficient evidence of effectiveness in increasing vaccination rates in children and adults.\n\nThis Task Force finding is based on evidence from a Community Guide systematic review completed in 2011 (6 studies with 7 study arms, search period 1980-2009) combined with more recent evidence (1 study, search period 2009-2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on sufficient evidence of effectiveness.\n\nIncluded studies showed vaccination rates increased by a median of 8 percentage points (interquartile interval [IQI]: 4 to 16 percentage points). Two study arms that assessed the effectiveness of incentive rewards alone showed similar changes in vaccination rates (8.5 and 9.0 percentage points). In the six remaining study arms, incentive rewards were combined with additional interventions.\n\nAmong the studies included in this review, the type of incentive reward offered to clients included 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. \n\nOverall, the Task Force considers the evidence to be applicable to vaccinations for children and adults in a wide range of clinical and community settings, and for various types of incentive rewards.","This CPSTF report concludes that client or family incentive rewards can also be one component of an effective combined approach to increase vaccination rates in both clinical and community settings. Based on updated, concurrent reviews the Task Force finds strong evidence to recommend health care system-based interventions implemented in combination and community-based\ninterventions implemented in combination.\n\nAdditional research could focus on the independent effects of incentive rewards, examine the relationship between the value of the reward and effectiveness, and explore the duration of intervention impact. It also would be useful to have more information about the effectiveness of these interventions with adolescents and adults as most of the included studies examined the use of incentive rewards on vaccination rates for children."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Provider Assessment and Feedback. The Community Guide; 2015. \nAvailable here.","Adults","The CPSTF recommends assessment and feedback for vaccination providers on the basis of strong evidence of effectiveness in increasing vaccination rates: (1) among adults and children; (2) when used alone or with additional interventions; and (3) across a range of settings and populations. While there was not enough evidence to determine which characteristics of assessment and feedback contributed most to its effectiveness, various strategies have been consistently effective in a wide range of contexts.\n\nThe Task Force finding is based on evidence from a Community Guide systematic review completed in 2008 (19 studies, search period 1997–2007) combined with more recent evidence (1 study, search period 2007–February 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\n\nThe Task Force considered evidence from 20 studies. Of these, 16 studies with 20 study arms provided common measurements of change in vaccination rates. The median increase of 9 percentage points (IQI: 3 to 14 percentage points). Fifteen study arms provided sufficient information to calculate the change in vaccination rates and showed a median increase of 18.0% (IQI: 9.5% to 24.0%). Seven study arms evaluated the impact of assessment and feedback for providers when implemented alone and found a median increase of 11 percentage points (IQI: 7 to 12 percentage points). Thirteen study arms evaluated provider assessment and feedback with additional interventions and observed a median increase of 6 percentage points (IQI: 3 to 18 percentage points). One additional study did not provide a common measurement of change in vaccination rates, and reported no change after implementation of intervention.\n\nThe reviewed studies evaluated the impact of assessment and feedback for vaccination providers in a wide range of target populations and settings, and for most vaccines appropriate for adults or children. While no studies specifically evaluated the impact of assessment and feedback for vaccination of adolescents, evidence from this review is likely applicable to this population.","This CPSTF report concludes that none of the studies identified in this review evaluated the impact of provider assessment and feedback interventions on the delivery of vaccines to adolescents. Future studies should examine the effectiveness of these interventions in increasing vaccination rates among adolescents."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Provider Education When Used Alone. The Community Guide; 2015. \nAvailable here.","Not specified","The CPSTF finds insufficient evidence to determine the effectiveness of provider education interventions when implemented alone in improving vaccination rates or reducing vaccine-preventable illness. Evidence is considered insufficient because the six identified studies observed changes in vaccination rates that were both small in magnitude and inconsistent.\n\nThis Task Force finding is based on evidence from a Community Guide systematic review completed in 2010 (5 studies with 6 study arms, search period 1980-2009) combined with more recent evidence (1 study, search period 2009-2012). Based on the combined evidence, the Task Force reaffirms its finding of insufficient effectiveness.\n\nThe Task Force review included six studies that provided seven measurements of change in vaccination rates. The overall median absolute increase in vaccination rates was 4 percentage points (interquartile interval: 2 to 4 percentage points), however none of the study effect estimates were statistically significant, and results were inconsistent across the small body of evidence.\n\nThe Task Force identified, but did not consider in this review, an emerging body of evidence on the education of vaccination providers on the process of quality improvement. Education about quality improvement with the goal of reducing missed opportunities for vaccination and increasing vaccination rates was considered as a distinct intervention from provider education focused on vaccines and vaccinations.\n\nProvider education can be one component of an effective, combined approach to increase vaccination rates. Based on strong evidence of effectiveness identified in updated reviews, the Task Force recommends health care system-based interventions implemented in combination and community-based interventions implemented in combination.\n","This CPSTF report concludes that despite the common and continued use of provider education interventions alone, there are few published studies on their effectiveness.\n\nOne potential area for continued intervention research is provider education regarding new vaccines and expanded recommendations for specific vaccinations. As vaccine recommendations and schedules from the Advisory Committee on Immunization Practices continue to evolve, the potential effectiveness of provider education in increasing or improving the implementation of new recommendations warrants continued research.\n\nNone of the included studies assessed the effectiveness of provider education through distance-based training. Newer educational approaches might increase opportunities for vaccination providers to both share and learn from the experiences of peers and experts in the field."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Client Reminder and Recall Systems. The Community Guide; 2015. \nAvailable here.","Adults","The CPSTF recommends client reminder and recall interventions based on strong evidence of effectiveness in improving vaccination rates: (1) in children, adolescents 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.\n\nThis Task Force finding is based on evidence from a Community Guide systematic review completed in 2008 (19 studies, search period 1997-2007) combined with more recent evidence (10 studies, search period 2007-2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\n\nIncluded studies showed vaccination rates increased by a median of 11 percentage points (IQI: 4 to 17 percentage points). Client reminder and recall interventions used alone resulted in a median increase of 6 percentage points (IQI: 3 to 13 percentage points; 14 studies), and interventions implemented with additional components led to a median increase of 12 percentage points (IQI: 10 to 30 percentage points; 15 studies).\n\nThe included studies evaluated the effectiveness of client reminder and recall interventions for a wide range of client and provider populations, settings, vaccinations and delivery methods. Based on the evidence, the Task Force finding should be broadly applicable to all patient populations, in both clinical and community settings, and for the range of vaccines and delivery methods.\n","This CPSTF report concludes that client reminder and recall systems can also be important, effective components of combined approaches to increase vaccination rates. Based on updated, concurrent reviews, the Task Force finds strong evidence to recommend health care system-based interventions implemented in combination and community-based interventions implemented in combination. Immunization information systems, which can also generate client reminder or recall notices provide an additional implementation option.\n\nMore research is needed on effective implementation, sustainability, and expansion of reminder and recall interventions. Future research should also examine the effectiveness of reminder and recall notices using emerging communication technologies (i.e. text message, email). Additional studies should also examine the effectiveness of client reminder and recall interventions on adolescent vaccines such as the human papilloma virus (HPV).\n"]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Standing Orders. The Community Guide; 2015. \nAvailable here.","Adults","The Task Force finding is based on evidence from a Community Guide systematic review completed in 2009 (29 studies, search period 1997–2009) combined with more recent evidence (6 studies, search period 2009–February 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\n\nThe Task Force considered evidence from 35 studies. Of these, 27 studies provided a common measurement of change in vaccination rates with a median increase of 24 percentage points (IQI: 12 to 35 percentage points). Nine studies that examined the impact of standing orders alone documented a median increase of 16 percentage points (IQI: 9 to 29 percentage points). Nineteen studies that evaluated standing orders when combined with additional interventions documented a median increase of 27 percentage points (IQI: 13 to 40 percentage points). Seven studies that did not provide a common measure of change for vaccination rates all reported favorable results after implementation of standing orders.\n\nThe reviewed studies evaluated the effectiveness of standing orders across a wide range of clinical vaccination settings, health care personnel, and client populations. Standing orders were found to be effective in various settings including clinics, hospitals, and long-term care facilities. Interventions were effective when used with different vaccination providers including nurses and pharmacists. While most studies looked at adult populations, four examined intervention effectiveness among children and found a median absolute percent increase of 28 percentage points (range: 8 to 49). While no studies specifically evaluated the impact of standing orders for vaccination of adolescents, evidence from this review is likely applicable to this population. In addition, a subset of the included evidence suggests that standing orders may be more effective in improving vaccination rates in both inpatient and outpatient settings when compared to a provider reminder system.\n\nOne paper from the updated search period described the following barriers encountered during implementation of a pneumococcal vaccination standing orders program in three hospitals: gaps in staff education and training; personnel concerns about additional workload; staff reluctance to administer vaccines without a physician's order; attending physicians' resistance to having hospitalized patients vaccinated; and logistical difficulties. Some attending physicians expressed concern that vaccination would interfere with scheduled treatments or procedures. Other attending physicians did not consider inpatient stays to be an appropriate time for vaccinations (Middleton et al. 2005).\n\nAn additional study reported barriers to implementation of influenza and pneumococcal vaccination standing orders in various health care settings. Findings suggested that the adoption of these policies may have been too difficult to administer, staff were unclear or unconvinced of program benefits, and there was perceived physician discomfort with delegating responsibility for immunizations to nursing staff. A few of the respondents also indicated that resources, effectiveness of the vaccine, and time required to administer the vaccine were barriers for adoption. The majority of these barriers were specific to the administration of the influenza vaccine (Goldstein et al. 2005).","This CPSTF report concludes that standing orders were shown to be effective in increasing vaccination rates for influenza and pneumococcal vaccines. Additional research is needed, however, to determine if these interventions are effective for different vaccines (e.g. hepatitis, tetanus and vaccines recommended for adolescents). More evidence is also needed on ways to address barriers to the implementation of standing orders in health systems.\n"]
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[null,"Stokes G, Richardson M, Brunton G, Khatwa M, Thomas J (2015) Review 3: Community engagement for health via coalitions, collaborations and partnerships (on-line social media and social networks) – a systematic review and metaanalysis. London: EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London.\nAvailable here.","Adults \n\nOccupational groups (university staff)","This systematic review sought to answer the following research question:\nWhat health issues and populations have been studied using online social media/social networking?\n\nThere is evidence of health issues focused on healthy eating/physical activity, cancer detection and screening, diabetes, general wellbeing and lifestyle, sexual health, flu immunisation, food safety. However there were a low number of studies for each health topic and population. There is evidence of studies focused on populations under 25 years of age or on those over 40 years of age, but gaps in evaluated interventions in those aged under 16, 30 to 40 and over 60. There is inconsistent evidence of studies targeting women only and no evidence of studies targeting men specifically. There is inconsistent evidence of social media/social networking interventions directed to minority ethnic groups.\n\nThe studies included in this review focused on a broad range of health topics, only one RCT focussed amongst Australian university students and staff focused on influenza immunisation (Lau et al. 2012). For their study into the impact of a web-based personally controlled health management system entitled Healthy.me on influenza vaccination and health service utilisation rates, Lau et al. (2012) incorporated social forums and messaging to allow consumers to interact with each other and with healthcare professionals. \n\nThe provider of the additional potentially active content was either automated or anonymous. The content was also provided by the health professional experts. The study described the use of a mandatory five-minute session on how to use a website. Primary analysis examined differences in the proportion of participants obtaining influenza vaccination during the study in the waitlist and PCHMS groups using the c2 test, including participants who had the opportunity to use the PCHMS but did not\ndo so. \n\nThe extent of community engagement was low (0.48 95% CI: 0.09 to 0.87). The review concluded that there is weak evidence that employing either peers or professionals to facilitate online discussions forums is seen more often to have effective outcomes. ","In summary, although the effect sizes are very small overall, QCA demonstrated that including a facilitator in the delivery of social media/social networking interventions demonstrated higher effect sizes for studies not focused on healthy eating and physical activity and which did not employ the use of theory in intervention development. Nonhealthy eating/physical activity topics focused on sexually transmitted infection prevention, cancer screening/prevention, influenza immunization and mental health promotion. The use of this combination of conditions is conceptually well supported, lending confidence to its findings. However, it must be considered that these findings are exploratory in nature and should be evaluated robustly in future intervention development and evaluation."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Reducing Client Out-of-Pocket Costs for Vaccinations. The Community Guide; 2014. \nAvailable here.","Adults","The CPSTF recommends interventions that reduce client out-of-pocket costs based on strong evidence of effectiveness in improving vaccination rates. The effectiveness of these interventions has been demonstrated among children, adolescents, and adults, in a range of settings and populations, when applied in varying levels of scale from individual clinical settings to statewide programs to national efforts, and whether used alone or as part of a multi-component intervention.\n\nThis Task Force finding is based on evidence from a Community Guide systematic review completed in 2009 (15 studies; search period 1997 - 2009) combined with more recent evidence (5 studies, search period 2009 - 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\n\nEleven studies provided a common measurement of change in vaccination rates and showed a median increase of 22 percentage points (IQI: 6 to 33 percentage points). Six studies examined the impact of reducing client out-of-pocket costs alone (median increase of 28 percentage points; IQI: 2 to 47 percentage points) and 5 studies examined reducing client out-of-pocket costs as part of a multi-component strategy (median increase of 20 percentage points; IQI: 6 to 20 percentage points). The nine qualifying studies that did not provide a common measurement of change also reported overall increases in vaccinations received or administered.\n\nIncluded studies evaluated intervention effects on childhood vaccination series (3 studies), influenza (9 studies), pneumococcal (6 studies), hepatitis B (2 studies), and human papilloma virus (1 study). The reviewed studies evaluated the effectiveness of interventions that reduced client out-of-pocket costs in a range of client and provider populations and settings.\n\nPolicies adopted in the United States, including the Federal Vaccines for Children Program and the Affordable Care Act, have expanded access to many vaccines at reduced out-of-pocket cost. Barriers to expanded implementation of efforts include the adequacy and timeliness of reimbursement for the costs of vaccines, storage, and administration. In the United States, the ability of health care systems and providers to implement these interventions may depend on the adequacy and timeliness of reimbursement for the costs of the vaccines, storage, and administration.","This CPSTF report concludes that additional research is needed to determine the effectiveness of reducing client out-of-pocket cost interventions to increase rates of recommended vaccinations for adolescents (e.g., HPV, meningococcal, influenza). In addition, the Task Force suggests additional research to determine if these interventions are effective options to increase receipt of annual influenza vaccinations. Future research should also examine whether reducing client out-of-pocket cost interventions are essential components of school-based vaccination programs and on-site vaccination programs in general."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Community-Based Interventions Implemented in Combination. The Community Guide; 2014. \nAvailable here.","Adults","The CPSTF recommends community-based interventions implemented in combination to increase vaccinations in targeted populations, on the basis of strong evidence of effectiveness in increasing vaccination rates.\n\nThe conclusion of strong evidence was based on findings from 18 studies that evaluated coordinated interventions to:\n- Increase community demand\n- Enhance access to vaccination services, and\n- Reduce missed opportunities by vaccination providers\nIn 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.\n\nThe Task Force 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 resources are available.\n\nThis Task Force 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 - 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\n\nAll of the included studies provided a common measure of change and showed a median increase in vacation rates of 14 percentage points (IQI: 7 to 24 percentage points).\n\nThe included studies evaluated a variety of interventions in different combinations. The Task Force examined the evidence of differences attributable to specific interventions and combinations of interventions using different strategic approaches.\nFourteen studies implemented an effective combination of one or more interventions to increase community demand with one or more interventions to enhance access to vaccination services and showed a median increase in vaccination rates of 16 percentage points (IQI: 12 to 26 percentage points).\n\nClient reminder and recall systems were used in most of the evaluated programs (15 study arms). Systems were implemented by vaccination providers, established as one part of a community manual outreach and tracking program, or generated from a regional immunization information system (IIS).","This CPSTF report concludes that coordinated interventions may be especially important in communities that have wide disparities in vaccination coverage. Program planners should consider community characteristics, such as mobility and fragmentation of health care, in the selection and combination of interventions to increase vaccination rates and reduce disparities.\n\nPartnerships between community organizations and vaccination providers are likely to be an essential component of effective, sustained community-based efforts. Most studies involved partnerships with existing vaccination providers in\nthe community to increase access to vaccinations, rather than creating new vaccination services. Coalitions represent one way to establish effective partnerships, with the size of the coalition varying based on the community, targeted population, and scope of the problem. Four studies involved community coalitions that used the principles of community-based participatory research.\n\nMore evidence is needed on the effectiveness of these programs in adolescents, and when implemented in rural settings. More economic information on these interventions is needed, specifically, evaluations on the efficiencies of the resource-intensive components of manual outreach and tracking and home visits. Future research could compare program effectiveness based on differences in the component interventions and strategic combinations. Additional research also should examine ways to sustain these programs, especially when provided by existing community-based organizations."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Health Care System-Based Interventions Implemented in Combination. The Community Guide; 2014. \nAvailable here.","Adults (older: age not specified)\n","The CPSTF recommends health care system-based interventions implemented in combination on the basis of strong evidence of effectiveness in increasing vaccination rates in targeted client populations.\n\nBased on findings from 37 of the 64 included studies, the Task Force further recommends a combination that includes the following:\nAt least one intervention to increase client demand for vaccinations, such as:\n- Client reminder and recall systems\n- Clinic-based client education\n- Manual outreach and tracking\nAnd one or more interventions that address either, or both, of the following strategies:\n- Interventions to enhance access to vaccinations: Expanded access in health care settings, reduced client out-of-pocket costs, home visits\n- Interventions directed at vaccination providers or systems: Provider reminders, standing orders, provider assessment and feedback\n\nInterventions listed as examples for each strategy were those that showed the greatest effect on vaccination rates.\n\nThe Task Force finding is based on evidence from a Community Guide systematic review completed in 2010 (62 studies; search period 1980-2010) combined with more recent evidence (2 studies; search period 2010-February 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness. \n\nOf the combined 64 included studies (76 study arms), 58 of them (70 study arms) provided a common measure of change in vaccination rates and showed a median increase of 9 percentage points (IQI: 4 to 21 percentage points). In general, changes in vaccination rates were greater when interventions were implemented in settings with low baseline rates.\n\nThe included studies evaluated a variety of interventions in different combinations. The Task Force examined the evidence of differences attributable to specific interventions and combinations of interventions using different strategic approaches. These strategic approaches included the following:\n- Interventions to increase client demand (client reminder and recall systems, clinic-based client education, client\nor family incentives, client-held paper immunization records, case management, and manual outreach and\ntracking)\n- Interventions to enhance access to vaccination services (expanded access in health care settings, reduced client\nout-of-pocket costs, and home visits)\n- Interventions directed at vaccination providers (provider reminder systems, standing orders, provider\nassessment and feedback, provider education, and provider incentives)\n\nThe most common individual interventions implemented in a combined approach were client reminder and recall\nsystems (34 study arms) and provider reminders (31 study arms).\n\nThirty-seven studies (44 study arms) evaluated a combination of interventions across two or three of the strategic approaches and showed a median increase in vaccination rates of 17 percentage points (IQI: 6 to 27 percentage points). In 26 study arms, interventions were combined within only one strategic approach and found a median increase in vaccination rates of 4 percentage points (IQI: 2 to 9 percentage points).\n\nNine studies evaluated combinations of interventions implemented as a part of a health care system quality improvement effort. The most commonly implemented interventions were those directed at vaccination providers (provider education, provider reminders, and provider assessment and feedback). The studies included in this evaluation were typically short in duration and reported mixed results.\n\nEvidence did not show a direct relationship between the number of interventions implemented and changes in vaccination rates. Included studies evaluated combinations of between two and nine interventions. The majority of studies implemented two (31 study arms) or three (18 study arms) interventions.","This CPSTF report concludes that overall, included studies provided evidence of effectiveness for intervention combinations implemented in a range of clinical settings and communities, although evidence from rural settings was limited. Studies also demonstrated effectiveness across a range of client populations and vaccinations, including young children (childhood series, influenza) and older adults (influenza, pneumococcal, and tetanus vaccines). Two of the included studies evaluated interventions targeted at increasing vaccination rates among adolescents. Finally, the included studies demonstrated increases in vaccination rates for populations of low socioeconomic status (22 study arms) and across a range of racial and ethnic groups. Most of the included evidence evaluated client populations with low to moderate baseline vaccination rates,\nand findings are most applicable to these situations.\n\nMore evidence is needed on the effectiveness of these interventions in rural settings and when applied to increase vaccinations recommended for adolescents. Future research on quality improvement activities in these settings should incorporate study periods sufficient to evaluate continuous quality improvement efforts."]

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[null,"OEDOLION"]
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[null,"ADRAN CANLLAWIAU - OEDOLION"]
[null,"Ffynhonnell:","Cynulleidfa:","Argymhellion:"]
[null,"National Institute for Health and Care Excellence. Flu vaccination: increasing uptake. NG103. London: NICE; 2018.\nAvailable here.","This guideline is for: \n- Commissioners and providers of primary and secondary healthcare services, including maternity providers and community pharmacies\n- All employers of staff who provide NHS or social-care funded services (including maternity care, domiciliary care and care homes)\n- Local authorities, and community and voluntary sector organisations that employ health and social care workers\n- Occupational health services and infection prevention and control teams\n- NHS England teams and Health Education England teams\n- People using services, their families, carers and other members of the public, in particular those eligible for flu vaccination","This guideline covers how to increase uptake of the free flu vaccination among people who are eligible. It describes ways to increase awareness and how to use all opportunities in primary and secondary care to identify people who should be encouraged to have the vaccination.\n\nIt includes recommendations on:\n- Using a multicomponent approach\n- Raising awareness\n- Offering vaccination\n- Increasing uptake among eligible groups in primary and secondary care\n- Audit, monitoring and feedback\n- Vaccination in carers\n- Increasing uptake in health and social care staff"]
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[null,"National Institute for Health and Care Excellence. Hepatitis B and C testing: people at risk of infection. PH43. London: NICE; 2012.\nAvailable here.\nLast updated in March 2013.","This public health guidance is relevant to:\n- Commissioners and providers\n- People at increased risk of viral hepatitis\n- Members of the public","This guideline covers raising awareness of and testing for hepatitis B and C infection. It aims to ensure that people at increased risk of hepatitis B and C infection are tested.\n\nIt  includes recommendations on:\n- Raising awareness about hepatitis B and C among the general population and people at increased risk of infection\n- Education and training for professionals who provide services for people at increased risk of infection\n- Testing for hepatitis B and C in primary care, prisons and immigration removal centres, drugs services, and sexual health and genitourinary medicine clinics\n- Tracing close contacts of people with hepatitis B infection\n- Neonatal hepatitis B vaccination\n- Commissioning integrated services for testing and treatment and laboratory services for testing"]
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[null,"ADRAN ADOLYGIAD SYSTEMATIG - OEDOLION"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau'r awduron:"]
[null,"Jia  L et al. Payment methods for healthcare providers working in outpatient healthcare settings. Cochrane Database of Systematic Reviews 2021, Issue 1. Art. No.: CD011865. DOI: 10.1002/14651858.CD011865.pub2. \nAvailable here.","Adults (65 years+)","This Cochrane review aimed to assess the impact of different payment methods for healthcare providers working in outpatient healthcare settings on the quantity and quality of health service provision, patient outcomes, healthcare provider outcomes, cost of service provision, and adverse effects.\n\nThe reviewers' included 27 studies in the review: 12 randomised trials, 13 controlled before‐and‐after studies, one interrupted time series, and one repeated measure study. Only one randomised controlled trial (Kouides et al. 1998) based in USA fulfilled the inclusion criteria of this evidence map. \nPrimary care physicians in the intervention group received a fee for each immunisation of USD 8 and an additional 10% (USD 0.8) or 20% (USD 1.6) reimbursement per shot according to whether they immunised 70% or 85% (respectively) of the eligible population. The primary care physicians in the control group received only the fee for each immunisation of USD 8. The mean immunisation rate with payment for performance plus existing payment methods was 0.34 per cent points higher (0.2 per cent points lower to 0.87 points higher) compared to existing payment methods [MD 0.34 (−0.20 to 0.87)].\n\n\n\n\n\n","Based on the evidence from one study, the authors were uncertain of the effect of payment for performance added to existing payment methods on immunisation rates for the elderly.\n\nThere is a need for further well‐conducted research on payment methods for healthcare providers working in outpatient healthcare settings in low‐ and middle‐income countries; more studies comparing the impacts of different designs of the same payment method; and studies that consider the unintended consequences of payment interventions."]
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[null,"Abdullahi  LH et al. Improving vaccination uptake among adolescents. Cochrane Database of Systematic Reviews 2020, Issue 1. Art. No.: CD011895. DOI: 10.1002/14651858.CD011895.pub2.\nAvailable here.","Adults (under 19s)","This Cochrane review aimed to evaluate the effects of interventions to improve vaccine uptake among adolescents.\n\nThe reviewers' included 16 studies (eight individually randomised trials, four cluster randomised trials, three non‐randomised trials, and one controlled before‐after study). Twelve studies were conducted in the USA, while there was one study each from: Australia, Sweden, Tanzania, and the UK. Ten studies had unclear or high risk of bias. They categorised interventions as recipient‐oriented, provider‐oriented, or health systems‐oriented.\n\nThe interventions targeted adolescent boys or girls or both (seven studies), parents (four studies), and providers (two studies). Five studies had mixed participants that included adolescents and parents, adolescents and healthcare providers, and parents and healthcare providers. The outcomes included uptake of human papillomavirus (HPV) (11 studies); hepatitis B (three studies); and tetanus–diphtheria–acellular–pertussis (Tdap), meningococcal, HPV, and influenza (three studies) vaccines among adolescents.\n\nHealth education improves HPV vaccine uptake compared to usual practice (RR 1.43, 95% CI 1.16 to 1.76; I² = 0%; 3 studies, 1054 participants; high‐certainty evidence). In addition, one large study provided evidence that a complex multi‐component health education intervention probably results in little to no difference in hepatitis B vaccine uptake compared to simplified information leaflets on the vaccine (RR 0.98, 95% CI 0.97 to 0.99; 17,411 participants; moderate‐certainty evidence).\n\nFinancial incentives may improve HPV vaccine uptake compared to usual practice (RR 1.45, 95% CI 1.05 to 1.99; 1 study, 500 participants; low‐certainty evidence). However, we are uncertain whether combining health education and financial incentives has an effect on hepatitis B vaccine uptake, compared to usual practice (RR 1.38, 95% CI 0.96 to 2.00; 1 study, 104 participants; very low certainty evidence).\n\nMandatory vaccination probably leads to a large increase in hepatitis B vaccine uptake compared to usual practice (RR 3.92, 95% CI 3.65 to 4.20; 1 study, 6462 participants; moderate‐certainty evidence).\n\nProvider prompts probably make little or no difference compared to usual practice, on completion of Tdap (OR 1.28, 95% CI 0.59 to 2.80; 2 studies, 3296 participants), meningococcal (OR 1.09, 95% CI 0.67 to 1.79; 2 studies, 3219 participants), HPV (OR 0.99, 95% CI 0.55 to 1.81; 2 studies, 859 participants), and influenza (OR 0.91, 95% CI 0.61 to 1.34; 2 studies, 1439 participants) vaccination schedules (moderate‐certainty evidence).\n\nProvider education with performance feedback may increase the proportion of adolescents who are offered and accept HPV vaccination by clinicians, compared to usual practice. Compared to adolescents visiting non‐participating clinicians (in the usual practice group), the adolescents visiting clinicians in the intervention group were more likely to receive the first dose of HPV during preventive visits (5.7 percentage points increase) and during acute visits (0.7 percentage points for the first and 5.6 percentage points for the second doses of HPV) (227 clinicians and more than 200,000 children; low‐certainty evidence).\n\nA class‐based school vaccination strategy probably leads to slightly higher HPV vaccine uptake than an age‐based school vaccination strategy (RR 1.09, 95% CI 1.06 to 1.13; 1 study, 5537 participants; moderate‐certainty evidence).\n\nA multi‐component provider intervention (including an education session, repeated contacts, individualised feedback, and incentives) probably improves uptake of HPV vaccine compared to usual practice (moderate‐certainty evidence).\n\nA multi‐component intervention targeting providers and parents involving social marketing and health education may improve HPV vaccine uptake compared to usual practice (RR 1.41, 95% CI 1.25 to 1.59; 1 study, 25,869 participants; low‐certainty evidence).","The authors conclude that various strategies have been evaluated to improve adolescent vaccination including health education, financial incentives, mandatory vaccination, and class‐based school vaccine delivery. However, most of the evidence is of low to moderate certainty. This implies that while this research provides some indication of the likely effect of these interventions, the likelihood that the effects will be substantially different is high. \n\nTherefore, additional research is needed to further enhance adolescent immunisation strategies, especially in low‐ and middle‐income countries where there are limited adolescent vaccination programmes. In addition, it is critical to understand the factors that influence hesitancy, acceptance, and demand for adolescent vaccination in different settings. This is the topic of an ongoing Cochrane qualitative evidence synthesis, which may help to explain why and how some interventions were more effective than others in increasing adolescent HPV vaccination coverage."]
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[null,"Thomas  RE and Lorenzetti  DL. Interventions to increase influenza vaccination rates of those 60 years and older in the community. Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD005188. DOI: 10.1002/14651858.CD005188.pub4. \nAvailable here.","Adults (60 years+)","This Cochrane review aimed to assess access, provider, system, and societal interventions to increase the uptake of influenza vaccination in people aged 60 years and older in the community.\n\nThe reviewers' included 3 new RCTs for this update (total 61 RCTs; 1,055,337 participants). Trials involved people aged 60 years and older living in the community in high‐income countries. Heterogeneity limited some meta‐analyses. They assessed studies as at low risk of bias for randomisation (38%), allocation concealment (11%), blinding (44%), and selective reporting (100%). Half (51%) had missing data. We assessed the evidence as low‐quality. They identified three levels of intervention intensity: low (e.g. postcards), medium (e.g. personalised phone calls), and high (e.g. home visits, facilitators).\n\nIncreasing community demand (12 strategies, 41 trials, 53 study arms, 767,460 participants): One successful intervention that could be meta‐analysed was client reminders or recalls by letter plus leaflet or postcard compared to reminder (OR 1.11, 95% CI 1.07 to 1.15; 3 studies; 64,200 participants). Successful interventions tested by single studies were patient outreach by retired teachers (OR 3.33, 95% CI 1.79 to 6.22); invitations by clinic receptionists (OR 2.72, 95% CI 1.55 to 4.76); nurses or pharmacists educating and nurses vaccinating patients (OR 152.95, 95% CI 9.39 to 2490.67); medical students counselling patients (OR 1.62, 95% CI 1.11 to 2.35); and multiple recall questionnaires (OR 1.13, 95% CI 1.03 to 1.24).\n\nSome interventions could not be meta‐analysed due to significant heterogeneity: 17 studies tested simple reminders (the 95% CI was entirely above unity in 11 trials implying all 11 interventions increased vaccination rates); 16 tested personalised reminders (the 95% CI was entirely above unity in 12 trials implying all 12 interventions increased vaccination rates ); 2 investigated customised compared to form letters (the 95% CI was above unity in both trials implying both interventions increased vaccination rates); and 4 studies examined the impact of health risk appraisals (the 95% CI was above unity in all 4 trials implying all 4 interventions increased vaccination rates). One study of a lottery for free groceries was not effective.\n\nEnhancing vaccination access (6 strategies, 8 trials, 10 arms, 9353 participants): The reviewers meta‐analysed results from 2 studies of home visits (OR 1.30, 95% CI 1.05 to 1.61), and 2 studies that tested free vaccine compared to patient payment for vaccine (OR 2.36, 95% CI 1.98 to 2.82). They were unable to conduct meta‐analyses of 2 studies of home visits by nurses plus a physician care plan (the 95% CI was entirely above unity in both trials implying both interventions increased vaccination rates) and 2 studies of free vaccine compared to no intervention (the 95% CI was entirely above unity in both trials implying both interventions increased vaccination rates). One study of group visits (OR 27.2, 95% CI 1.60 to 463.3) was effective, and 1 study of home visits compared to safety interventions was not.\n\nProvider‐ or system‐based interventions (11 strategies, 15 trials, 17 arms, 278,524 participants): One successful intervention that could be meta‐analysed focused on payments to physicians (OR 2.22, 95% CI 1.77 to 2.77). Successful interventions tested by individual studies were: reminding physicians to vaccinate all patients (OR 2.47, 95% CI 1.53 to 3.99); posters in clinics presenting vaccination rates and encouraging competition between doctors (OR 2.03, 95% CI 1.86 to 2.22); and chart reviews and benchmarking to the rates achieved by the top 10% of physicians (OR 3.43, 95% CI 2.37 to 4.97).\n\nThe reviewers were unable to meta‐analyse 4 studies that looked at physician reminders (the 95% CI was entirely above unity in 3 trials implying all 3 interventions increased vaccination rates) and 3 studies of facilitator encouragement of vaccination (the 95% CI was entirely above unity in 2 trials implying both interventions increased vaccination rates). Interventions that were not effective were: comparing letters on discharge from hospital to letters to general practitioners; posters plus postcards versus posters alone; educational reminders, academic detailing, and peer comparisons compared to mailed educational materials; educational outreach plus feedback to teams versus written feedback; and an intervention to increase staff vaccination rates.\n\nInterventions at the societal level: No studies reported on societal‐level interventions.","The reviewers identified interventions that demonstrated significant positive effects of low (postcards), medium (personalised phone calls), and high (home visits, facilitators) intensity that increase community demand for vaccination, enhance access, and improve provider/system response. The overall GRADE assessment of the evidence was moderate quality. Conclusions are unchanged from the 2014 review."]
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[null,"Jacobson Vann  JC et al. Patient reminder and recall interventions to improve immunization rates. Cochrane Database of Systematic Reviews 2018, Issue 1. Art. No.: CD003941. DOI: 10.1002/14651858.CD003941.pub3. \nAvailable here.","Adults","This Cochrane review aimed to evaluate and compare the effectiveness of various types of patient reminder and recall interventions to improve receipt of immunizations.\n\nThe 75 included studies involved child, adolescent, and adult participants in outpatient, community‐based, primary care, and other settings in 10 countries.\n\nPatient reminder or recall interventions, including telephone and autodialer calls, letters, postcards, text messages, combination of mail or telephone, or a combination of patient reminder or recall with outreach, probably improve the proportion of participants who receive immunization (RR of 1.28, 95% CI 1.23 to 1.35; risk difference of 8%) based on moderate certainty evidence from 55 studies with 138,625 participants.\n\nThree types of single‐method reminders improve receipt of immunizations based on high certainty evidence: the use of postcards (RR 1.18, 95% CI 1.08 to 1.30; eight studies; 27,734 participants), text messages (RR 1.29, 95% CI 1.15 to 1.44; six studies; 7772 participants), and autodialer (RR 1.17, 95% CI 1.03 to 1.32; five studies; 11,947 participants). Two types of single‐method reminders probably improve receipt of immunizations based on moderate certainty evidence: the use of telephone calls (RR 1.75, 95% CI 1.20 to 2.54; seven studies; 9120 participants) and letters to patients (RR 1.29, 95% CI 1.21 to 1.38; 27 studies; 81,100 participants).\n\nBased on high certainty evidence, reminders improve receipt of immunizations for childhood (RR 1.22, 95% CI 1.15 to 1.29; risk difference of 8%; 23 studies; 31,099 participants) and adolescent vaccinations (RR 1.29, 95% CI 1.17 to 1.42; risk difference of 7%; 10 studies; 30,868 participants). Reminders probably improve receipt of vaccinations for childhood influenza (RR 1.51, 95% CI 1.14 to 1.99; risk difference of 22%; five studies; 9265 participants) and adult influenza (RR 1.29, 95% CI 1.17 to 1.43; risk difference of 9%; 15 studies; 59,328 participants) based on moderate certainty evidence. They may improve receipt of vaccinations for adult pneumococcus, tetanus, hepatitis B, and other non‐influenza vaccinations based on low certainty evidence although the confidence interval includes no effect of these interventions (RR 2.08, 95% CI 0.91 to 4.78; four studies; 8065 participants).","The reviewers conclude that patient reminder and recall systems, in primary care settings, are likely to be effective at improving the proportion of the target population who receive immunizations."]
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[null,"Arditi  C et al. Computer‐generated reminders delivered on paper to healthcare professionals: effects on professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD001175. DOI: 10.1002/14651858.CD001175.pub4.\nAvailable here.","Adults","This Cochrane review aimed to evaluate the effects of reminders automatically generated through a computerized system (computer‐generated) and delivered on paper to healthcare professionals on quality of care (outcomes related to healthcare professionals' practice) and patient outcomes (outcomes related to patients' health condition).\n\nReview authors identified 35 studies (30 RCTs trials and five non‐RCTs) and analyzed 34 studies (40 comparisons). Twenty‐nine studies took place in the USA and six studies took place in Canada, France, Israel, and Kenya. All studies except two took place in outpatient care. Reminders were aimed at enhancing compliance with preventive guidelines (e.g. cancer screening tests, vaccination) in half the studies and at enhancing compliance with disease management guidelines for acute or chronic conditions (e.g. annual follow‐ups, laboratory tests, medication adjustment, counseling) in the other half.\n\nComputer‐generated reminders delivered on paper to healthcare professionals, alone or in addition to co‐intervention(s), probably improves quality of care slightly compared with usual care or the co‐intervention(s) without the reminder component (median improvement 6.8% : 3.8% to 17.5%]; 34 studies (40 comparisons); moderate‐certainty evidence).\n\nComputer‐generated reminders delivered on paper to healthcare professionals alone (single‐component intervention) probably improves quality of care compared with usual care (median improvement 11.0% (IQR 5.4% to 20.0%); 27 studies (27 comparisons); moderate‐certainty evidence). Adding computer‐generated reminders delivered on paper to healthcare professionals to one or more co‐interventions (multi‐component intervention) probably improves quality of care slightly compared with the co‐intervention(s) without the reminder component (median improvement 4.0% (IQR 3.0% to 6.0%); 11 studies (13 comparisons); moderate‐certainty evidence). \n\nSub-group analyses revealed largest improvement seen in vaccination, with a median improvement of 13.1% [Interquartile range (IQR) 12.2% to 20.7%].\n\nThe authors are uncertain whether reminders, alone or in addition to co‐intervention(s), improve patient outcomes as the certainty of the evidence is very low (n = 6 studies (seven comparisons)). None of the included studies reported outcomes related to harms or adverse effects of the intervention.","The review concludes that there is moderate‐certainty evidence that computer‐generated reminders delivered on paper to healthcare professionals probably slightly improves quality of care, in terms of compliance with preventive guidelines and compliance with disease management guidelines. It is uncertain whether reminders improve patient outcomes because the certainty of the evidence is very low. The heterogeneity of the reminder interventions included in this review also suggests that reminders can probably improve quality of care in various settings under various conditions."]
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[null,"Posadzki  P et al. Automated telephone communication systems for preventive healthcare and management of long‐term conditions. Cochrane Database of Systematic Reviews 2016, Issue 12. Art. No.: CD009921. DOI: 10.1002/14651858.CD009921.pub2.\nAvailable here.","Adults\n\nHigh risk groups (long-term health conditions)","This Cochrane review aimed to assess the effects of automated telephone communication system (ATCS) for preventing disease and managing long‐term conditions on behavioural change, clinical, process, cognitive, patient‐centred and adverse outcomes.\n\nThe review authors found 132 trials with over 4 million participants across preventive healthcare areas and for the management of long‐term conditions.\n\nStudies compared ATCS types in many ways. Some studies reported findings across diseases. For prevention, ATCS probably increase immunisation uptake in children, and slightly in adolescents, but in adults effects are uncertain. \n\nTen studies, all in the USA, evaluated ATCS for promoting immunisation uptake. For preventive healthcare, ATCS (ATCS Plus, IVR, unidirectional) probably increase immunisation uptake in children (risk ratio (RR) 1.25, 95% confidence interval (CI) 1.18 to 1.32; 5 studies, N = 10,454; moderate certainty) and to a lesser extent in adolescents (RR 1.06, 95% CI 1.02 to 1.11; 2 studies, N = 5725; moderate certainty). Based on evidence from 2 studies the effects of ATCS in adults are unclear (RR 2.18, 95% CI 0.53 to 9.02; 2 studies, N = 1743; very low certainty).","The review authors concluded that ATCS interventions can change patients' health behaviours, improve clinical outcomes and increase healthcare uptake with positive effects in several important areas including immunisation, screening, appointment attendance, and adherence to medications or tests. The decision to integrate ATCS interventions in routine healthcare delivery should reflect variations in the certainty of the evidence available and the size of effects across different conditions, together with the varied nature of ATCS interventions assessed. Future research should investigate both the content of ATCS interventions and the mode of delivery; users' experiences, particularly with regard to acceptability; and clarify which ATCS types are most effective and cost‐effective."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Vaccination Programs: Home Visits to Increase Vaccination Rates. The Community Guide; 2016. \nAvailable here.","Adults","This report examines home visits to increase vaccination rates in children and adults, leading to a Community Preventive Services Task Force (CPSTF) recommendation on the subject. 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). \n\nThe Task Force considered evidence from 23 studies of home visits, with 20 studies and 21 study arms using a common measure of change in vaccination rates. The overall effect was a median increase of 11 percentage points (IQR: 5 to 15 percentage points). Meaningful improvements were observed as a result of home visits delivered to all clients (12 study arms) and to only those clients unresponsive to other interventions (9 study arms), home visits focused on vaccination alone (12 study arms) and in combination with other health concerns (9 study arms), and home visits providing on-site vaccinations (8 study arms) and referring clients to vaccination services outside the home (13 study arms). Home visits delivered as the sole intervention (8 study arms) and home visits delivered as part of a larger healthcare system or community-based program (13 study arms) also produced meaningful change in vaccination rates.","The CPSTF recommends home visits based on strong evidence of their effectiveness in increasing vaccination rates. Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness. The Task Force notes that home visiting interventions are potentially effective in addressing a wide range of public health problems and that the focus of this review is the subset of interventions specifically addressing vaccination rates.\n\nThe report identified that more research is needed on the effectiveness and economic benefits of home visits to increase vaccination rates among adolescents and in rural settings. Additional economic research is needed to estimate the portion of home visits that can be attributed solely to improving vaccination rates when home visits include other activities and objectives."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Clinic-based Client Education\nWhen Used Alone. The Community Guide; 2016. \nAvailable here.","Adults (older: age not specified)","This report aimed to determine the effectiveness of clinic-based client education interventions when implemented alone in increasing vaccination rates or reducing rates of vaccine preventable illness and found insufficient evidence. Four of the included studies provided sufficient evidence of effectiveness but were limited to immunizations for pneumococcal polysaccharide vaccine among older adults with very low baseline coverage. The Task Force finding reflects concerns about the intervention's applicability to a broader range vaccinations, populations, and clinic-based settings.\n\nThis Task Force finding is based on evidence from a Community Guide systematic review completed in 2011 (4 studies with 6 study arms, search period 1980-2009) combined with more recent evidence (1 study, search period 2009-2012). Based on the combined evidence, the Task Force reaffirms its finding of insufficient evidence. The combined Task Force review included five studies. Four studies with six study arms providing a common measurement of change in vaccination rates. Although the median change in vaccination rates was an increase of 10 percentage points (IQR: 3 to 19 percentage points), results were dominated by findings from three related study arms focused on increasing pneumococcal polysaccharide vaccinations among older adult patients in one clinical setting. Changes in vaccination rates from the other three study arms were inconsistent and smaller in magnitude. The final study did not evaluate changes in vaccination rates, and found only a very small change in the proportion of tetanus booster doses administered with the use of an audiovisual message in clinic waiting areas.\n\nTwo studies included in this review implemented a potentially useful educational approach to increase vaccination rates by prompting discussions between the client and their vaccination provider. In these studies, an educational brochure distributed to patients in the waiting area included a specific request for a discussion with their provider about the pneumococcal polysaccharide vaccine. In both studies, use of the brochure increased vaccination rates by 16 percentage points in a client population with very low baseline rates. \n\nClinic-based client education can be one component of an effective combined approach to increase vaccination rates. The Task Force finds strong evidence to recommend health care system-based interventions implemented in combination and community-based interventions implemented in combination.","This CPSTF report states that although the evidence identified in this systematic review is small and inconsistent, at least one format demonstrates sufficient evidence of effectiveness. The Task Force considers the applicability of this educational approach to other vaccines and populations an important question for further study.\n"]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Community-Wide Education When Used Alone. The Community Guide; 2015. \nAvailable here.","Adults (older: age not specified)","This report aimed to determine the effectiveness of community-wide education interventions when implemented alone in increasing vaccination rates or reducing rates of vaccine preventable illness and found insufficient evidence. Evidence is considered insufficient due to inconsistent results and concerns about the applicability of evidence to more diverse communities in the United States where improvements in vaccination rates are needed.\n\nThis Task Force finding is based on evidence from a Community Guide systematic review completed in 2010 (6 studies with 8 study arms, search period 1980-2009) combined with more recent evidence (1 study, search period 2009- February 2012). Based on the combined evidence, the Task Force reaffirms its finding of insufficient evidence.\n\nThe Task Force considered evidence from 7 studies with 9 study arms. Among the studies providing a common measure of change in vaccination rates (4 studies with 6 arms) there was a median increase of 6 percentage points (range of values: 0.4 to 12.2 percentage points).\n\nThree studies evaluated mass media activities using different measures of change. In a targeted community in Australia, pneumococcal vaccines dispatched to service providers increased during the period of a mass media campaign. In Finland, a mass media campaign briefly increased MMR vaccine receipt for children 6 years of age, though changes were not reported for younger children. In the U.S., a mass media campaign addressing flu-related topics among a nationally representative population of older adults found a positive association between flu-related media reports and influenza vaccination rates in the weeks following the campaign (annual vaccination rates increased by 2.3-7.9 percentage points, p<0.001).\n\nOne U.S. study observed moderate increases in vaccination rates for hepatitis B vaccine following intensive communitywide educational efforts in two Vietnamese-American communities. Characteristics of the study communities that may have contributed to intervention effectiveness included: (1) popular Vietnamese-language media, (2) established Vietnamese service organizations, and (3) culturally appropriate strategies and materials.\n\nCommunity-wide education is commonly implemented in combination with additional interventions (such as efforts to expand and enhance access to vaccinations). In another review, the Task Force found strong evidence of effectiveness for community-based interventions implemented in combination to increase vaccination rates, and five of the included studies used community-wide education in the combination of interventions.","This CPSTF report states that although the evidence identified in this systematic review is insufficient to determine the effectiveness of community-wide education when implemented alone, two studies suggest that these interventions may be useful with certain communities. More research is needed to understand the potential applicability of these interventions to other populations, and for other vaccines.\n\nThe Task Force acknowledges an important role for mass media (and the potential role of social media) in disseminating\ninformation to large audiences and shaping public attitudes and behaviours.\n\nVaccine manufacturers have been increasing direct-to-consumer mass and small media advertising to promote new vaccines. While evidence from private sector marketing campaigns on vaccine uptake was not included in this review, the Task Force considered the applicability of these marketing experiences to public health efforts. They determined that community-wide educational efforts may have greater impact when used to inform members of the community about new vaccines (such as HPV), or new recommendations (such as the universal recommendation for seasonal influenza), and in situations of public health urgency (such as the H1N1 pandemic). The effectiveness of community-wide education to increase vaccination rates in these circumstances remains an important issue for further evaluation research.\n"]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Provider Reminders. The Community Guide; 2015. \nAvailable here.","Adults","The CPSTF recommends provider reminders on the basis of strong evidence of effectiveness in increasing vaccination rates: (1) among adults, adolescents and children; (2) when used alone or with additional interventions; (3) across a range of intervention characteristics (e.g., computerized or simple reminders, checklists, flowcharts); and (4) in a range of settings and populations.\n\nThe Task Force finding is based on evidence from a Community Guide systematic review completed in 2008 (23 studies, search period 1997–2007) combined with more recent evidence (5 studies, search period 2007–February 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\nThe Task Force considered evidence from 28 studies. Twenty-two studies provided a measurement of change in vaccination rates, with an overall median increase of 10 percentage points (IQI: 6 to 25 percentage points). Of these, seven studies examined provider reminders alone with a median increase of 12 percentage points (IQI: 6 percentage point to 25 percentage points). Fifteen studies examined the impact of provider reminders with additional interventions and observed a median increase of 9 percentage points (IQI: 5 to 25 percentage points). Six additional studies did not provide a common measurement of change in vaccination rates; however, five of the studies provided additional support for the use of provider reminders.\n\nEvidence indicates that provider reminders remain an effective option for consideration in a wide range of clinical settings and populations. A subset of the included evidence, however, suggests that standing orders may be more effective in improving vaccination rates in both inpatient and outpatient settings than provider reminder systems.","Evidence in this CPSTF report indicates that provider reminders are effective in a wide range of contexts. Additional research should focus on system-level implementation of reminder systems, and identify strategies to encourage regular and sustained use. In addition, future research could examine or compare the effectiveness of specific reminder prompts provided as a capability of regional or state-level immunization information systems."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Client or Family Incentive Rewards. The Community Guide; 2015. \nAvailable here.","Adults","The CPSTF recommends client or family incentive rewards, used alone or in combination with additional interventions, based on sufficient evidence of effectiveness in increasing vaccination rates in children and adults.\n\nThis Task Force finding is based on evidence from a Community Guide systematic review completed in 2011 (6 studies with 7 study arms, search period 1980-2009) combined with more recent evidence (1 study, search period 2009-2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on sufficient evidence of effectiveness.\n\nIncluded studies showed vaccination rates increased by a median of 8 percentage points (interquartile interval [IQI]: 4 to 16 percentage points). Two study arms that assessed the effectiveness of incentive rewards alone showed similar changes in vaccination rates (8.5 and 9.0 percentage points). In the six remaining study arms, incentive rewards were combined with additional interventions.\n\nAmong the studies included in this review, the type of incentive reward offered to clients included 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. \n\nOverall, the Task Force considers the evidence to be applicable to vaccinations for children and adults in a wide range of clinical and community settings, and for various types of incentive rewards.","This CPSTF report concludes that client or family incentive rewards can also be one component of an effective combined approach to increase vaccination rates in both clinical and community settings. Based on updated, concurrent reviews the Task Force finds strong evidence to recommend health care system-based interventions implemented in combination and community-based\ninterventions implemented in combination.\n\nAdditional research could focus on the independent effects of incentive rewards, examine the relationship between the value of the reward and effectiveness, and explore the duration of intervention impact. It also would be useful to have more information about the effectiveness of these interventions with adolescents and adults as most of the included studies examined the use of incentive rewards on vaccination rates for children."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Provider Assessment and Feedback. The Community Guide; 2015. \nAvailable here.","Adults","The CPSTF recommends assessment and feedback for vaccination providers on the basis of strong evidence of effectiveness in increasing vaccination rates: (1) among adults and children; (2) when used alone or with additional interventions; and (3) across a range of settings and populations. While there was not enough evidence to determine which characteristics of assessment and feedback contributed most to its effectiveness, various strategies have been consistently effective in a wide range of contexts.\n\nThe Task Force finding is based on evidence from a Community Guide systematic review completed in 2008 (19 studies, search period 1997–2007) combined with more recent evidence (1 study, search period 2007–February 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\n\nThe Task Force considered evidence from 20 studies. Of these, 16 studies with 20 study arms provided common measurements of change in vaccination rates. The median increase of 9 percentage points (IQI: 3 to 14 percentage points). Fifteen study arms provided sufficient information to calculate the change in vaccination rates and showed a median increase of 18.0% (IQI: 9.5% to 24.0%). Seven study arms evaluated the impact of assessment and feedback for providers when implemented alone and found a median increase of 11 percentage points (IQI: 7 to 12 percentage points). Thirteen study arms evaluated provider assessment and feedback with additional interventions and observed a median increase of 6 percentage points (IQI: 3 to 18 percentage points). One additional study did not provide a common measurement of change in vaccination rates, and reported no change after implementation of intervention.\n\nThe reviewed studies evaluated the impact of assessment and feedback for vaccination providers in a wide range of target populations and settings, and for most vaccines appropriate for adults or children. While no studies specifically evaluated the impact of assessment and feedback for vaccination of adolescents, evidence from this review is likely applicable to this population.","This CPSTF report concludes that none of the studies identified in this review evaluated the impact of provider assessment and feedback interventions on the delivery of vaccines to adolescents. Future studies should examine the effectiveness of these interventions in increasing vaccination rates among adolescents."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Client Reminder and Recall Systems. The Community Guide; 2015. \nAvailable here.","Adults","The CPSTF recommends client reminder and recall interventions based on strong evidence of effectiveness in improving vaccination rates: (1) in children, adolescents 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.\n\nThis Task Force finding is based on evidence from a Community Guide systematic review completed in 2008 (19 studies, search period 1997-2007) combined with more recent evidence (10 studies, search period 2007-2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\n\nIncluded studies showed vaccination rates increased by a median of 11 percentage points (IQI: 4 to 17 percentage points). Client reminder and recall interventions used alone resulted in a median increase of 6 percentage points (IQI: 3 to 13 percentage points; 14 studies), and interventions implemented with additional components led to a median increase of 12 percentage points (IQI: 10 to 30 percentage points; 15 studies).\n\nThe included studies evaluated the effectiveness of client reminder and recall interventions for a wide range of client and provider populations, settings, vaccinations and delivery methods. Based on the evidence, the Task Force finding should be broadly applicable to all patient populations, in both clinical and community settings, and for the range of vaccines and delivery methods.\n","This CPSTF report concludes that client reminder and recall systems can also be important, effective components of combined approaches to increase vaccination rates. Based on updated, concurrent reviews, the Task Force finds strong evidence to recommend health care system-based interventions implemented in combination and community-based interventions implemented in combination. Immunization information systems, which can also generate client reminder or recall notices provide an additional implementation option.\n\nMore research is needed on effective implementation, sustainability, and expansion of reminder and recall interventions. Future research should also examine the effectiveness of reminder and recall notices using emerging communication technologies (i.e. text message, email). Additional studies should also examine the effectiveness of client reminder and recall interventions on adolescent vaccines such as the human papilloma virus (HPV).\n"]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Standing Orders. The Community Guide; 2015. \nAvailable here.","Adults","The Task Force finding is based on evidence from a Community Guide systematic review completed in 2009 (29 studies, search period 1997–2009) combined with more recent evidence (6 studies, search period 2009–February 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\n\nThe Task Force considered evidence from 35 studies. Of these, 27 studies provided a common measurement of change in vaccination rates with a median increase of 24 percentage points (IQI: 12 to 35 percentage points). Nine studies that examined the impact of standing orders alone documented a median increase of 16 percentage points (IQI: 9 to 29 percentage points). Nineteen studies that evaluated standing orders when combined with additional interventions documented a median increase of 27 percentage points (IQI: 13 to 40 percentage points). Seven studies that did not provide a common measure of change for vaccination rates all reported favorable results after implementation of standing orders.\n\nThe reviewed studies evaluated the effectiveness of standing orders across a wide range of clinical vaccination settings, health care personnel, and client populations. Standing orders were found to be effective in various settings including clinics, hospitals, and long-term care facilities. Interventions were effective when used with different vaccination providers including nurses and pharmacists. While most studies looked at adult populations, four examined intervention effectiveness among children and found a median absolute percent increase of 28 percentage points (range: 8 to 49). While no studies specifically evaluated the impact of standing orders for vaccination of adolescents, evidence from this review is likely applicable to this population. In addition, a subset of the included evidence suggests that standing orders may be more effective in improving vaccination rates in both inpatient and outpatient settings when compared to a provider reminder system.\n\nOne paper from the updated search period described the following barriers encountered during implementation of a pneumococcal vaccination standing orders program in three hospitals: gaps in staff education and training; personnel concerns about additional workload; staff reluctance to administer vaccines without a physician's order; attending physicians' resistance to having hospitalized patients vaccinated; and logistical difficulties. Some attending physicians expressed concern that vaccination would interfere with scheduled treatments or procedures. Other attending physicians did not consider inpatient stays to be an appropriate time for vaccinations (Middleton et al. 2005).\n\nAn additional study reported barriers to implementation of influenza and pneumococcal vaccination standing orders in various health care settings. Findings suggested that the adoption of these policies may have been too difficult to administer, staff were unclear or unconvinced of program benefits, and there was perceived physician discomfort with delegating responsibility for immunizations to nursing staff. A few of the respondents also indicated that resources, effectiveness of the vaccine, and time required to administer the vaccine were barriers for adoption. The majority of these barriers were specific to the administration of the influenza vaccine (Goldstein et al. 2005).","This CPSTF report concludes that standing orders were shown to be effective in increasing vaccination rates for influenza and pneumococcal vaccines. Additional research is needed, however, to determine if these interventions are effective for different vaccines (e.g. hepatitis, tetanus and vaccines recommended for adolescents). More evidence is also needed on ways to address barriers to the implementation of standing orders in health systems.\n"]
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[null,"Stokes G, Richardson M, Brunton G, Khatwa M, Thomas J (2015) Review 3: Community engagement for health via coalitions, collaborations and partnerships (on-line social media and social networks) – a systematic review and metaanalysis. London: EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London.\nAvailable here.","Adults \n\nOccupational groups (university staff)","This systematic review sought to answer the following research question:\nWhat health issues and populations have been studied using online social media/social networking?\n\nThere is evidence of health issues focused on healthy eating/physical activity, cancer detection and screening, diabetes, general wellbeing and lifestyle, sexual health, flu immunisation, food safety. However there were a low number of studies for each health topic and population. There is evidence of studies focused on populations under 25 years of age or on those over 40 years of age, but gaps in evaluated interventions in those aged under 16, 30 to 40 and over 60. There is inconsistent evidence of studies targeting women only and no evidence of studies targeting men specifically. There is inconsistent evidence of social media/social networking interventions directed to minority ethnic groups.\n\nThe studies included in this review focused on a broad range of health topics, only one RCT focussed amongst Australian university students and staff focused on influenza immunisation (Lau et al. 2012). For their study into the impact of a web-based personally controlled health management system entitled Healthy.me on influenza vaccination and health service utilisation rates, Lau et al. (2012) incorporated social forums and messaging to allow consumers to interact with each other and with healthcare professionals. \n\nThe provider of the additional potentially active content was either automated or anonymous. The content was also provided by the health professional experts. The study described the use of a mandatory five-minute session on how to use a website. Primary analysis examined differences in the proportion of participants obtaining influenza vaccination during the study in the waitlist and PCHMS groups using the c2 test, including participants who had the opportunity to use the PCHMS but did not\ndo so. \n\nThe extent of community engagement was low (0.48 95% CI: 0.09 to 0.87). The review concluded that there is weak evidence that employing either peers or professionals to facilitate online discussions forums is seen more often to have effective outcomes. ","In summary, although the effect sizes are very small overall, QCA demonstrated that including a facilitator in the delivery of social media/social networking interventions demonstrated higher effect sizes for studies not focused on healthy eating and physical activity and which did not employ the use of theory in intervention development. Nonhealthy eating/physical activity topics focused on sexually transmitted infection prevention, cancer screening/prevention, influenza immunization and mental health promotion. The use of this combination of conditions is conceptually well supported, lending confidence to its findings. However, it must be considered that these findings are exploratory in nature and should be evaluated robustly in future intervention development and evaluation."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Reducing Client Out-of-Pocket Costs for Vaccinations. The Community Guide; 2014. \nAvailable here.","Adults ","The CPSTF recommends interventions that reduce client out-of-pocket costs based on strong evidence of effectiveness in improving vaccination rates. The effectiveness of these interventions has been demonstrated among children, adolescents, and adults, in a range of settings and populations, when applied in varying levels of scale from individual clinical settings to statewide programs to national efforts, and whether used alone or as part of a multi-component intervention.\n\nThis Task Force finding is based on evidence from a Community Guide systematic review completed in 2009 (15 studies; search period 1997 - 2009) combined with more recent evidence (5 studies, search period 2009 - 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\n\nEleven studies provided a common measurement of change in vaccination rates and showed a median increase of 22 percentage points (IQI: 6 to 33 percentage points). Six studies examined the impact of reducing client out-of-pocket costs alone (median increase of 28 percentage points; IQI: 2 to 47 percentage points) and 5 studies examined reducing client out-of-pocket costs as part of a multi-component strategy (median increase of 20 percentage points; IQI: 6 to 20 percentage points). The nine qualifying studies that did not provide a common measurement of change also reported overall increases in vaccinations received or administered.\n\nIncluded studies evaluated intervention effects on childhood vaccination series (3 studies), influenza (9 studies), pneumococcal (6 studies), hepatitis B (2 studies), and human papilloma virus (1 study). The reviewed studies evaluated the effectiveness of interventions that reduced client out-of-pocket costs in a range of client and provider populations and settings.\n\nPolicies adopted in the United States, including the Federal Vaccines for Children Program and the Affordable Care Act, have expanded access to many vaccines at reduced out-of-pocket cost. Barriers to expanded implementation of efforts include the adequacy and timeliness of reimbursement for the costs of vaccines, storage, and administration. In the United States, the ability of health care systems and providers to implement these interventions may depend on the adequacy and timeliness of reimbursement for the costs of the vaccines, storage, and administration.","This CPSTF report concludes that additional research is needed to determine the effectiveness of reducing client out-of-pocket cost interventions to increase rates of recommended vaccinations for adolescents (e.g., HPV, meningococcal, influenza). In addition, the Task Force suggests additional research to determine if these interventions are effective options to increase receipt of annual influenza vaccinations. Future research should also examine whether reducing client out-of-pocket cost interventions are essential components of school-based vaccination programs and on-site vaccination programs in general."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Community-Based Interventions Implemented in Combination. The Community Guide; 2014. \nAvailable here.","Adults","The CPSTF recommends community-based interventions implemented in combination to increase vaccinations in targeted populations, on the basis of strong evidence of effectiveness in increasing vaccination rates.\n\nThe conclusion of strong evidence was based on findings from 18 studies that evaluated coordinated interventions to:\n- Increase community demand\n- Enhance access to vaccination services, and\n- Reduce missed opportunities by vaccination providers\nIn 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.\n\nThe Task Force 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 resources are available.\n\nThis Task Force 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 - 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\n\nAll of the included studies provided a common measure of change and showed a median increase in vacation rates of 14 percentage points (IQI: 7 to 24 percentage points).\n\nThe included studies evaluated a variety of interventions in different combinations. The Task Force examined the evidence of differences attributable to specific interventions and combinations of interventions using different strategic approaches.\nFourteen studies implemented an effective combination of one or more interventions to increase community demand with one or more interventions to enhance access to vaccination services and showed a median increase in vaccination rates of 16 percentage points (IQI: 12 to 26 percentage points).\n\nClient reminder and recall systems were used in most of the evaluated programs (15 study arms). Systems were implemented by vaccination providers, established as one part of a community manual outreach and tracking program, or generated from a regional immunization information system (IIS).","This CPSTF report concludes that coordinated interventions may be especially important in communities that have wide disparities in vaccination coverage. Program planners should consider community characteristics, such as mobility and fragmentation of health care, in the selection and combination of interventions to increase vaccination rates and reduce disparities.\n\nPartnerships between community organizations and vaccination providers are likely to be an essential component of effective, sustained community-based efforts. Most studies involved partnerships with existing vaccination providers in\nthe community to increase access to vaccinations, rather than creating new vaccination services. Coalitions represent one way to establish effective partnerships, with the size of the coalition varying based on the community, targeted population, and scope of the problem. Four studies involved community coalitions that used the principles of community-based participatory research.\n\nMore evidence is needed on the effectiveness of these programs in adolescents, and when implemented in rural settings. More economic information on these interventions is needed, specifically, evaluations on the efficiencies of the resource-intensive components of manual outreach and tracking and home visits. Future research could compare program effectiveness based on differences in the component interventions and strategic combinations. Additional research also should examine ways to sustain these programs, especially when provided by existing community-based organizations."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Health Care System-Based Interventions Implemented in Combination. The Community Guide; 2014. \nAvailable here.","Adults (older: age not specified)\n","The CPSTF recommends health care system-based interventions implemented in combination on the basis of strong evidence of effectiveness in increasing vaccination rates in targeted client populations.\n\nBased on findings from 37 of the 64 included studies, the Task Force further recommends a combination that includes the following:\nAt least one intervention to increase client demand for vaccinations, such as:\n- Client reminder and recall systems\n- Clinic-based client education\n- Manual outreach and tracking\nAnd one or more interventions that address either, or both, of the following strategies:\n- Interventions to enhance access to vaccinations: Expanded access in health care settings, reduced client out-of-pocket costs, home visits\n- Interventions directed at vaccination providers or systems: Provider reminders, standing orders, provider assessment and feedback\n\nInterventions listed as examples for each strategy were those that showed the greatest effect on vaccination rates.\n\nThe Task Force finding is based on evidence from a Community Guide systematic review completed in 2010 (62 studies; search period 1980-2010) combined with more recent evidence (2 studies; search period 2010-February 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness. \n\nOf the combined 64 included studies (76 study arms), 58 of them (70 study arms) provided a common measure of change in vaccination rates and showed a median increase of 9 percentage points (IQI: 4 to 21 percentage points). In general, changes in vaccination rates were greater when interventions were implemented in settings with low baseline rates.\n\nThe included studies evaluated a variety of interventions in different combinations. The Task Force examined the evidence of differences attributable to specific interventions and combinations of interventions using different strategic approaches. These strategic approaches included the following:\n- Interventions to increase client demand (client reminder and recall systems, clinic-based client education, client\nor family incentives, client-held paper immunization records, case management, and manual outreach and\ntracking)\n- Interventions to enhance access to vaccination services (expanded access in health care settings, reduced client\nout-of-pocket costs, and home visits)\n- Interventions directed at vaccination providers (provider reminder systems, standing orders, provider\nassessment and feedback, provider education, and provider incentives)\n\nThe most common individual interventions implemented in a combined approach were client reminder and recall\nsystems (34 study arms) and provider reminders (31 study arms).\n\nThirty-seven studies (44 study arms) evaluated a combination of interventions across two or three of the strategic approaches and showed a median increase in vaccination rates of 17 percentage points (IQI: 6 to 27 percentage points). In 26 study arms, interventions were combined within only one strategic approach and found a median increase in vaccination rates of 4 percentage points (IQI: 2 to 9 percentage points).\n\nNine studies evaluated combinations of interventions implemented as a part of a health care system quality improvement effort. The most commonly implemented interventions were those directed at vaccination providers (provider education, provider reminders, and provider assessment and feedback). The studies included in this evaluation were typically short in duration and reported mixed results.\n\nEvidence did not show a direct relationship between the number of interventions implemented and changes in vaccination rates. Included studies evaluated combinations of between two and nine interventions. The majority of studies implemented two (31 study arms) or three (18 study arms) interventions.","This CPSTF report concludes that overall, included studies provided evidence of effectiveness for intervention combinations implemented in a range of clinical settings and communities, although evidence from rural settings was limited. Studies also demonstrated effectiveness across a range of client populations and vaccinations, including young children (childhood series, influenza) and older adults (influenza, pneumococcal, and tetanus vaccines). Two of the included studies evaluated interventions targeted at increasing vaccination rates among adolescents. Finally, the included studies demonstrated increases in vaccination rates for populations of low socioeconomic status (22 study arms) and across a range of racial and ethnic groups. Most of the included evidence evaluated client populations with low to moderate baseline vaccination rates,\nand findings are most applicable to these situations.\n\nMore evidence is needed on the effectiveness of these interventions in rural settings and when applied to increase vaccinations recommended for adolescents. Future research on quality improvement activities in these settings should incorporate study periods sufficient to evaluate continuous quality improvement efforts."]

{"sheet":"HighRisk","index":4,"n_rows":178,"n_cols":5,"rows_kept":178,"cut":false,"hidden":false,"merged":[[177,1,212,1],[177,2,212,2],[177,3,212,3],[177,4,212,4],[136,1,155,1],[136,2,155,2],[136,3,155,3],[136,4,155,4],[156,1,176,1],[156,2,176,2],[156,3,176,3],[156,4,176,4],[24,1,52,1],[24,2,52,2],[24,3,52,4],[19,1,20,4],[22,1,22,4],[53,1,70,1],[53,2,70,2],[53,3,70,4],[71,1,80,1],[71,2,80,2],[71,3,80,4],[81,1,95,1],[81,2,95,2],[81,3,95,4],[96,1,112,1],[96,2,112,2],[96,3,112,4],[114,1,114,4],[116,1,135,1],[116,2,135,2],[116,3,135,3],[116,4,135,4]]}
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[null,"GRWPIAU RISG UCHEL"]
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[null,"ADRAN CANLLAWIAU - GRWPIAU RISG UCHEL"]
[null,"Ffynhonnell:","Cynulleidfa:","Argymhellion:"]
[null,"National Institute for Health and Care Excellence. Flu vaccination: increasing uptake. NG103. London: NICE; 2018.\nAvailable here.","This guideline is for: \n- Commissioners and providers of primary and secondary healthcare services, including maternity providers and community pharmacies\n- All employers of staff who provide NHS or social-care funded services (including maternity care, domiciliary care and care homes)\n- Local authorities, and community and voluntary sector organisations that employ health and social care workers\n- Occupational health services and infection prevention and control teams\n- NHS England teams and Health Education England teams\n- People using services, their families, carers and other members of the public, in particular those eligible for flu vaccination","This guideline covers how to increase uptake of the free flu vaccination among people who are eligible. It describes ways to increase awareness and how to use all opportunities in primary and secondary care to identify people who should be encouraged to have the vaccination.\n\nIt includes recommendations on:\n- Using a multicomponent approach\n- Raising awareness\n- Offering vaccination\n- Increasing uptake among eligible groups in primary and secondary care\n- Audit, monitoring and feedback\n- Vaccination in carers\n- Increasing uptake in health and social care staff"]
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[null,"National Institute for Health and Care Excellence. Tuberculosis. NG33. London: NICE; 2016.\nAvailable here.\nLast updated in September 2019.","This guideline is for: \n- Healthcare professionals and TB multidisciplinary teams\n- Substance misuse services, prisons and immigration removal centres\n- Local government and commissioners\n- TB control boards, directors of public health and public health consultants\n- Public Health England and NHS England\n- Voluntary sector workers\n- People with TB and their carers","This guideline covers preventing, identifying and managing latent and active tuberculosis (TB) in children, young people and adults. It aims to improve ways of finding people who have TB in the community and recommends that everyone under 65 with latent TB should be treated. It describes how TB services should be organised, including the role of the TB control board.\n\nIt includes recommendations on:\n- Preventing TB, including in under-served groups\n- Diagnosing and managing latent TB, including recommendations specifically for children and young people\n- Diagnosing and managing active TB, including recommendations specifically for children and young people\n- Drug-resistant TB\n- Infection control\n- Case finding and adherence, treatment completion and follow-up, including in under-served groups\n- Service organisation"]
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[null,"National Institute for Health and Care Excellence. Hepatitis B and C testing: people at risk of infection. PH43. London: NICE; 2012.\nAvailable here.\nLast updated in March 2013.","This public health guidance is relevant to:\n- Commissioners and providers\n- People at increased risk of viral hepatitis\n- Members of the public","This guideline covers raising awareness of and testing for hepatitis B and C infection. It aims to ensure that people at increased risk of hepatitis B and C infection are tested.\n\nIt  includes recommendations on:\n- Raising awareness about hepatitis B and C among the general population and people at increased risk of infection\n- Education and training for professionals who provide services for people at increased risk of infection\n- Testing for hepatitis B and C in primary care, prisons and immigration removal centres, drugs services, and sexual health and genitourinary medicine clinics\n- Tracing close contacts of people with hepatitis B infection\n- Neonatal hepatitis B vaccination\n- Commissioning integrated services for testing and treatment and laboratory services for testing"]
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[null,"National Institute for Health and Care Excellence. Immunisations: reducing differences in uptake in under 19s. PH21. London: NICE; 2009.\nAvailable here.\nLast updated in September 2017.","This public health guidance is relevant to:\n- Healthcare professionals\n- Commissioners and providers\n- People who work in children’s services and local authorities\n- People who work in schools, colleges and workplaces\n- People who work in the private, voluntary and community sectors\n- Parents, carers and young people","This guideline covers increasing immunisation uptake among children and young people aged under 19 years in groups and settings where immunisation coverage is low. It aims to improve access to immunisation services and increase timely immunisation of children and young people. It also aims to ensure babies born to mothers infected with hepatitis B are immunised.\n\nIt includes recommendations on:\n- Immunisation programmes\n- Information systems for recording immunisation status\n- Training for staff involved in immunisation services\n- Contribution of nurseries, schools and further education colleges\n- Targeting groups at risk of not being fully immunised\n- Hepatitis B immunisation for infants"]
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[null,"National Institute for Health and Care Excellence. Drug misuse in over 16s: psychosocial interventions. CG51. London: NICE; 2007.\nAvailable here.\nLast checked in July 2016.","This clinical guidance is relevant to:\n- Healthcare professionals\n- Commissioners and providers\n- People who work in specialist residential and community-based treatment settings\n- People who work in prisons and criminal justice settings\n- Adults and young people over 16 who misuse opioids, stimulants or cannabis and their families and carers","This guideline covers using psychosocial interventions to treat adults and young people over 16 who have a problem with or are dependent on opioids, stimulants or cannabis. It aims to reduce illicit drug use and improve people’s physical and mental health, relationships and employment.\n\nIt includes recommendations on:\n- Principles for supporting people who misuse drugs and their families and carers\n- Identification and assessment of drug misuse\n- Brief interventions and self-help\n- Formal psychosocial interventions\n- Residential, prison and inpatient care"]
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[null,"ADRAN ADOLYGIAD SYSTEMATIG - GRWPIAU RISG UCHEL"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau'r awduron:"]
[null,"Palmer  MJ et al. Targeted client communication via mobile devices for improving maternal, neonatal, and child health. Cochrane Database of Systematic Reviews 2020, Issue 8. Art. No.: CD013679. DOI: 10.1002/14651858.CD013679.\nAvailable here.","High risk groups (pregnant women)","This Cochrane review aimed to assess the effects of TCC via MD on health behaviour, service use, health, and well‐being for maternal, neonatal and child health (MNCH).\n\nThe reviewers'  included 27 trials (17,463 participants). Trial populations were: pregnant and postpartum women (11 trials conducted in low‐, middle‐ or high‐income countries; pregnant and postpartum women living with HIV (three trials carried out in one lower middle‐income country); and parents of children under the age of five years (13 trials conducted in LMHIC). \n\nOnly two studies within the targeted client communication via mobile device versus digital non-targeted communication fulfilled the criteria of this review:\nOne study (Yudin et al. 2017) found that a mobile phone text message reinforcing that the influenza vaccine is recommended for all pregnant women and safe during pregnancy and breastfeeding compared to standard care/ no intervention, may make little or no difference to attendance for antenatal influenza vaccination (risk ratio (RR) 1.05, 95% confidence interval (CI) 0.71 to 1.58), though the CI encompasses both benefit and harm (low‐certainty evidence). \nAnother study (Lund et al. 2012) found that a multi-component approach combining mobile phone text message with voucher compared to simple health education and appointment reminders to encourage attendance to routine antenatal classes, make little or no difference to attendance for antenatal tetanus vaccine (OR 1.67, 95% CI 0.84 to 3.33). ","The authors conclude that the effect of targeted client communication via mobile devices for most outcomes is uncertain. There may be improvements for some outcomes using targeted communication but these findings were of low certainty. \n\nHigh‐quality, adequately powered trials and cost‐effectiveness analyses are required to reliably ascertain the effects and relative benefits of TCCMD. Future studies should measure potential unintended consequences, such as partner violence or breaches of confidentiality."]
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[null,"Stormacq C et al. Effects of health literacy interventions on health-related outcomes in socioeconomically disadvantaged adults living in the community: a systematic review. JBI evidence synthesis 2020, Issue 18(7). pp.1389-1469. doi: 10.11124/JBISRIR-D-18-00023.\nAvailable here.","High risk groups (pregnant women)","The objectives of this JBI review were: i) to identify and synthesize the best available evidence on the effectiveness on health-related outcomes of health literacy interventions for enabling socioeconomically disadvantaged people living in the community to access, understand, appraise and apply health information; and ii) to identify components of health literacy interventions associated with improved health-related outcomes.\n\nTwenty-one studies were included in the review. Only one randomised controlled trial fulfilled the criteria of this evidence map (Stockwell et al. 2014). It included 1153 low-income women initiating prenatal care, 576 of whom participated in the experimental group and 577 in the control group. Participants in the experimental group received health information and health education about influenza during pregnancy through five weekly text messages. The text messages covered various topics such as risk of influenza for the pregnant woman and fetus, vaccine safety and vaccine recommendations. Participants in the control group received usual care. At four months follow-up, there was a higher rate of vaccination in the experimental group than in the control group (P = 0.048). Text messages are a simple, convenient and cost-effective tool to send specific health information to a large number of people simultaneously. Text messages can be an effective tool for delivering health information and encouraging the adoption of positive health behaviors within a population with limited access to health information.","The review concluded that mostly, health literacy interventions in the Disease Prevention domain of the health continuum were effective for improving preventive health behaviors and practices such as vaccination and screenings."]
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[null,"Posadzki  P et al. Automated telephone communication systems for preventive healthcare and management of long‐term conditions. Cochrane Database of Systematic Reviews 2016, Issue 12. Art. No.: CD009921. DOI: 10.1002/14651858.CD009921.pub2.\nAvailable here.","Adults\n\nHigh risk groups (long-term health conditions)","This Cochrane review aimed to assess the effects of automated telephone communication system (ATCS) for preventing disease and managing long‐term conditions on behavioural change, clinical, process, cognitive, patient‐centred and adverse outcomes.\n\nThe review authors found 132 trials with over 4 million participants across preventive healthcare areas and for the management of long‐term conditions.\n\nStudies compared ATCS types in many ways. Some studies reported findings across diseases. For prevention, ATCS probably increase immunisation uptake in children, and slightly in adolescents, but in adults effects are uncertain. \n\nTen studies, all in the USA, evaluated ATCS for promoting immunisation uptake. For preventive healthcare, ATCS (ATCS Plus, IVR, unidirectional) probably increase immunisation uptake in children (risk ratio (RR) 1.25, 95% confidence interval (CI) 1.18 to 1.32; 5 studies, N = 10,454; moderate certainty) and to a lesser extent in adolescents (RR 1.06, 95% CI 1.02 to 1.11; 2 studies, N = 5725; moderate certainty). Based on evidence from 2 studies the effects of ATCS in adults are unclear (RR 2.18, 95% CI 0.53 to 9.02; 2 studies, N = 1743; very low certainty).","The review authors concluded that ATCS interventions can change patients' health behaviours, improve clinical outcomes and increase healthcare uptake with positive effects in several important areas including immunisation, screening, appointment attendance, and adherence to medications or tests. The decision to integrate ATCS interventions in routine healthcare delivery should reflect variations in the certainty of the evidence available and the size of effects across different conditions, together with the varied nature of ATCS interventions assessed. Future research should investigate both the content of ATCS interventions and the mode of delivery; users' experiences, particularly with regard to acceptability; and clarify which ATCS types are most effective and cost‐effective."]
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[null,"Till  SR et al. Incentives for increasing prenatal care use by women in order to improve maternal and neonatal outcomes. Cochrane Database of Systematic Reviews 2015, Issue 12. Art. No.: CD009916. DOI: 10.1002/14651858.CD009916.pub2.\nAvailable here.","High risk groups (pregnant women)","This Cochrane review aimed to determine whether incentives are an effective tool to increase utilization of timely prenatal care among women.\n\nThe review authors identified 11 studies (19 reports), six of which we excluded. Five studies, involving 11,935 pregnancies were included, but only 1893 pregnancies contributed data regarding our specified outcomes. Incentives in the studies included cash, gift card, baby carrier, baby blanket or taxicab voucher and were compared with no incentives. Meta‐analysis was performed for only one outcome 'Return for postpartum care' and this outcome was not pre‐specified in their protocol. Other analyses were restricted to data from single studies.\n\nThe five included studies of incentive programs did not report any of this review's primary outcomes: preterm birth, small‐for‐gestational age, or perinatal death.\n\nIn terms of this review's secondary outcomes, pregnant women receiving incentives were no more likely to initiate prenatal care (risk ratio (RR) 1.04, 95% confidence interval (CI) 0.78 to 1.38, one study, 104 pregnancies). Pregnant women receiving incentives were more likely to attend prenatal visits on a frequent basis (RR 1.18, 95% CI 1.01 to 1.38, one study, 606 pregnancies) and obtain adequate prenatal care defined by number of “procedures” such as testing blood sugar or blood pressure, vaccinations and counseling about breastfeeding and birth control (mean difference (MD) 5.84, 95% CI 1.88 to 9.80, one study, 892 pregnancies). In contrast, women who received incentives were more likely to deliver by cesarean section (RR 1.97, 95% CI 1.18 to 3.30, one study, 979 pregnancies) compared to those women who did not receive incentives.","The included studies did not report on this review's main outcomes: preterm birth, small‐for‐gestational age, or perinatal death. There is limited evidence that incentives may increase utilization and quality of prenatal care, but may also increase cesarean rate. Overall, there is insufficient evidence to fully evaluate the impact of incentives on prenatal care initiation. \n\nThere is a need for high‐quality RCTs to determine whether incentive program increase prenatal care use and improve maternal and neonatal outcomes. Incentive programs, in particular cash‐based programs, as suggested in this review and in several observational studies may improve the frequency and ensure adequate quality of prenatal care. No peer‐reviewed data have been made publicly available for one of the largest incentive‐based prenatal programs – the statewide Medicaid‐based programs within the United States. These observational data represent an important starting point for future research with significant implications for policy development and allocation of healthcare resources. The disparate findings related to attending postpartum care should also be further explored as the findings were limited by the number of studies. Future large RCTs are needed to focus on the outcomes of preterm birth, small‐for‐gestational age and perinatal outcomes."]

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[null,"GRWPIAU GALWEDIGAETHOL"]
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[]
[null,"ADRAN CANLLAWIAU - GRWPIAU GALWEDIGAETHOL"]
[null,"Ffynhonnell:","Cynulleidfa:","Argymhellion:"]
[null,"National Institute for Health and Care Excellence. Flu vaccination: increasing uptake. NG103. London: NICE; 2018.\nAvailable here.","This guideline is for: \n- Commissioners and providers of primary and secondary healthcare services, including maternity providers and community pharmacies\n- All employers of staff who provide NHS or social-care funded services (including maternity care, domiciliary care and care homes)\n- Local authorities, and community and voluntary sector organisations that employ health and social care workers\n- Occupational health services and infection prevention and control teams\n- NHS England teams and Health Education England teams\n- People using services, their families, carers and other members of the public, in particular those eligible for flu vaccination","This guideline covers how to increase uptake of the free flu vaccination among people who are eligible. It describes ways to increase awareness and how to use all opportunities in primary and secondary care to identify people who should be encouraged to have the vaccination.\n\nIt includes recommendations on:\n- Using a multicomponent approach\n- Raising awareness\n- Offering vaccination\n- Increasing uptake among eligible groups in primary and secondary care\n- Audit, monitoring and feedback\n- Vaccination in carers\n- Increasing uptake in health and social care staff"]
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[null,"ADRAN ADOLYGIAD SYSTEMATIG - GRWPIAU GALWEDIGAETHOL"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau'r awduron:"]
[null,"Lorenc T, Marshall D, Wright K, Sutcliffe K, Sowden A (2018). Seasonal influenza vaccination of healthcare workers: evidence synthesis. London: EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London. \nAvailable here.","Occupational groups (healthcare workers)","This report by EPPI-centre presents the findings from: (1) a synthesis of evidence about seasonal flu vaccination interventions: content and components, processes, and implementation; and (2) a systematic review of qualitative studies investigating HCWs’ views, attitudes and perceptions about seasonal flu vaccination. \n\nThe reviewers identified 60 studies evaluating interventions to promote seasonal flu vaccination among HCWs. Of these, only 13 used an RCT design. The types of strategy, number of studies, strength of evidence and likely effectiveness are presented in the summary table, overleaf. Most of the RCTs focused on increasing awareness, or on education. Few RCTs evaluated strategies to increase access, or incentives, and none assessed mandatory vaccination programmes. Most interventions combined several different elements and this is likely to be the most promising approach, as components are likely to work in different ways, and for different people. Most RCTs were conducted either in hospitals or in long-term care (e.g., nursing homes).\n\nThree studies were conducted in the UK (two RCTs), mainly focusing on increasing awareness or education. Most interventions appear not to have been based on any clear theoretical framework, or on any formative research or substantive engagement with HCWs themselves. Most non-mandatory interventions focused on individual beliefs, rather than on the social or institutional factors which may affect vaccination uptake. Data on implementation indicate that it is important to ensure adequate resources and management support; to address HCWs’ beliefs about vaccination; and to collect accurate data on vaccination coverage.\n\nThe findings from 25 qualitative studies. The data indicated a number of personal beliefs which may be barriers to vaccination, including perceived low risk of influenza, fear of side-effects of the vaccine, and scepticism about vaccine effectiveness. There were serious barriers to the acceptability of some interventions, particularly coercive mandatory policies, but also some educational or awareness-raising strategies.\n","The review concluded that bringing together the findings from the quantitative and qualitative studies, it appears that HCWs have clear views about their needs and priorities in relation to seasonal flu\nvaccination, which were mostly not addressed by the evaluated interventions. \n\nThe key messages were:\n- Promising interventions combine several components, including individual, social and environmental elements\n- Education alone is probably ineffective, but broader awareness-raising strategies appear promising\n- Increasing access to vaccination may be effective, but the evidence is weak with few RCTs\n- Both “soft” and “hard” mandates appear promising, but have yet to be evaluated using robust study designs, and may have limited acceptability\n- Interventions should ideally target everyone working in a healthcare context, but this may be practically difficult\n- The culture and context of the organisation(s), within which interventions are implemented, may have an important influence on outcomes. Evaluators should seek\nto understand interventions within an organisational system\n- Very few interventions engaged with HCWs to understand their needs and priorities\n- Intervention developers/implementers should engage with HCWs to understand their views, conduct formative research and pilot interventions before full-scale evaluation\n- Mixed-methods research to understand the context, in which an intervention will be implemented, and HCWs’ likely responses to an intervention, may be valuable"]
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[null,"Stokes G, Richardson M, Brunton G, Khatwa M, Thomas J (2015) Review 3: Community engagement for health via coalitions, collaborations and partnerships (on-line social media and social networks) – a systematic review and metaanalysis. London: EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London.\nAvailable here.","Adults \n\nOccupational groups (university staff)","This systematic review sought to answer the following research question:\nWhat health issues and populations have been studied using online social media/social networking?\n\nThere is evidence of health issues focused on healthy eating/physical activity, cancer detection and screening, diabetes, general wellbeing and lifestyle, sexual health, flu immunisation, food safety. However there were a low number of studies for each health topic and population. There is evidence of studies focused on populations under 25 years of age or on those over 40 years of age, but gaps in evaluated interventions in those aged under 16, 30 to 40 and over 60. There is inconsistent evidence of studies targeting women only and no evidence of studies targeting men specifically. There is inconsistent evidence of social media/social networking interventions directed to minority ethnic groups.\n\nThe studies included in this review focused on a broad range of health topics, only one RCT focussed amongst Australian university students and staff focused on influenza immunisation (Lau et al. 2012). For their study into the impact of a web-based personally controlled health management system entitled Healthy.me on influenza vaccination and health service utilisation rates, Lau et al. (2012) incorporated social forums and messaging to allow consumers to interact with each other and with healthcare professionals. \n\nThe provider of the additional potentially active content was either automated or anonymous. The content was also provided by the health professional experts. The study described the use of a mandatory five-minute session on how to use a website. Primary analysis examined differences in the proportion of participants obtaining influenza vaccination during the study in the waitlist and PCHMS groups using the c2 test, including participants who had the opportunity to use the PCHMS but did not\ndo so. \n\nThe extent of community engagement was low (0.48 95% CI: 0.09 to 0.87). The review concluded that there is weak evidence that employing either peers or professionals to facilitate online discussions forums is seen more often to have effective outcomes. ","In summary, although the effect sizes are very small overall, QCA demonstrated that including a facilitator in the delivery of social media/social networking interventions demonstrated higher effect sizes for studies not focused on healthy eating and physical activity and which did not employ the use of theory in intervention development. Nonhealthy eating/physical activity topics focused on sexually transmitted infection prevention, cancer screening/prevention, influenza immunization and mental health promotion. The use of this combination of conditions is conceptually well supported, lending confidence to its findings. However, it must be considered that these findings are exploratory in nature and should be evaluated robustly in future intervention development and evaluation."]

{"sheet":"Reminders","index":6,"n_rows":312,"n_cols":5,"rows_kept":312,"cut":false,"hidden":false,"merged":[[28,1,28,4],[311,1,335,1],[311,2,335,2],[311,3,337,3],[311,4,337,4],[232,1,264,1],[232,2,264,2],[232,3,264,3],[232,4,264,4],[286,1,310,1],[286,2,310,2],[286,3,310,3],[286,4,310,4],[265,1,285,1],[265,2,285,2],[30,1,44,1],[30,2,44,2],[30,3,44,4],[69,1,123,1],[69,2,123,2],[69,3,123,3],[69,4,123,4],[46,1,46,4],[48,1,68,1],[48,2,68,2],[48,3,68,3],[48,4,68,4],[124,1,143,1],[124,2,143,2],[265,3,285,3],[265,4,285,4],[124,3,143,3],[124,4,143,4],[144,1,201,1],[144,2,201,2],[144,3,201,3],[144,4,201,4],[202,1,231,1],[202,2,231,2],[202,3,231,3],[202,4,231,4]]}
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[null,"ADRAN CANLLAWIAU - GWASANAETHAU ATGOFFA/GALW'N ÔL"]
[null,"Ffynhonnell:","Cynulleidfa:","Argymhellion:"]
[null,"National Institute for Health and Care Excellence. Immunisations: reducing differences in uptake in under 19s. PH21. London: NICE; 2009.\nAvailable here.\nLast updated in September 2017.","This public health guidance is relevant to:\n- Healthcare professionals\n- Commissioners and providers\n- People who work in children’s services and local authorities\n- People who work in schools, colleges and workplaces\n- People who work in the private, voluntary and community sectors\n- Parents, carers and young people","This guideline covers increasing immunisation uptake among children and young people aged under 19 years in groups and settings where immunisation coverage is low. It aims to improve access to immunisation services and increase timely immunisation of children and young people. It also aims to ensure babies born to mothers infected with hepatitis B are immunised.\n\nIt includes recommendations on:\n- Immunisation programmes\n- Information systems for recording immunisation status\n- Training for staff involved in immunisation services\n- Contribution of nurseries, schools and further education colleges\n- Targeting groups at risk of not being fully immunised\n- Hepatitis B immunisation for infants"]
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[null,"ADRAN ADOLYGIAD SYSTEMATIG - GWASANAETHAU ATGOFFA/GALW'N ÔL"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau'r awduron:"]
[null,"Palmer  MJ et al. Targeted client communication via mobile devices for improving maternal, neonatal, and child health. Cochrane Database of Systematic Reviews 2020, Issue 8. Art. No.: CD013679. DOI: 10.1002/14651858.CD013679.\nAvailable here.","High risk groups (pregnant women)","This Cochrane review aimed to assess the effects of TCC via MD on health behaviour, service use, health, and well‐being for maternal, neonatal and child health (MNCH).\n\nThe reviewers'  included 27 trials (17,463 participants). Trial populations were: pregnant and postpartum women (11 trials conducted in low‐, middle‐ or high‐income countries; pregnant and postpartum women living with HIV (three trials carried out in one lower middle‐income country); and parents of children under the age of five years (13 trials conducted in LMHIC). \n\nOnly two studies within the targeted client communication via mobile device versus digital non-targeted communication fulfilled the criteria of this review:\nOne study (Yudin et al. 2017) found that a mobile phone text message reinforcing that the influenza vaccine is recommended for all pregnant women and safe during pregnancy and breastfeeding compared to standard care/ no intervention, may make little or no difference to attendance for antenatal influenza vaccination (risk ratio (RR) 1.05, 95% confidence interval (CI) 0.71 to 1.58), though the CI encompasses both benefit and harm (low‐certainty evidence). \nAnother study (Lund et al. 2012) found that a multi-component approach combining mobile phone text message with voucher compared to simple health education and appointment reminders to encourage attendance to routine antenatal classes, make little or no difference to attendance for antenatal tetanus vaccine (OR 1.67, 95% CI 0.84 to 3.33). ","The authors conclude that the effect of targeted client communication via mobile devices for most outcomes is uncertain. There may be improvements for some outcomes using targeted communication but these findings were of low certainty. \n\nHigh‐quality, adequately powered trials and cost‐effectiveness analyses are required to reliably ascertain the effects and relative benefits of TCCMD. Future studies should measure potential unintended consequences, such as partner violence or breaches of confidentiality."]
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[null,"Abdullahi  LH et al. Improving vaccination uptake among adolescents. Cochrane Database of Systematic Reviews 2020, Issue 1. Art. No.: CD011895. DOI: 10.1002/14651858.CD011895.pub2.\nAvailable here.","Adults (under 19s)","This Cochrane review aimed to evaluate the effects of interventions to improve vaccine uptake among adolescents.\n\nThe reviewers' included 16 studies (eight individually randomised trials, four cluster randomised trials, three non‐randomised trials, and one controlled before‐after study). Twelve studies were conducted in the USA, while there was one study each from: Australia, Sweden, Tanzania, and the UK. Ten studies had unclear or high risk of bias. They categorised interventions as recipient‐oriented, provider‐oriented, or health systems‐oriented.\n\nThe interventions targeted adolescent boys or girls or both (seven studies), parents (four studies), and providers (two studies). Five studies had mixed participants that included adolescents and parents, adolescents and healthcare providers, and parents and healthcare providers. The outcomes included uptake of human papillomavirus (HPV) (11 studies); hepatitis B (three studies); and tetanus–diphtheria–acellular–pertussis (Tdap), meningococcal, HPV, and influenza (three studies) vaccines among adolescents.\n\nHealth education improves HPV vaccine uptake compared to usual practice (RR 1.43, 95% CI 1.16 to 1.76; I² = 0%; 3 studies, 1054 participants; high‐certainty evidence). In addition, one large study provided evidence that a complex multi‐component health education intervention probably results in little to no difference in hepatitis B vaccine uptake compared to simplified information leaflets on the vaccine (RR 0.98, 95% CI 0.97 to 0.99; 17,411 participants; moderate‐certainty evidence).\n\nFinancial incentives may improve HPV vaccine uptake compared to usual practice (RR 1.45, 95% CI 1.05 to 1.99; 1 study, 500 participants; low‐certainty evidence). However, we are uncertain whether combining health education and financial incentives has an effect on hepatitis B vaccine uptake, compared to usual practice (RR 1.38, 95% CI 0.96 to 2.00; 1 study, 104 participants; very low certainty evidence).\n\nMandatory vaccination probably leads to a large increase in hepatitis B vaccine uptake compared to usual practice (RR 3.92, 95% CI 3.65 to 4.20; 1 study, 6462 participants; moderate‐certainty evidence).\n\nProvider prompts probably make little or no difference compared to usual practice, on completion of Tdap (OR 1.28, 95% CI 0.59 to 2.80; 2 studies, 3296 participants), meningococcal (OR 1.09, 95% CI 0.67 to 1.79; 2 studies, 3219 participants), HPV (OR 0.99, 95% CI 0.55 to 1.81; 2 studies, 859 participants), and influenza (OR 0.91, 95% CI 0.61 to 1.34; 2 studies, 1439 participants) vaccination schedules (moderate‐certainty evidence).\n\nProvider education with performance feedback may increase the proportion of adolescents who are offered and accept HPV vaccination by clinicians, compared to usual practice. Compared to adolescents visiting non‐participating clinicians (in the usual practice group), the adolescents visiting clinicians in the intervention group were more likely to receive the first dose of HPV during preventive visits (5.7 percentage points increase) and during acute visits (0.7 percentage points for the first and 5.6 percentage points for the second doses of HPV) (227 clinicians and more than 200,000 children; low‐certainty evidence).\n\nA class‐based school vaccination strategy probably leads to slightly higher HPV vaccine uptake than an age‐based school vaccination strategy (RR 1.09, 95% CI 1.06 to 1.13; 1 study, 5537 participants; moderate‐certainty evidence).\n\nA multi‐component provider intervention (including an education session, repeated contacts, individualised feedback, and incentives) probably improves uptake of HPV vaccine compared to usual practice (moderate‐certainty evidence).\n\nA multi‐component intervention targeting providers and parents involving social marketing and health education may improve HPV vaccine uptake compared to usual practice (RR 1.41, 95% CI 1.25 to 1.59; 1 study, 25,869 participants; low‐certainty evidence).","The authors conclude that various strategies have been evaluated to improve adolescent vaccination including health education, financial incentives, mandatory vaccination, and class‐based school vaccine delivery. However, most of the evidence is of low to moderate certainty. This implies that while this research provides some indication of the likely effect of these interventions, the likelihood that the effects will be substantially different is high. \n\nTherefore, additional research is needed to further enhance adolescent immunisation strategies, especially in low‐ and middle‐income countries where there are limited adolescent vaccination programmes. In addition, it is critical to understand the factors that influence hesitancy, acceptance, and demand for adolescent vaccination in different settings. This is the topic of an ongoing Cochrane qualitative evidence synthesis, which may help to explain why and how some interventions were more effective than others in increasing adolescent HPV vaccination coverage."]
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[null,"Stormacq C et al. Effects of health literacy interventions on health-related outcomes in socioeconomically disadvantaged adults living in the community: a systematic review. JBI evidence synthesis 2020, Issue 18(7). pp.1389-1469. doi: 10.11124/JBISRIR-D-18-00023.\nAvailable here.","High risk groups (pregnant women)","The objectives of this JBI review were: i) to identify and synthesize the best available evidence on the effectiveness on health-related outcomes of health literacy interventions for enabling socioeconomically disadvantaged people living in the community to access, understand, appraise and apply health information; and ii) to identify components of health literacy interventions associated with improved health-related outcomes.\n\nTwenty-one studies were included in the review. Only one randomised controlled trial fulfilled the criteria of this evidence map (Stockwell et al. 2014). It included 1153 low-income women initiating prenatal care, 576 of whom participated in the experimental group and 577 in the control group. Participants in the experimental group received health information and health education about influenza during pregnancy through five weekly text messages. The text messages covered various topics such as risk of influenza for the pregnant woman and fetus, vaccine safety and vaccine recommendations. Participants in the control group received usual care. At four months follow-up, there was a higher rate of vaccination in the experimental group than in the control group (P = 0.048). Text messages are a simple, convenient and cost-effective tool to send specific health information to a large number of people simultaneously. Text messages can be an effective tool for delivering health information and encouraging the adoption of positive health behaviors within a population with limited access to health information.","The review concluded that mostly, health literacy interventions in the Disease Prevention domain of the health continuum were effective for improving preventive health behaviors and practices such as vaccination and screenings."]
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[null,"Thomas  RE and Lorenzetti  DL. Interventions to increase influenza vaccination rates of those 60 years and older in the community. Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD005188. DOI: 10.1002/14651858.CD005188.pub4. \nAvailable here.","Adults (60 years+)","This Cochrane review aimed to assess access, provider, system, and societal interventions to increase the uptake of influenza vaccination in people aged 60 years and older in the community.\n\nThe reviewers' included 3 new RCTs for this update (total 61 RCTs; 1,055,337 participants). Trials involved people aged 60 years and older living in the community in high‐income countries. Heterogeneity limited some meta‐analyses. They assessed studies as at low risk of bias for randomisation (38%), allocation concealment (11%), blinding (44%), and selective reporting (100%). Half (51%) had missing data. We assessed the evidence as low‐quality. They identified three levels of intervention intensity: low (e.g. postcards), medium (e.g. personalised phone calls), and high (e.g. home visits, facilitators).\n\nIncreasing community demand (12 strategies, 41 trials, 53 study arms, 767,460 participants): One successful intervention that could be meta‐analysed was client reminders or recalls by letter plus leaflet or postcard compared to reminder (OR 1.11, 95% CI 1.07 to 1.15; 3 studies; 64,200 participants). Successful interventions tested by single studies were patient outreach by retired teachers (OR 3.33, 95% CI 1.79 to 6.22); invitations by clinic receptionists (OR 2.72, 95% CI 1.55 to 4.76); nurses or pharmacists educating and nurses vaccinating patients (OR 152.95, 95% CI 9.39 to 2490.67); medical students counselling patients (OR 1.62, 95% CI 1.11 to 2.35); and multiple recall questionnaires (OR 1.13, 95% CI 1.03 to 1.24).\n\nSome interventions could not be meta‐analysed due to significant heterogeneity: 17 studies tested simple reminders (the 95% CI was entirely above unity in 11 trials implying all 11 interventions increased vaccination rates); 16 tested personalised reminders (the 95% CI was entirely above unity in 12 trials implying all 12 interventions increased vaccination rates ); 2 investigated customised compared to form letters (the 95% CI was above unity in both trials implying both interventions increased vaccination rates); and 4 studies examined the impact of health risk appraisals (the 95% CI was above unity in all 4 trials implying all 4 interventions increased vaccination rates). One study of a lottery for free groceries was not effective.\n\nEnhancing vaccination access (6 strategies, 8 trials, 10 arms, 9353 participants): The reviewers meta‐analysed results from 2 studies of home visits (OR 1.30, 95% CI 1.05 to 1.61), and 2 studies that tested free vaccine compared to patient payment for vaccine (OR 2.36, 95% CI 1.98 to 2.82). They were unable to conduct meta‐analyses of 2 studies of home visits by nurses plus a physician care plan (the 95% CI was entirely above unity in both trials implying both interventions increased vaccination rates) and 2 studies of free vaccine compared to no intervention (the 95% CI was entirely above unity in both trials implying both interventions increased vaccination rates). One study of group visits (OR 27.2, 95% CI 1.60 to 463.3) was effective, and 1 study of home visits compared to safety interventions was not.\n\nProvider‐ or system‐based interventions (11 strategies, 15 trials, 17 arms, 278,524 participants): One successful intervention that could be meta‐analysed focused on payments to physicians (OR 2.22, 95% CI 1.77 to 2.77). Successful interventions tested by individual studies were: reminding physicians to vaccinate all patients (OR 2.47, 95% CI 1.53 to 3.99); posters in clinics presenting vaccination rates and encouraging competition between doctors (OR 2.03, 95% CI 1.86 to 2.22); and chart reviews and benchmarking to the rates achieved by the top 10% of physicians (OR 3.43, 95% CI 2.37 to 4.97).\n\nThe reviewers were unable to meta‐analyse 4 studies that looked at physician reminders (the 95% CI was entirely above unity in 3 trials implying all 3 interventions increased vaccination rates) and 3 studies of facilitator encouragement of vaccination (the 95% CI was entirely above unity in 2 trials implying both interventions increased vaccination rates). Interventions that were not effective were: comparing letters on discharge from hospital to letters to general practitioners; posters plus postcards versus posters alone; educational reminders, academic detailing, and peer comparisons compared to mailed educational materials; educational outreach plus feedback to teams versus written feedback; and an intervention to increase staff vaccination rates.\n\nInterventions at the societal level: No studies reported on societal‐level interventions.","The reviewers identified interventions that demonstrated significant positive effects of low (postcards), medium (personalised phone calls), and high (home visits, facilitators) intensity that increase community demand for vaccination, enhance access, and improve provider/system response. The overall GRADE assessment of the evidence was moderate quality. Conclusions are unchanged from the 2014 review."]
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[null,"Jacobson Vann  JC et al. Patient reminder and recall interventions to improve immunization rates. Cochrane Database of Systematic Reviews 2018, Issue 1. Art. No.: CD003941. DOI: 10.1002/14651858.CD003941.pub3. \nAvailable here.","Adults","This Cochrane review aimed to evaluate and compare the effectiveness of various types of patient reminder and recall interventions to improve receipt of immunizations.\n\nThe 75 included studies involved child, adolescent, and adult participants in outpatient, community‐based, primary care, and other settings in 10 countries.\n\nPatient reminder or recall interventions, including telephone and autodialer calls, letters, postcards, text messages, combination of mail or telephone, or a combination of patient reminder or recall with outreach, probably improve the proportion of participants who receive immunization (RR of 1.28, 95% CI 1.23 to 1.35; risk difference of 8%) based on moderate certainty evidence from 55 studies with 138,625 participants.\n\nThree types of single‐method reminders improve receipt of immunizations based on high certainty evidence: the use of postcards (RR 1.18, 95% CI 1.08 to 1.30; eight studies; 27,734 participants), text messages (RR 1.29, 95% CI 1.15 to 1.44; six studies; 7772 participants), and autodialer (RR 1.17, 95% CI 1.03 to 1.32; five studies; 11,947 participants). Two types of single‐method reminders probably improve receipt of immunizations based on moderate certainty evidence: the use of telephone calls (RR 1.75, 95% CI 1.20 to 2.54; seven studies; 9120 participants) and letters to patients (RR 1.29, 95% CI 1.21 to 1.38; 27 studies; 81,100 participants).\n\nBased on high certainty evidence, reminders improve receipt of immunizations for childhood (RR 1.22, 95% CI 1.15 to 1.29; risk difference of 8%; 23 studies; 31,099 participants) and adolescent vaccinations (RR 1.29, 95% CI 1.17 to 1.42; risk difference of 7%; 10 studies; 30,868 participants). Reminders probably improve receipt of vaccinations for childhood influenza (RR 1.51, 95% CI 1.14 to 1.99; risk difference of 22%; five studies; 9265 participants) and adult influenza (RR 1.29, 95% CI 1.17 to 1.43; risk difference of 9%; 15 studies; 59,328 participants) based on moderate certainty evidence. They may improve receipt of vaccinations for adult pneumococcus, tetanus, hepatitis B, and other non‐influenza vaccinations based on low certainty evidence although the confidence interval includes no effect of these interventions (RR 2.08, 95% CI 0.91 to 4.78; four studies; 8065 participants).","The reviewers conclude that patient reminder and recall systems, in primary care settings, are likely to be effective at improving the proportion of the target population who receive immunizations."]
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[null,"Arditi  C et al. Computer‐generated reminders delivered on paper to healthcare professionals: effects on professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD001175. DOI: 10.1002/14651858.CD001175.pub4.\nAvailable here.","Adults","This Cochrane review aimed to evaluate the effects of reminders automatically generated through a computerized system (computer‐generated) and delivered on paper to healthcare professionals on quality of care (outcomes related to healthcare professionals' practice) and patient outcomes (outcomes related to patients' health condition).\n\nReview authors identified 35 studies (30 RCTs trials and five non‐RCTs) and analyzed 34 studies (40 comparisons). Twenty‐nine studies took place in the USA and six studies took place in Canada, France, Israel, and Kenya. All studies except two took place in outpatient care. Reminders were aimed at enhancing compliance with preventive guidelines (e.g. cancer screening tests, vaccination) in half the studies and at enhancing compliance with disease management guidelines for acute or chronic conditions (e.g. annual follow‐ups, laboratory tests, medication adjustment, counseling) in the other half.\n\nComputer‐generated reminders delivered on paper to healthcare professionals, alone or in addition to co‐intervention(s), probably improves quality of care slightly compared with usual care or the co‐intervention(s) without the reminder component (median improvement 6.8% : 3.8% to 17.5%]; 34 studies (40 comparisons); moderate‐certainty evidence).\n\nComputer‐generated reminders delivered on paper to healthcare professionals alone (single‐component intervention) probably improves quality of care compared with usual care (median improvement 11.0% (IQR 5.4% to 20.0%); 27 studies (27 comparisons); moderate‐certainty evidence). Adding computer‐generated reminders delivered on paper to healthcare professionals to one or more co‐interventions (multi‐component intervention) probably improves quality of care slightly compared with the co‐intervention(s) without the reminder component (median improvement 4.0% (IQR 3.0% to 6.0%); 11 studies (13 comparisons); moderate‐certainty evidence). \n\nSub-group analyses revealed largest improvement seen in vaccination, with a median improvement of 13.1% [Interquartile range (IQR) 12.2% to 20.7%].\n\nThe authors are uncertain whether reminders, alone or in addition to co‐intervention(s), improve patient outcomes as the certainty of the evidence is very low (n = 6 studies (seven comparisons)). None of the included studies reported outcomes related to harms or adverse effects of the intervention.","The review concludes that there is moderate‐certainty evidence that computer‐generated reminders delivered on paper to healthcare professionals probably slightly improves quality of care, in terms of compliance with preventive guidelines and compliance with disease management guidelines. It is uncertain whether reminders improve patient outcomes because the certainty of the evidence is very low. The heterogeneity of the reminder interventions included in this review also suggests that reminders can probably improve quality of care in various settings under various conditions."]
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[null,"Posadzki  P et al. Automated telephone communication systems for preventive healthcare and management of long‐term conditions. Cochrane Database of Systematic Reviews 2016, Issue 12. Art. No.: CD009921. DOI: 10.1002/14651858.CD009921.pub2.\nAvailable here.","Adults\n\nHigh risk groups (long-term health conditions)\n","This Cochrane review aimed to assess the effects of automated telephone communication system (ATCS) for preventing disease and managing long‐term conditions on behavioural change, clinical, process, cognitive, patient‐centred and adverse outcomes.\n\nThe review authors found 132 trials with over 4 million participants across preventive healthcare areas and for the management of long‐term conditions.\n\nStudies compared ATCS types in many ways. Some studies reported findings across diseases. For prevention, ATCS probably increase immunisation uptake in children, and slightly in adolescents, but in adults effects are uncertain. \n\nTen studies, all in the USA, evaluated ATCS for promoting immunisation uptake. For preventive healthcare, ATCS (ATCS Plus, IVR, unidirectional) probably increase immunisation uptake in children (risk ratio (RR) 1.25, 95% confidence interval (CI) 1.18 to 1.32; 5 studies, N = 10,454; moderate certainty) and to a lesser extent in adolescents (RR 1.06, 95% CI 1.02 to 1.11; 2 studies, N = 5725; moderate certainty). Based on evidence from 2 studies the effects of ATCS in adults are unclear (RR 2.18, 95% CI 0.53 to 9.02; 2 studies, N = 1743; very low certainty).","The review authors concluded that ATCS interventions can change patients' health behaviours, improve clinical outcomes and increase healthcare uptake with positive effects in several important areas including immunisation, screening, appointment attendance, and adherence to medications or tests. The decision to integrate ATCS interventions in routine healthcare delivery should reflect variations in the certainty of the evidence available and the size of effects across different conditions, together with the varied nature of ATCS interventions assessed. Future research should investigate both the content of ATCS interventions and the mode of delivery; users' experiences, particularly with regard to acceptability; and clarify which ATCS types are most effective and cost‐effective."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Provider Reminders. The Community Guide; 2015. \nAvailable here.","Adults","The CPSTF recommends provider reminders on the basis of strong evidence of effectiveness in increasing vaccination rates: (1) among adults, adolescents and children; (2) when used alone or with additional interventions; (3) across a range of intervention characteristics (e.g., computerized or simple reminders, checklists, flowcharts); and (4) in a range of settings and populations.\n\nThe Task Force finding is based on evidence from a Community Guide systematic review completed in 2008 (23 studies, search period 1997–2007) combined with more recent evidence (5 studies, search period 2007–February 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\nThe Task Force considered evidence from 28 studies. Twenty-two studies provided a measurement of change in vaccination rates, with an overall median increase of 10 percentage points (IQI: 6 to 25 percentage points). Of these, seven studies examined provider reminders alone with a median increase of 12 percentage points (IQI: 6 percentage point to 25 percentage points). Fifteen studies examined the impact of provider reminders with additional interventions and observed a median increase of 9 percentage points (IQI: 5 to 25 percentage points). Six additional studies did not provide a common measurement of change in vaccination rates; however, five of the studies provided additional support for the use of provider reminders.\n\nEvidence indicates that provider reminders remain an effective option for consideration in a wide range of clinical settings and populations. A subset of the included evidence, however, suggests that standing orders may be more effective in improving vaccination rates in both inpatient and outpatient settings than provider reminder systems.","Evidence in this CPSTF report indicates that provider reminders are effective in a wide range of contexts. Additional research should focus on system-level implementation of reminder systems, and identify strategies to encourage regular and sustained use. In addition, future research could examine or compare the effectiveness of specific reminder prompts provided as a capability of regional or state-level immunization information systems."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Client Reminder and Recall Systems. The Community Guide; 2015. \nAvailable here.","Adults ","The CPSTF recommends client reminder and recall interventions based on strong evidence of effectiveness in improving vaccination rates: (1) in children, adolescents 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.\n\nThis Task Force finding is based on evidence from a Community Guide systematic review completed in 2008 (19 studies, search period 1997-2007) combined with more recent evidence (10 studies, search period 2007-2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\n\nIncluded studies showed vaccination rates increased by a median of 11 percentage points (IQI: 4 to 17 percentage points). Client reminder and recall interventions used alone resulted in a median increase of 6 percentage points (IQI: 3 to 13 percentage points; 14 studies), and interventions implemented with additional components led to a median increase of 12 percentage points (IQI: 10 to 30 percentage points; 15 studies).\n\nThe included studies evaluated the effectiveness of client reminder and recall interventions for a wide range of client and provider populations, settings, vaccinations and delivery methods. Based on the evidence, the Task Force finding should be broadly applicable to all patient populations, in both clinical and community settings, and for the range of vaccines and delivery methods.\n","This CPSTF report concludes that client reminder and recall systems can also be important, effective components of combined approaches to increase vaccination rates. Based on updated, concurrent reviews, the Task Force finds strong evidence to recommend health care system-based interventions implemented in combination and community-based interventions implemented in combination. Immunization information systems, which can also generate client reminder or recall notices provide an additional implementation option.\n\nMore research is needed on effective implementation, sustainability, and expansion of reminder and recall interventions. Future research should also examine the effectiveness of reminder and recall notices using emerging communication technologies (i.e. text message, email). Additional studies should also examine the effectiveness of client reminder and recall interventions on adolescent vaccines such as the human papilloma virus (HPV).\n"]

{"sheet":"Incentives","index":7,"n_rows":280,"n_cols":5,"rows_kept":280,"cut":false,"hidden":false,"merged":[[255,1,277,1],[255,2,277,2],[255,3,278,3],[255,4,277,4],[279,1,310,1],[279,2,310,2],[279,3,311,3],[279,4,310,4],[24,1,24,4],[26,1,42,1],[26,2,42,2],[26,3,42,4],[44,1,44,4],[46,1,61,1],[46,2,61,2],[46,3,61,3],[46,4,61,4],[117,3,174,3],[117,4,174,4],[117,1,174,1],[117,2,174,2],[62,1,116,1],[62,2,116,2],[62,3,116,3],[62,4,116,4],[219,1,254,1],[219,2,254,2],[219,3,254,3],[219,4,254,4],[175,4,218,4],[175,1,218,1],[175,2,218,2],[175,3,218,3]]}
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[null,"ADRAN CANLLAWIAU - CYMHELLION"]
[null,"Ffynhonnell:","Cynulleidfa:","Argymhellion:"]
[null,"National Institute for Health and Care Excellence. Drug misuse in over 16s: psychosocial interventions. CG51. London: NICE; 2007.\nAvailable here.\nLast checked in July 2016.","This clinical guidance is relevant to:\n- Healthcare professionals\n- Commissioners and providers\n- People who work in specialist residential and community-based treatment settings\n- People who work in prisons and criminal justice settings\n- Adults and young people over 16 who misuse opioids, stimulants or cannabis and their families and carers","This guideline covers using psychosocial interventions to treat adults and young people over 16 who have a problem with or are dependent on opioids, stimulants or cannabis. It aims to reduce illicit drug use and improve people’s physical and mental health, relationships and employment.\n\nIt includes recommendations on:\n- Principles for supporting people who misuse drugs and their families and carers\n- Identification and assessment of drug misuse\n- Brief interventions and self-help\n- Formal psychosocial interventions\n- Residential, prison and inpatient care"]
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[null,"ADRAN ADOLYGIAD SYSTEMATIG - CYMHELLION"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau'r awduron:"]
[null,"Jia  L et al. Payment methods for healthcare providers working in outpatient healthcare settings. Cochrane Database of Systematic Reviews 2021, Issue 1. Art. No.: CD011865. DOI: 10.1002/14651858.CD011865.pub2. \nAvailable here.","Adults (65 years+)","This Cochrane review aimed to assess the impact of different payment methods for healthcare providers working in outpatient healthcare settings on the quantity and quality of health service provision, patient outcomes, healthcare provider outcomes, cost of service provision, and adverse effects.\n\nThe reviewers' included 27 studies in the review: 12 randomised trials, 13 controlled before‐and‐after studies, one interrupted time series, and one repeated measure study. Only one randomised controlled trial (Kouides et al. 1998) based in USA fulfilled the inclusion criteria of this evidence map. \nPrimary care physicians in the intervention group received a fee for each immunisation of USD 8 and an additional 10% (USD 0.8) or 20% (USD 1.6) reimbursement per shot according to whether they immunised 70% or 85% (respectively) of the eligible population. The primary care physicians in the control group received only the fee for each immunisation of USD 8. The mean immunisation rate with payment for performance plus existing payment methods was 0.34 per cent points higher (0.2 per cent points lower to 0.87 points higher) compared to existing payment methods [MD 0.34 (−0.20 to 0.87)].\n\n\n\n\n\n","Based on the evidence from one study, the authors were uncertain of the effect of payment for performance added to existing payment methods on immunisation rates for the elderly.\n\nThere is a need for further well‐conducted research on payment methods for healthcare providers working in outpatient healthcare settings in low‐ and middle‐income countries; more studies comparing the impacts of different designs of the same payment method; and studies that consider the unintended consequences of payment interventions."]
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[null,"Abdullahi  LH et al. Improving vaccination uptake among adolescents. Cochrane Database of Systematic Reviews 2020, Issue 1. Art. No.: CD011895. DOI: 10.1002/14651858.CD011895.pub2.\nAvailable here.","Adults (under 19s)","This Cochrane review aimed to evaluate the effects of interventions to improve vaccine uptake among adolescents.\n\nThe reviewers' included 16 studies (eight individually randomised trials, four cluster randomised trials, three non‐randomised trials, and one controlled before‐after study). Twelve studies were conducted in the USA, while there was one study each from: Australia, Sweden, Tanzania, and the UK. Ten studies had unclear or high risk of bias. They categorised interventions as recipient‐oriented, provider‐oriented, or health systems‐oriented.\n\nThe interventions targeted adolescent boys or girls or both (seven studies), parents (four studies), and providers (two studies). Five studies had mixed participants that included adolescents and parents, adolescents and healthcare providers, and parents and healthcare providers. The outcomes included uptake of human papillomavirus (HPV) (11 studies); hepatitis B (three studies); and tetanus–diphtheria–acellular–pertussis (Tdap), meningococcal, HPV, and influenza (three studies) vaccines among adolescents.\n\nHealth education improves HPV vaccine uptake compared to usual practice (RR 1.43, 95% CI 1.16 to 1.76; I² = 0%; 3 studies, 1054 participants; high‐certainty evidence). In addition, one large study provided evidence that a complex multi‐component health education intervention probably results in little to no difference in hepatitis B vaccine uptake compared to simplified information leaflets on the vaccine (RR 0.98, 95% CI 0.97 to 0.99; 17,411 participants; moderate‐certainty evidence).\n\nFinancial incentives may improve HPV vaccine uptake compared to usual practice (RR 1.45, 95% CI 1.05 to 1.99; 1 study, 500 participants; low‐certainty evidence). However, we are uncertain whether combining health education and financial incentives has an effect on hepatitis B vaccine uptake, compared to usual practice (RR 1.38, 95% CI 0.96 to 2.00; 1 study, 104 participants; very low certainty evidence).\n\nMandatory vaccination probably leads to a large increase in hepatitis B vaccine uptake compared to usual practice (RR 3.92, 95% CI 3.65 to 4.20; 1 study, 6462 participants; moderate‐certainty evidence).\n\nProvider prompts probably make little or no difference compared to usual practice, on completion of Tdap (OR 1.28, 95% CI 0.59 to 2.80; 2 studies, 3296 participants), meningococcal (OR 1.09, 95% CI 0.67 to 1.79; 2 studies, 3219 participants), HPV (OR 0.99, 95% CI 0.55 to 1.81; 2 studies, 859 participants), and influenza (OR 0.91, 95% CI 0.61 to 1.34; 2 studies, 1439 participants) vaccination schedules (moderate‐certainty evidence).\n\nProvider education with performance feedback may increase the proportion of adolescents who are offered and accept HPV vaccination by clinicians, compared to usual practice. Compared to adolescents visiting non‐participating clinicians (in the usual practice group), the adolescents visiting clinicians in the intervention group were more likely to receive the first dose of HPV during preventive visits (5.7 percentage points increase) and during acute visits (0.7 percentage points for the first and 5.6 percentage points for the second doses of HPV) (227 clinicians and more than 200,000 children; low‐certainty evidence).\n\nA class‐based school vaccination strategy probably leads to slightly higher HPV vaccine uptake than an age‐based school vaccination strategy (RR 1.09, 95% CI 1.06 to 1.13; 1 study, 5537 participants; moderate‐certainty evidence).\n\nA multi‐component provider intervention (including an education session, repeated contacts, individualised feedback, and incentives) probably improves uptake of HPV vaccine compared to usual practice (moderate‐certainty evidence).\n\nA multi‐component intervention targeting providers and parents involving social marketing and health education may improve HPV vaccine uptake compared to usual practice (RR 1.41, 95% CI 1.25 to 1.59; 1 study, 25,869 participants; low‐certainty evidence).","The authors conclude that various strategies have been evaluated to improve adolescent vaccination including health education, financial incentives, mandatory vaccination, and class‐based school vaccine delivery. However, most of the evidence is of low to moderate certainty. This implies that while this research provides some indication of the likely effect of these interventions, the likelihood that the effects will be substantially different is high. \n\nTherefore, additional research is needed to further enhance adolescent immunisation strategies, especially in low‐ and middle‐income countries where there are limited adolescent vaccination programmes. In addition, it is critical to understand the factors that influence hesitancy, acceptance, and demand for adolescent vaccination in different settings. This is the topic of an ongoing Cochrane qualitative evidence synthesis, which may help to explain why and how some interventions were more effective than others in increasing adolescent HPV vaccination coverage."]
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[null,"Thomas  RE and Lorenzetti  DL. Interventions to increase influenza vaccination rates of those 60 years and older in the community. Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD005188. DOI: 10.1002/14651858.CD005188.pub4. \nAvailable here.","Adults (60 years+)","This Cochrane review aimed to assess access, provider, system, and societal interventions to increase the uptake of influenza vaccination in people aged 60 years and older in the community.\n\nThe reviewers' included 3 new RCTs for this update (total 61 RCTs; 1,055,337 participants). Trials involved people aged 60 years and older living in the community in high‐income countries. Heterogeneity limited some meta‐analyses. They assessed studies as at low risk of bias for randomisation (38%), allocation concealment (11%), blinding (44%), and selective reporting (100%). Half (51%) had missing data. We assessed the evidence as low‐quality. They identified three levels of intervention intensity: low (e.g. postcards), medium (e.g. personalised phone calls), and high (e.g. home visits, facilitators).\n\nIncreasing community demand (12 strategies, 41 trials, 53 study arms, 767,460 participants): One successful intervention that could be meta‐analysed was client reminders or recalls by letter plus leaflet or postcard compared to reminder (OR 1.11, 95% CI 1.07 to 1.15; 3 studies; 64,200 participants). Successful interventions tested by single studies were patient outreach by retired teachers (OR 3.33, 95% CI 1.79 to 6.22); invitations by clinic receptionists (OR 2.72, 95% CI 1.55 to 4.76); nurses or pharmacists educating and nurses vaccinating patients (OR 152.95, 95% CI 9.39 to 2490.67); medical students counselling patients (OR 1.62, 95% CI 1.11 to 2.35); and multiple recall questionnaires (OR 1.13, 95% CI 1.03 to 1.24).\n\nSome interventions could not be meta‐analysed due to significant heterogeneity: 17 studies tested simple reminders (the 95% CI was entirely above unity in 11 trials implying all 11 interventions increased vaccination rates); 16 tested personalised reminders (the 95% CI was entirely above unity in 12 trials implying all 12 interventions increased vaccination rates ); 2 investigated customised compared to form letters (the 95% CI was above unity in both trials implying both interventions increased vaccination rates); and 4 studies examined the impact of health risk appraisals (the 95% CI was above unity in all 4 trials implying all 4 interventions increased vaccination rates). One study of a lottery for free groceries was not effective.\n\nEnhancing vaccination access (6 strategies, 8 trials, 10 arms, 9353 participants): The reviewers meta‐analysed results from 2 studies of home visits (OR 1.30, 95% CI 1.05 to 1.61), and 2 studies that tested free vaccine compared to patient payment for vaccine (OR 2.36, 95% CI 1.98 to 2.82). They were unable to conduct meta‐analyses of 2 studies of home visits by nurses plus a physician care plan (the 95% CI was entirely above unity in both trials implying both interventions increased vaccination rates) and 2 studies of free vaccine compared to no intervention (the 95% CI was entirely above unity in both trials implying both interventions increased vaccination rates). One study of group visits (OR 27.2, 95% CI 1.60 to 463.3) was effective, and 1 study of home visits compared to safety interventions was not.\n\nProvider‐ or system‐based interventions (11 strategies, 15 trials, 17 arms, 278,524 participants): One successful intervention that could be meta‐analysed focused on payments to physicians (OR 2.22, 95% CI 1.77 to 2.77). Successful interventions tested by individual studies were: reminding physicians to vaccinate all patients (OR 2.47, 95% CI 1.53 to 3.99); posters in clinics presenting vaccination rates and encouraging competition between doctors (OR 2.03, 95% CI 1.86 to 2.22); and chart reviews and benchmarking to the rates achieved by the top 10% of physicians (OR 3.43, 95% CI 2.37 to 4.97).\n\nThe reviewers were unable to meta‐analyse 4 studies that looked at physician reminders (the 95% CI was entirely above unity in 3 trials implying all 3 interventions increased vaccination rates) and 3 studies of facilitator encouragement of vaccination (the 95% CI was entirely above unity in 2 trials implying both interventions increased vaccination rates). Interventions that were not effective were: comparing letters on discharge from hospital to letters to general practitioners; posters plus postcards versus posters alone; educational reminders, academic detailing, and peer comparisons compared to mailed educational materials; educational outreach plus feedback to teams versus written feedback; and an intervention to increase staff vaccination rates.\n\nInterventions at the societal level: No studies reported on societal‐level interventions.","The reviewers identified interventions that demonstrated significant positive effects of low (postcards), medium (personalised phone calls), and high (home visits, facilitators) intensity that increase community demand for vaccination, enhance access, and improve provider/system response. The overall GRADE assessment of the evidence was moderate quality. Conclusions are unchanged from the 2014 review."]
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[null,"Lorenc T, Marshall D, Wright K, Sutcliffe K, Sowden A (2018). Seasonal influenza vaccination of healthcare workers: evidence synthesis. London: EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London. \nAvailable here.","Occupational groups (healthcare workers)","This report by EPPI-centre presents the findings from: (1) a synthesis of evidence about seasonal flu vaccination interventions: content and components, processes, and implementation; and (2) a systematic review of qualitative studies investigating HCWs’ views, attitudes and perceptions about seasonal flu vaccination. \n\nThe reviewers identified 60 studies evaluating interventions to promote seasonal flu vaccination among HCWs. Of these, only 13 used an RCT design. The types of strategy, number of studies, strength of evidence and likely effectiveness are presented in the summary table, overleaf. Most of the RCTs focused on increasing awareness, or on education. Few RCTs evaluated strategies to increase access, or incentives, and none assessed mandatory vaccination programmes. Most interventions combined several different elements and this is likely to be the most promising approach, as components are likely to work in different ways, and for different people. Most RCTs were conducted either in hospitals or in long-term care (e.g., nursing homes).\n\nThree studies were conducted in the UK (two RCTs), mainly focusing on increasing awareness or education. Most interventions appear not to have been based on any clear theoretical framework, or on any formative research or substantive engagement with HCWs themselves. Most non-mandatory interventions focused on individual beliefs, rather than on the social or institutional factors which may affect vaccination uptake. Data on implementation indicate that it is important to ensure adequate resources and management support; to address HCWs’ beliefs about vaccination; and to collect accurate data on vaccination coverage.\n\nThe findings from 25 qualitative studies. The data indicated a number of personal beliefs which may be barriers to vaccination, including perceived low risk of influenza, fear of side-effects of the vaccine, and scepticism about vaccine effectiveness. There were serious barriers to the acceptability of some interventions, particularly coercive mandatory policies, but also some educational or awareness-raising strategies.\n","The review concluded that bringing together the findings from the quantitative and qualitative studies, it appears that HCWs have clear views about their needs and priorities in relation to seasonal flu\nvaccination, which were mostly not addressed by the evaluated interventions. \n\nThe key messages were:\n- Promising interventions combine several components, including individual, social and environmental elements\n- Education alone is probably ineffective, but broader awareness-raising strategies appear promising\n- Increasing access to vaccination may be effective, but the evidence is weak with few RCTs\n- Both “soft” and “hard” mandates appear promising, but have yet to be evaluated using robust study designs, and may have limited acceptability\n- Interventions should ideally target everyone working in a healthcare context, but this may be practically difficult\n- The culture and context of the organisation(s), within which interventions are implemented, may have an important influence on outcomes. Evaluators should seek\nto understand interventions within an organisational system\n- Very few interventions engaged with HCWs to understand their needs and priorities\n- Intervention developers/implementers should engage with HCWs to understand their views, conduct formative research and pilot interventions before full-scale evaluation\n- Mixed-methods research to understand the context, in which an intervention will be implemented, and HCWs’ likely responses to an intervention, may be valuable"]
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[null,"Till  SR et al. Incentives for increasing prenatal care use by women in order to improve maternal and neonatal outcomes. Cochrane Database of Systematic Reviews 2015, Issue 12. Art. No.: CD009916. DOI: 10.1002/14651858.CD009916.pub2.\nAvailable here.","High risk groups (pregnant women)","This Cochrane review aimed to determine whether incentives are an effective tool to increase utilization of timely prenatal care among women.\n\nThe review authors identified 11 studies (19 reports), six of which we excluded. Five studies, involving 11,935 pregnancies were included, but only 1893 pregnancies contributed data regarding our specified outcomes. Incentives in the studies included cash, gift card, baby carrier, baby blanket or taxicab voucher and were compared with no incentives. Meta‐analysis was performed for only one outcome 'Return for postpartum care' and this outcome was not pre‐specified in their protocol. Other analyses were restricted to data from single studies.\n\nThe five included studies of incentive programs did not report any of this review's primary outcomes: preterm birth, small‐for‐gestational age, or perinatal death.\n\nIn terms of this review's secondary outcomes, pregnant women receiving incentives were no more likely to initiate prenatal care (risk ratio (RR) 1.04, 95% confidence interval (CI) 0.78 to 1.38, one study, 104 pregnancies). Pregnant women receiving incentives were more likely to attend prenatal visits on a frequent basis (RR 1.18, 95% CI 1.01 to 1.38, one study, 606 pregnancies) and obtain adequate prenatal care defined by number of “procedures” such as testing blood sugar or blood pressure, vaccinations and counseling about breastfeeding and birth control (mean difference (MD) 5.84, 95% CI 1.88 to 9.80, one study, 892 pregnancies). In contrast, women who received incentives were more likely to deliver by cesarean section (RR 1.97, 95% CI 1.18 to 3.30, one study, 979 pregnancies) compared to those women who did not receive incentives.","The included studies did not report on this review's main outcomes: preterm birth, small‐for‐gestational age, or perinatal death. There is limited evidence that incentives may increase utilization and quality of prenatal care, but may also increase cesarean rate. Overall, there is insufficient evidence to fully evaluate the impact of incentives on prenatal care initiation. \n\nThere is a need for high‐quality RCTs to determine whether incentive program increase prenatal care use and improve maternal and neonatal outcomes. Incentive programs, in particular cash‐based programs, as suggested in this review and in several observational studies may improve the frequency and ensure adequate quality of prenatal care. No peer‐reviewed data have been made publicly available for one of the largest incentive‐based prenatal programs – the statewide Medicaid‐based programs within the United States. These observational data represent an important starting point for future research with significant implications for policy development and allocation of healthcare resources. The disparate findings related to attending postpartum care should also be further explored as the findings were limited by the number of studies. Future large RCTs are needed to focus on the outcomes of preterm birth, small‐for‐gestational age and perinatal outcomes."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Client or Family Incentive Rewards. The Community Guide; 2015. \nAvailable here.","Adults ","The CPSTF recommends client or family incentive rewards, used alone or in combination with additional interventions, based on sufficient evidence of effectiveness in increasing vaccination rates in children and adults.\n\nThis Task Force finding is based on evidence from a Community Guide systematic review completed in 2011 (6 studies with 7 study arms, search period 1980-2009) combined with more recent evidence (1 study, search period 2009-2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on sufficient evidence of effectiveness.\n\nIncluded studies showed vaccination rates increased by a median of 8 percentage points (interquartile interval [IQI]: 4 to 16 percentage points). Two study arms that assessed the effectiveness of incentive rewards alone showed similar changes in vaccination rates (8.5 and 9.0 percentage points). In the six remaining study arms, incentive rewards were combined with additional interventions.\n\nAmong the studies included in this review, the type of incentive reward offered to clients included 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. \n\nOverall, the Task Force considers the evidence to be applicable to vaccinations for children and adults in a wide range of clinical and community settings, and for various types of incentive rewards.","This CPSTF report concludes that client or family incentive rewards can also be one component of an effective combined approach to increase vaccination rates in both clinical and community settings. Based on updated, concurrent reviews the Task Force finds strong evidence to recommend health care system-based interventions implemented in combination and community-based\ninterventions implemented in combination.\n\nAdditional research could focus on the independent effects of incentive rewards, examine the relationship between the value of the reward and effectiveness, and explore the duration of intervention impact. It also would be useful to have more information about the effectiveness of these interventions with adolescents and adults as most of the included studies examined the use of incentive rewards on vaccination rates for children."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Reducing Client Out-of-Pocket Costs for Vaccinations. The Community Guide; 2014. \nAvailable here.","Adults ","The CPSTF recommends interventions that reduce client out-of-pocket costs based on strong evidence of effectiveness in improving vaccination rates. The effectiveness of these interventions has been demonstrated among children, adolescents, and adults, in a range of settings and populations, when applied in varying levels of scale from individual clinical settings to statewide programs to national efforts, and whether used alone or as part of a multi-component intervention.\n\nThis Task Force finding is based on evidence from a Community Guide systematic review completed in 2009 (15 studies; search period 1997 - 2009) combined with more recent evidence (5 studies, search period 2009 - 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\n\nEleven studies provided a common measurement of change in vaccination rates and showed a median increase of 22 percentage points (IQI: 6 to 33 percentage points). Six studies examined the impact of reducing client out-of-pocket costs alone (median increase of 28 percentage points; IQI: 2 to 47 percentage points) and 5 studies examined reducing client out-of-pocket costs as part of a multi-component strategy (median increase of 20 percentage points; IQI: 6 to 20 percentage points). The nine qualifying studies that did not provide a common measurement of change also reported overall increases in vaccinations received or administered.\n\nIncluded studies evaluated intervention effects on childhood vaccination series (3 studies), influenza (9 studies), pneumococcal (6 studies), hepatitis B (2 studies), and human papilloma virus (1 study). The reviewed studies evaluated the effectiveness of interventions that reduced client out-of-pocket costs in a range of client and provider populations and settings.\n\nPolicies adopted in the United States, including the Federal Vaccines for Children Program and the Affordable Care Act, have expanded access to many vaccines at reduced out-of-pocket cost. Barriers to expanded implementation of efforts include the adequacy and timeliness of reimbursement for the costs of vaccines, storage, and administration. In the United States, the ability of health care systems and providers to implement these interventions may depend on the adequacy and timeliness of reimbursement for the costs of the vaccines, storage, and administration.","This CPSTF report concludes that additional research is needed to determine the effectiveness of reducing client out-of-pocket cost interventions to increase rates of recommended vaccinations for adolescents (e.g., HPV, meningococcal, influenza). In addition, the Task Force suggests additional research to determine if these interventions are effective options to increase receipt of annual influenza vaccinations. Future research should also examine whether reducing client out-of-pocket cost interventions are essential components of school-based vaccination programs and on-site vaccination programs in general."]

{"sheet":"Health literacy","index":8,"n_rows":345,"n_cols":5,"rows_kept":345,"cut":false,"hidden":false,"merged":[[24,1,24,4],[26,1,43,1],[26,2,43,2],[26,3,43,4],[318,1,342,1],[318,2,342,2],[318,3,343,3],[318,4,343,4],[144,3,173,3],[144,4,173,4],[174,1,217,1],[174,2,217,2],[174,3,217,3],[174,4,217,4],[69,1,85,1],[69,2,85,2],[69,3,85,4],[144,1,173,1],[44,1,53,1],[44,2,53,2],[44,3,53,4],[89,1,143,1],[89,2,143,2],[89,3,143,3],[89,4,143,4],[87,1,87,4],[54,1,68,1],[54,2,68,2],[54,3,68,4],[144,2,173,2],[344,1,371,1],[344,2,371,2],[344,3,373,3],[344,4,371,4],[218,4,248,4],[249,1,289,1],[249,2,289,2],[249,3,289,3],[218,1,248,1],[218,2,248,2],[218,3,248,3],[249,4,289,4],[290,1,317,1],[290,2,317,2],[290,3,317,3],[290,4,317,4]]}
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[null,"ADRAN CANLLAWIAU: - LLYTHRENNEDD IECHYD"]
[null,"Ffynhonnell:","Cynulleidfa:","Argymhellion:"]
[null,"National Institute for Health and Care Excellence. Tuberculosis. NG33. London: NICE; 2016.\nAvailable here.\nLast updated in September 2019.","This guideline is for: \n- Healthcare professionals and TB multidisciplinary teams\n- Substance misuse services, prisons and immigration removal centres\n- Local government and commissioners\n- TB control boards, directors of public health and public health consultants\n- Public Health England and NHS England\n- Voluntary sector workers\n- People with TB and their carers","This guideline covers preventing, identifying and managing latent and active tuberculosis (TB) in children, young people and adults. It aims to improve ways of finding people who have TB in the community and recommends that everyone under 65 with latent TB should be treated. It describes how TB services should be organised, including the role of the TB control board.\n\nIt includes recommendations on:\n- Preventing TB, including in under-served groups\n- Diagnosing and managing latent TB, including recommendations specifically for children and young people\n- Diagnosing and managing active TB, including recommendations specifically for children and young people\n- Drug-resistant TB\n- Infection control\n- Case finding and adherence, treatment completion and follow-up, including in under-served groups\n- Service organisation"]
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[null,"National Institute for Health and Care Excellence. Hepatitis B and C testing: people at risk of infection. PH43. London: NICE; 2012.\nAvailable here.\nLast updated in March 2013.","This public health guidance is relevant to:\n- Commissioners and providers\n- People at increased risk of viral hepatitis\n- Members of the public","This guideline covers raising awareness of and testing for hepatitis B and C infection. It aims to ensure that people at increased risk of hepatitis B and C infection are tested.\n\nIt  includes recommendations on:\n- Raising awareness about hepatitis B and C among the general population and people at increased risk of infection\n- Education and training for professionals who provide services for people at increased risk of infection\n- Testing for hepatitis B and C in primary care, prisons and immigration removal centres, drugs services, and sexual health and genitourinary medicine clinics\n- Tracing close contacts of people with hepatitis B infection\n- Neonatal hepatitis B vaccination\n- Commissioning integrated services for testing and treatment and laboratory services for testing"]
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[null,"National Institute for Health and Care Excellence. Immunisations: reducing differences in uptake in under 19s. PH21. London: NICE; 2009.\nAvailable here.\nLast updated in September 2017.","This public health guidance is relevant to:\n- Healthcare professionals\n- Commissioners and providers\n- People who work in children’s services and local authorities\n- People who work in schools, colleges and workplaces\n- People who work in the private, voluntary and community sectors\n- Parents, carers and young people","This guideline covers increasing immunisation uptake among children and young people aged under 19 years in groups and settings where immunisation coverage is low. It aims to improve access to immunisation services and increase timely immunisation of children and young people. It also aims to ensure babies born to mothers infected with hepatitis B are immunised.\n\nIt includes recommendations on:\n- Immunisation programmes\n- Information systems for recording immunisation status\n- Training for staff involved in immunisation services\n- Contribution of nurseries, schools and further education colleges\n- Targeting groups at risk of not being fully immunised\n- Hepatitis B immunisation for infants"]
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[null,"National Institute for Health and Care Excellence. Drug misuse in over 16s: psychosocial interventions. CG51. London: NICE; 2007.\nAvailable here.\nLast checked in July 2016.","This clinical guidance is relevant to:\n- Healthcare professionals\n- Commissioners and providers\n- People who work in specialist residential and community-based treatment settings\n- People who work in prisons and criminal justice settings\n- Adults and young people over 16 who misuse opioids, stimulants or cannabis and their families and carers","This guideline covers using psychosocial interventions to treat adults and young people over 16 who have a problem with or are dependent on opioids, stimulants or cannabis. It aims to reduce illicit drug use and improve people’s physical and mental health, relationships and employment.\n\nIt includes recommendations on:\n- Principles for supporting people who misuse drugs and their families and carers\n- Identification and assessment of drug misuse\n- Brief interventions and self-help\n- Formal psychosocial interventions\n- Residential, prison and inpatient care"]
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[null,"ADRAN ADOLYGIAD SYSTEMATIG - LLYTHRENNEDD IECHYD"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau'r awduron:"]
[null,"Abdullahi  et al. Improving vaccination uptake among adolescents. Cochrane Database of Systematic Reviews 2020, Issue 1. Art. No.: CD011895. DOI: 10.1002/14651858.CD011895.pub2.\nAvailable here.","Adults (under 19s)","This Cochrane review aimed to evaluate the effects of interventions to improve vaccine uptake among adolescents.\n\nThe reviewers' included 16 studies (eight individually randomised trials, four cluster randomised trials, three non‐randomised trials, and one controlled before‐after study). Twelve studies were conducted in the USA, while there was one study each from: Australia, Sweden, Tanzania, and the UK. Ten studies had unclear or high risk of bias. They categorised interventions as recipient‐oriented, provider‐oriented, or health systems‐oriented.\n\nThe interventions targeted adolescent boys or girls or both (seven studies), parents (four studies), and providers (two studies). Five studies had mixed participants that included adolescents and parents, adolescents and healthcare providers, and parents and healthcare providers. The outcomes included uptake of human papillomavirus (HPV) (11 studies); hepatitis B (three studies); and tetanus–diphtheria–acellular–pertussis (Tdap), meningococcal, HPV, and influenza (three studies) vaccines among adolescents.\n\nHealth education improves HPV vaccine uptake compared to usual practice (RR 1.43, 95% CI 1.16 to 1.76; I² = 0%; 3 studies, 1054 participants; high‐certainty evidence). In addition, one large study provided evidence that a complex multi‐component health education intervention probably results in little to no difference in hepatitis B vaccine uptake compared to simplified information leaflets on the vaccine (RR 0.98, 95% CI 0.97 to 0.99; 17,411 participants; moderate‐certainty evidence).\n\nFinancial incentives may improve HPV vaccine uptake compared to usual practice (RR 1.45, 95% CI 1.05 to 1.99; 1 study, 500 participants; low‐certainty evidence). However, we are uncertain whether combining health education and financial incentives has an effect on hepatitis B vaccine uptake, compared to usual practice (RR 1.38, 95% CI 0.96 to 2.00; 1 study, 104 participants; very low certainty evidence).\n\nMandatory vaccination probably leads to a large increase in hepatitis B vaccine uptake compared to usual practice (RR 3.92, 95% CI 3.65 to 4.20; 1 study, 6462 participants; moderate‐certainty evidence).\n\nProvider prompts probably make little or no difference compared to usual practice, on completion of Tdap (OR 1.28, 95% CI 0.59 to 2.80; 2 studies, 3296 participants), meningococcal (OR 1.09, 95% CI 0.67 to 1.79; 2 studies, 3219 participants), HPV (OR 0.99, 95% CI 0.55 to 1.81; 2 studies, 859 participants), and influenza (OR 0.91, 95% CI 0.61 to 1.34; 2 studies, 1439 participants) vaccination schedules (moderate‐certainty evidence).\n\nProvider education with performance feedback may increase the proportion of adolescents who are offered and accept HPV vaccination by clinicians, compared to usual practice. Compared to adolescents visiting non‐participating clinicians (in the usual practice group), the adolescents visiting clinicians in the intervention group were more likely to receive the first dose of HPV during preventive visits (5.7 percentage points increase) and during acute visits (0.7 percentage points for the first and 5.6 percentage points for the second doses of HPV) (227 clinicians and more than 200,000 children; low‐certainty evidence).\n\nA class‐based school vaccination strategy probably leads to slightly higher HPV vaccine uptake than an age‐based school vaccination strategy (RR 1.09, 95% CI 1.06 to 1.13; 1 study, 5537 participants; moderate‐certainty evidence).\n\nA multi‐component provider intervention (including an education session, repeated contacts, individualised feedback, and incentives) probably improves uptake of HPV vaccine compared to usual practice (moderate‐certainty evidence).\n\nA multi‐component intervention targeting providers and parents involving social marketing and health education may improve HPV vaccine uptake compared to usual practice (RR 1.41, 95% CI 1.25 to 1.59; 1 study, 25,869 participants; low‐certainty evidence).","The authors conclude that various strategies have been evaluated to improve adolescent vaccination including health education, financial incentives, mandatory vaccination, and class‐based school vaccine delivery. However, most of the evidence is of low to moderate certainty. This implies that while this research provides some indication of the likely effect of these interventions, the likelihood that the effects will be substantially different is high. \n\nTherefore, additional research is needed to further enhance adolescent immunisation strategies, especially in low‐ and middle‐income countries where there are limited adolescent vaccination programmes. In addition, it is critical to understand the factors that influence hesitancy, acceptance, and demand for adolescent vaccination in different settings. This is the topic of an ongoing Cochrane qualitative evidence synthesis, which may help to explain why and how some interventions were more effective than others in increasing adolescent HPV vaccination coverage."]
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[null,"Jacobson Vann  JC et al. Patient reminder and recall interventions to improve immunization rates. Cochrane Database of Systematic Reviews 2018, Issue 1. Art. No.: CD003941. DOI: 10.1002/14651858.CD003941.pub3. \nAvailable here.","Adults","This Cochrane review aimed to evaluate and compare the effectiveness of various types of patient reminder and recall interventions to improve receipt of immunizations.\n\nThe 75 included studies involved child, adolescent, and adult participants in outpatient, community‐based, primary care, and other settings in 10 countries.\n\nPatient reminder or recall interventions, including telephone and autodialer calls, letters, postcards, text messages, combination of mail or telephone, or a combination of patient reminder or recall with outreach, probably improve the proportion of participants who receive immunization (RR of 1.28, 95% CI 1.23 to 1.35; risk difference of 8%) based on moderate certainty evidence from 55 studies with 138,625 participants.\n\nThree types of single‐method reminders improve receipt of immunizations based on high certainty evidence: the use of postcards (RR 1.18, 95% CI 1.08 to 1.30; eight studies; 27,734 participants), text messages (RR 1.29, 95% CI 1.15 to 1.44; six studies; 7772 participants), and autodialer (RR 1.17, 95% CI 1.03 to 1.32; five studies; 11,947 participants). Two types of single‐method reminders probably improve receipt of immunizations based on moderate certainty evidence: the use of telephone calls (RR 1.75, 95% CI 1.20 to 2.54; seven studies; 9120 participants) and letters to patients (RR 1.29, 95% CI 1.21 to 1.38; 27 studies; 81,100 participants).\n\nBased on high certainty evidence, reminders improve receipt of immunizations for childhood (RR 1.22, 95% CI 1.15 to 1.29; risk difference of 8%; 23 studies; 31,099 participants) and adolescent vaccinations (RR 1.29, 95% CI 1.17 to 1.42; risk difference of 7%; 10 studies; 30,868 participants). Reminders probably improve receipt of vaccinations for childhood influenza (RR 1.51, 95% CI 1.14 to 1.99; risk difference of 22%; five studies; 9265 participants) and adult influenza (RR 1.29, 95% CI 1.17 to 1.43; risk difference of 9%; 15 studies; 59,328 participants) based on moderate certainty evidence. They may improve receipt of vaccinations for adult pneumococcus, tetanus, hepatitis B, and other non‐influenza vaccinations based on low certainty evidence although the confidence interval includes no effect of these interventions (RR 2.08, 95% CI 0.91 to 4.78; four studies; 8065 participants).","The reviewers conclude that patient reminder and recall systems, in primary care settings, are likely to be effective at improving the proportion of the target population who receive immunizations."]
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[null,"Lorenc T, Marshall D, Wright K, Sutcliffe K, Sowden A (2018). Seasonal influenza vaccination of healthcare workers: evidence synthesis. London: EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London. \nAvailable here.","Occupational groups (healthcare workers)","This report by EPPI-centre presents the findings from: (1) a synthesis of evidence about seasonal flu vaccination interventions: content and components, processes, and implementation; and (2) a systematic review of qualitative studies investigating HCWs’ views, attitudes and perceptions about seasonal flu vaccination. \n\nThe reviewers identified 60 studies evaluating interventions to promote seasonal flu vaccination among HCWs. Of these, only 13 used an RCT design. The types of strategy, number of studies, strength of evidence and likely effectiveness are presented in the summary table, overleaf. Most of the RCTs focused on increasing awareness, or on education. Few RCTs evaluated strategies to increase access, or incentives, and none assessed mandatory vaccination programmes. Most interventions combined several different elements and this is likely to be the most promising approach, as components are likely to work in different ways, and for different people. Most RCTs were conducted either in hospitals or in long-term care (e.g., nursing homes).\n\nThree studies were conducted in the UK (two RCTs), mainly focusing on increasing awareness or education. Most interventions appear not to have been based on any clear theoretical framework, or on any formative research or substantive engagement with HCWs themselves. Most non-mandatory interventions focused on individual beliefs, rather than on the social or institutional factors which may affect vaccination uptake. Data on implementation indicate that it is important to ensure adequate resources and management support; to address HCWs’ beliefs about vaccination; and to collect accurate data on vaccination coverage.\n\nThe findings from 25 qualitative studies. The data indicated a number of personal beliefs which may be barriers to vaccination, including perceived low risk of influenza, fear of side-effects of the vaccine, and scepticism about vaccine effectiveness. There were serious barriers to the acceptability of some interventions, particularly coercive mandatory policies, but also some educational or awareness-raising strategies.\n","The review concluded that bringing together the findings from the quantitative and qualitative studies, it appears that HCWs have clear views about their needs and priorities in relation to seasonal flu\nvaccination, which were mostly not addressed by the evaluated interventions. \n\nThe key messages were:\n- Promising interventions combine several components, including individual, social and environmental elements\n- Education alone is probably ineffective, but broader awareness-raising strategies appear promising\n- Increasing access to vaccination may be effective, but the evidence is weak with few RCTs\n- Both “soft” and “hard” mandates appear promising, but have yet to be evaluated using robust study designs, and may have limited acceptability\n- Interventions should ideally target everyone working in a healthcare context, but this may be practically difficult\n- The culture and context of the organisation(s), within which interventions are implemented, may have an important influence on outcomes. Evaluators should seek\nto understand interventions within an organisational system\n- Very few interventions engaged with HCWs to understand their needs and priorities\n- Intervention developers/implementers should engage with HCWs to understand their views, conduct formative research and pilot interventions before full-scale evaluation\n- Mixed-methods research to understand the context, in which an intervention will be implemented, and HCWs’ likely responses to an intervention, may be valuable"]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Clinic-based Client Education\nWhen Used Alone. The Community Guide; 2016. \nAvailable here.","Adults (older: age not specified)","This report aimed to determine the effectiveness of clinic-based client education interventions when implemented alone in increasing vaccination rates or reducing rates of vaccine preventable illness and found insufficient evidence. Four of the included studies provided sufficient evidence of effectiveness but were limited to immunizations for pneumococcal polysaccharide vaccine among older adults with very low baseline coverage. The Task Force finding reflects concerns about the intervention's applicability to a broader range vaccinations, populations, and clinic-based settings.\n\nThis Task Force finding is based on evidence from a Community Guide systematic review completed in 2011 (4 studies with 6 study arms, search period 1980-2009) combined with more recent evidence (1 study, search period 2009-2012). Based on the combined evidence, the Task Force reaffirms its finding of insufficient evidence. The combined Task Force review included five studies. Four studies with six study arms providing a common measurement of change in vaccination rates. Although the median change in vaccination rates was an increase of 10 percentage points (IQR: 3 to 19 percentage points), results were dominated by findings from three related study arms focused on increasing pneumococcal polysaccharide vaccinations among older adult patients in one clinical setting. Changes in vaccination rates from the other three study arms were inconsistent and smaller in magnitude. The final study did not evaluate changes in vaccination rates, and found only a very small change in the proportion of tetanus booster doses administered with the use of an audiovisual message in clinic waiting areas.\n\nTwo studies included in this review implemented a potentially useful educational approach to increase vaccination rates by prompting discussions between the client and their vaccination provider. In these studies, an educational brochure distributed to patients in the waiting area included a specific request for a discussion with their provider about the pneumococcal polysaccharide vaccine. In both studies, use of the brochure increased vaccination rates by 16 percentage points in a client population with very low baseline rates. \n\nClinic-based client education can be one component of an effective combined approach to increase vaccination rates. The Task Force finds strong evidence to recommend health care system-based interventions implemented in combination and community-based interventions implemented in combination.","This CPSTF report states that although the evidence identified in this systematic review is small and inconsistent, at least one format demonstrates sufficient evidence of effectiveness. The Task Force considers the applicability of this educational approach to other vaccines and populations an important question for further study.\n"]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Community-Wide Education When Used Alone. The Community Guide; 2015. \nAvailable here.","Adults (older: age not specified)","This report aimed to determine the effectiveness of community-wide education interventions when implemented alone in increasing vaccination rates or reducing rates of vaccine preventable illness and found insufficient evidence. Evidence is considered insufficient due to inconsistent results and concerns about the applicability of evidence to more diverse communities in the United States where improvements in vaccination rates are needed.\n\nThis Task Force finding is based on evidence from a Community Guide systematic review completed in 2010 (6 studies with 8 study arms, search period 1980-2009) combined with more recent evidence (1 study, search period 2009- February 2012). Based on the combined evidence, the Task Force reaffirms its finding of insufficient evidence.\n\nThe Task Force considered evidence from 7 studies with 9 study arms. Among the studies providing a common measure of change in vaccination rates (4 studies with 6 arms) there was a median increase of 6 percentage points (range of values: 0.4 to 12.2 percentage points).\n\nThree studies evaluated mass media activities using different measures of change. In a targeted community in Australia, pneumococcal vaccines dispatched to service providers increased during the period of a mass media campaign. In Finland, a mass media campaign briefly increased MMR vaccine receipt for children 6 years of age, though changes were not reported for younger children. In the U.S., a mass media campaign addressing flu-related topics among a nationally representative population of older adults found a positive association between flu-related media reports and influenza vaccination rates in the weeks following the campaign (annual vaccination rates increased by 2.3-7.9 percentage points, p<0.001).\n\nOne U.S. study observed moderate increases in vaccination rates for hepatitis B vaccine following intensive communitywide educational efforts in two Vietnamese-American communities. Characteristics of the study communities that may have contributed to intervention effectiveness included: (1) popular Vietnamese-language media, (2) established Vietnamese service organizations, and (3) culturally appropriate strategies and materials.\n\nCommunity-wide education is commonly implemented in combination with additional interventions (such as efforts to expand and enhance access to vaccinations). In another review, the Task Force found strong evidence of effectiveness for community-based interventions implemented in combination to increase vaccination rates, and five of the included studies used community-wide education in the combination of interventions.","This CPSTF report states that although the evidence identified in this systematic review is insufficient to determine the effectiveness of community-wide education when implemented alone, two studies suggest that these interventions may be useful with certain communities. More research is needed to understand the potential applicability of these interventions to other populations, and for other vaccines.\n\nThe Task Force acknowledges an important role for mass media (and the potential role of social media) in disseminating\ninformation to large audiences and shaping public attitudes and behaviours.\n\nVaccine manufacturers have been increasing direct-to-consumer mass and small media advertising to promote new vaccines. While evidence from private sector marketing campaigns on vaccine uptake was not included in this review, the Task Force considered the applicability of these marketing experiences to public health efforts. They determined that community-wide educational efforts may have greater impact when used to inform members of the community about new vaccines (such as HPV), or new recommendations (such as the universal recommendation for seasonal influenza), and in situations of public health urgency (such as the H1N1 pandemic). The effectiveness of community-wide education to increase vaccination rates in these circumstances remains an important issue for further evaluation research.\n"]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Provider Assessment and Feedback. The Community Guide; 2015. \nAvailable here.","Adults","The CPSTF recommends assessment and feedback for vaccination providers on the basis of strong evidence of effectiveness in increasing vaccination rates: (1) among adults and children; (2) when used alone or with additional interventions; and (3) across a range of settings and populations. While there was not enough evidence to determine which characteristics of assessment and feedback contributed most to its effectiveness, various strategies have been consistently effective in a wide range of contexts.\n\nThe Task Force finding is based on evidence from a Community Guide systematic review completed in 2008 (19 studies, search period 1997–2007) combined with more recent evidence (1 study, search period 2007–February 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\n\nThe Task Force considered evidence from 20 studies. Of these, 16 studies with 20 study arms provided common measurements of change in vaccination rates. The median increase of 9 percentage points (IQI: 3 to 14 percentage points). Fifteen study arms provided sufficient information to calculate the change in vaccination rates and showed a median increase of 18.0% (IQI: 9.5% to 24.0%). Seven study arms evaluated the impact of assessment and feedback for providers when implemented alone and found a median increase of 11 percentage points (IQI: 7 to 12 percentage points). Thirteen study arms evaluated provider assessment and feedback with additional interventions and observed a median increase of 6 percentage points (IQI: 3 to 18 percentage points). One additional study did not provide a common measurement of change in vaccination rates, and reported no change after implementation of intervention.\n\nThe reviewed studies evaluated the impact of assessment and feedback for vaccination providers in a wide range of target populations and settings, and for most vaccines appropriate for adults or children. While no studies specifically evaluated the impact of assessment and feedback for vaccination of adolescents, evidence from this review is likely applicable to this population.","This CPSTF report concludes that none of the studies identified in this review evaluated the impact of provider assessment and feedback interventions on the delivery of vaccines to adolescents. Future studies should examine the effectiveness of these interventions in increasing vaccination rates among adolescents."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Provider Education When Used Alone. The Community Guide; 2015. \nAvailable here.","Not specified","The CPSTF finds insufficient evidence to determine the effectiveness of provider education interventions when implemented alone in improving vaccination rates or reducing vaccine-preventable illness. Evidence is considered insufficient because the six identified studies observed changes in vaccination rates that were both small in magnitude and inconsistent.\n\nThis Task Force finding is based on evidence from a Community Guide systematic review completed in 2010 (5 studies with 6 study arms, search period 1980-2009) combined with more recent evidence (1 study, search period 2009-2012). Based on the combined evidence, the Task Force reaffirms its finding of insufficient effectiveness.\n\nThe Task Force review included six studies that provided seven measurements of change in vaccination rates. The overall median absolute increase in vaccination rates was 4 percentage points (interquartile interval: 2 to 4 percentage points), however none of the study effect estimates were statistically significant, and results were inconsistent across the small body of evidence.\n\nThe Task Force identified, but did not consider in this review, an emerging body of evidence on the education of vaccination providers on the process of quality improvement. Education about quality improvement with the goal of reducing missed opportunities for vaccination and increasing vaccination rates was considered as a distinct intervention from provider education focused on vaccines and vaccinations.\n\nProvider education can be one component of an effective, combined approach to increase vaccination rates. Based on strong evidence of effectiveness identified in updated reviews, the Task Force recommends health care system-based interventions implemented in combination and community-based interventions implemented in combination.\n","This CPSTF report concludes that despite the common and continued use of provider education interventions alone, there are few published studies on their effectiveness.\n\nOne potential area for continued intervention research is provider education regarding new vaccines and expanded recommendations for specific vaccinations. As vaccine recommendations and schedules from the Advisory Committee on Immunization Practices continue to evolve, the potential effectiveness of provider education in increasing or improving the implementation of new recommendations warrants continued research.\n\nNone of the included studies assessed the effectiveness of provider education through distance-based training. Newer educational approaches might increase opportunities for vaccination providers to both share and learn from the experiences of peers and experts in the field."]
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[null,"Stokes G, Richardson M, Brunton G, Khatwa M, Thomas J (2015) Review 3: Community engagement for health via coalitions, collaborations and partnerships (on-line social media and social networks) – a systematic review and metaanalysis. London: EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London.\nAvailable here.","Adults \n\nOccupational groups (university staff)","This systematic review sought to answer the following research question:\nWhat health issues and populations have been studied using online social media/social networking?\n\nThere is evidence of health issues focused on healthy eating/physical activity, cancer detection and screening, diabetes, general wellbeing and lifestyle, sexual health, flu immunisation, food safety. However there were a low number of studies for each health topic and population. There is evidence of studies focused on populations under 25 years of age or on those over 40 years of age, but gaps in evaluated interventions in those aged under 16, 30 to 40 and over 60. There is inconsistent evidence of studies targeting women only and no evidence of studies targeting men specifically. There is inconsistent evidence of social media/social networking interventions directed to minority ethnic groups.\n\nThe studies included in this review focused on a broad range of health topics, only one RCT focussed amongst Australian university students and staff focused on influenza immunisation (Lau et al. 2012). For their study into the impact of a web-based personally controlled health management system entitled Healthy.me on influenza vaccination and health service utilisation rates, Lau et al. (2012) incorporated social forums and messaging to allow consumers to interact with each other and with healthcare professionals. \n\nThe provider of the additional potentially active content was either automated or anonymous. The content was also provided by the health professional experts. The study described the use of a mandatory five-minute session on how to use a website. Primary analysis examined differences in the proportion of participants obtaining influenza vaccination during the study in the waitlist and PCHMS groups using the c2 test, including participants who had the opportunity to use the PCHMS but did not\ndo so. \n\nThe extent of community engagement was low (0.48 95% CI: 0.09 to 0.87). The review concluded that there is weak evidence that employing either peers or professionals to facilitate online discussions forums is seen more often to have effective outcomes. ","In summary, although the effect sizes are very small overall, QCA demonstrated that including a facilitator in the delivery of social media/social networking interventions demonstrated higher effect sizes for studies not focused on healthy eating and physical activity and which did not employ the use of theory in intervention development. Nonhealthy eating/physical activity topics focused on sexually transmitted infection prevention, cancer screening/prevention, influenza immunization and mental health promotion. The use of this combination of conditions is conceptually well supported, lending confidence to its findings. However, it must be considered that these findings are exploratory in nature and should be evaluated robustly in future intervention development and evaluation."]

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[null,"ADRAN ADOLYGIAD SYSTEMATIG - GWELLA MYNEDIAD"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau'r awduron:"]
[null,"Thomas  RE and Lorenzetti  DL. Interventions to increase influenza vaccination rates of those 60 years and older in the community. Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD005188. DOI: 10.1002/14651858.CD005188.pub4. \nAvailable here.","Adults (60 years+)","This Cochrane review aimed to assess access, provider, system, and societal interventions to increase the uptake of influenza vaccination in people aged 60 years and older in the community.\n\nThe reviewers' included 3 new RCTs for this update (total 61 RCTs; 1,055,337 participants). Trials involved people aged 60 years and older living in the community in high‐income countries. Heterogeneity limited some meta‐analyses. They assessed studies as at low risk of bias for randomisation (38%), allocation concealment (11%), blinding (44%), and selective reporting (100%). Half (51%) had missing data. We assessed the evidence as low‐quality. They identified three levels of intervention intensity: low (e.g. postcards), medium (e.g. personalised phone calls), and high (e.g. home visits, facilitators).\n\nIncreasing community demand (12 strategies, 41 trials, 53 study arms, 767,460 participants): One successful intervention that could be meta‐analysed was client reminders or recalls by letter plus leaflet or postcard compared to reminder (OR 1.11, 95% CI 1.07 to 1.15; 3 studies; 64,200 participants). Successful interventions tested by single studies were patient outreach by retired teachers (OR 3.33, 95% CI 1.79 to 6.22); invitations by clinic receptionists (OR 2.72, 95% CI 1.55 to 4.76); nurses or pharmacists educating and nurses vaccinating patients (OR 152.95, 95% CI 9.39 to 2490.67); medical students counselling patients (OR 1.62, 95% CI 1.11 to 2.35); and multiple recall questionnaires (OR 1.13, 95% CI 1.03 to 1.24).\n\nSome interventions could not be meta‐analysed due to significant heterogeneity: 17 studies tested simple reminders (the 95% CI was entirely above unity in 11 trials implying all 11 interventions increased vaccination rates); 16 tested personalised reminders (the 95% CI was entirely above unity in 12 trials implying all 12 interventions increased vaccination rates ); 2 investigated customised compared to form letters (the 95% CI was above unity in both trials implying both interventions increased vaccination rates); and 4 studies examined the impact of health risk appraisals (the 95% CI was above unity in all 4 trials implying all 4 interventions increased vaccination rates). One study of a lottery for free groceries was not effective.\n\nEnhancing vaccination access (6 strategies, 8 trials, 10 arms, 9353 participants): The reviewers meta‐analysed results from 2 studies of home visits (OR 1.30, 95% CI 1.05 to 1.61), and 2 studies that tested free vaccine compared to patient payment for vaccine (OR 2.36, 95% CI 1.98 to 2.82). They were unable to conduct meta‐analyses of 2 studies of home visits by nurses plus a physician care plan (the 95% CI was entirely above unity in both trials implying both interventions increased vaccination rates) and 2 studies of free vaccine compared to no intervention (the 95% CI was entirely above unity in both trials implying both interventions increased vaccination rates). One study of group visits (OR 27.2, 95% CI 1.60 to 463.3) was effective, and 1 study of home visits compared to safety interventions was not.\n\nProvider‐ or system‐based interventions (11 strategies, 15 trials, 17 arms, 278,524 participants): One successful intervention that could be meta‐analysed focused on payments to physicians (OR 2.22, 95% CI 1.77 to 2.77). Successful interventions tested by individual studies were: reminding physicians to vaccinate all patients (OR 2.47, 95% CI 1.53 to 3.99); posters in clinics presenting vaccination rates and encouraging competition between doctors (OR 2.03, 95% CI 1.86 to 2.22); and chart reviews and benchmarking to the rates achieved by the top 10% of physicians (OR 3.43, 95% CI 2.37 to 4.97).\n\nThe reviewers were unable to meta‐analyse 4 studies that looked at physician reminders (the 95% CI was entirely above unity in 3 trials implying all 3 interventions increased vaccination rates) and 3 studies of facilitator encouragement of vaccination (the 95% CI was entirely above unity in 2 trials implying both interventions increased vaccination rates). Interventions that were not effective were: comparing letters on discharge from hospital to letters to general practitioners; posters plus postcards versus posters alone; educational reminders, academic detailing, and peer comparisons compared to mailed educational materials; educational outreach plus feedback to teams versus written feedback; and an intervention to increase staff vaccination rates.\n\nInterventions at the societal level: No studies reported on societal‐level interventions.","The reviewers identified interventions that demonstrated significant positive effects of low (postcards), medium (personalised phone calls), and high (home visits, facilitators) intensity that increase community demand for vaccination, enhance access, and improve provider/system response. The overall GRADE assessment of the evidence was moderate quality. Conclusions are unchanged from the 2014 review."]
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[null,"Lorenc T, Marshall D, Wright K, Sutcliffe K, Sowden A (2018). Seasonal influenza vaccination of healthcare workers: evidence synthesis. London: EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London. \nAvailable here.","Occupational groups (healthcare workers)","This report by EPPI-centre presents the findings from: (1) a synthesis of evidence about seasonal flu vaccination interventions: content and components, processes, and implementation; and (2) a systematic review of qualitative studies investigating HCWs’ views, attitudes and perceptions about seasonal flu vaccination. \n\nThe reviewers identified 60 studies evaluating interventions to promote seasonal flu vaccination among HCWs. Of these, only 13 used an RCT design. The types of strategy, number of studies, strength of evidence and likely effectiveness are presented in the summary table, overleaf. Most of the RCTs focused on increasing awareness, or on education. Few RCTs evaluated strategies to increase access, or incentives, and none assessed mandatory vaccination programmes. Most interventions combined several different elements and this is likely to be the most promising approach, as components are likely to work in different ways, and for different people. Most RCTs were conducted either in hospitals or in long-term care (e.g., nursing homes).\n\nThree studies were conducted in the UK (two RCTs), mainly focusing on increasing awareness or education. Most interventions appear not to have been based on any clear theoretical framework, or on any formative research or substantive engagement with HCWs themselves. Most non-mandatory interventions focused on individual beliefs, rather than on the social or institutional factors which may affect vaccination uptake. Data on implementation indicate that it is important to ensure adequate resources and management support; to address HCWs’ beliefs about vaccination; and to collect accurate data on vaccination coverage.\n\nThe findings from 25 qualitative studies. The data indicated a number of personal beliefs which may be barriers to vaccination, including perceived low risk of influenza, fear of side-effects of the vaccine, and scepticism about vaccine effectiveness. There were serious barriers to the acceptability of some interventions, particularly coercive mandatory policies, but also some educational or awareness-raising strategies.\n","The review concluded that bringing together the findings from the quantitative and qualitative studies, it appears that HCWs have clear views about their needs and priorities in relation to seasonal flu\nvaccination, which were mostly not addressed by the evaluated interventions. \n\nThe key messages were:\n- Promising interventions combine several components, including individual, social and environmental elements\n- Education alone is probably ineffective, but broader awareness-raising strategies appear promising\n- Increasing access to vaccination may be effective, but the evidence is weak with few RCTs\n- Both “soft” and “hard” mandates appear promising, but have yet to be evaluated using robust study designs, and may have limited acceptability\n- Interventions should ideally target everyone working in a healthcare context, but this may be practically difficult\n- The culture and context of the organisation(s), within which interventions are implemented, may have an important influence on outcomes. Evaluators should seek\nto understand interventions within an organisational system\n- Very few interventions engaged with HCWs to understand their needs and priorities\n- Intervention developers/implementers should engage with HCWs to understand their views, conduct formative research and pilot interventions before full-scale evaluation\n- Mixed-methods research to understand the context, in which an intervention will be implemented, and HCWs’ likely responses to an intervention, may be valuable"]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Vaccination Programs: Home Visits to Increase Vaccination Rates. The Community Guide; 2017. \nAvailable here.","Adults","This report examines home visits to increase vaccination rates in children and adults, leading to a Community Preventive Services Task Force (CPSTF) recommendation on the subject. 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). \n\nThe Task Force considered evidence from 23 studies of home visits, with 20 studies and 21 study arms using a common measure of change in vaccination rates. The overall effect was a median increase of 11 percentage points (IQR: 5 to 15 percentage points). Meaningful improvements were observed as a result of home visits delivered to all clients (12 study arms) and to only those clients unresponsive to other interventions (9 study arms), home visits focused on vaccination alone (12 study arms) and in combination with other health concerns (9 study arms), and home visits providing on-site vaccinations (8 study arms) and referring clients to vaccination services outside the home (13 study arms). Home visits delivered as the sole intervention (8 study arms) and home visits delivered as part of a larger healthcare system or community-based program (13 study arms) also produced meaningful change in vaccination rates.","The CPSTF recommends home visits based on strong evidence of their effectiveness in increasing vaccination rates. Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness. The Task Force notes that home visiting interventions are potentially effective in addressing a wide range of public health problems and that the focus of this review is the subset of interventions specifically addressing vaccination rates.\n\nThe report identified that more research is needed on the effectiveness and economic benefits of home visits to increase vaccination rates among adolescents and in rural settings. Additional economic research is needed to estimate the portion of home visits that can be attributed solely to improving vaccination rates when home visits include other activities and objectives."]

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[null,"ADRAN CANLLAWIAU - DULL AML-GYDRAN"]
[null,"Ffynhonnell:","Cynulleidfa:","Dull aml-gydran"]
[null,"National Institute for Health and Care Excellence. Flu vaccination: increasing uptake. NG103. London: NICE; 2018.\nAvailable here.","This guideline is for: \n- Commissioners and providers of primary and secondary healthcare services, including maternity providers and community pharmacies\n- All employers of staff who provide NHS or social-care funded services (including maternity care, domiciliary care and care homes)\n- Local authorities, and community and voluntary sector organisations that employ health and social care workers\n- Occupational health services and infection prevention and control teams\n- NHS England teams and Health Education England teams\n- People using services, their families, carers and other members of the public, in particular those eligible for flu vaccination","This guideline covers how to increase uptake of the free flu vaccination among people who are eligible. It describes ways to increase awareness and how to use all opportunities in primary and secondary care to identify people who should be encouraged to have the vaccination.\n\nIt includes recommendations on:\n- Using a multicomponent approach\n- Raising awareness\n- Offering vaccination\n- Increasing uptake among eligible groups in primary and secondary care\n- Audit, monitoring and feedback\n- Vaccination in carers\n- Increasing uptake in health and social care staff"]
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[null,"ADRAN ADOLYGIAD SYSTEMATIG - DULL AML-GYDRAN"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau'r awduron:"]
[null,"Palmer  MJ et al. Targeted client communication via mobile devices for improving maternal, neonatal, and child health. Cochrane Database of Systematic Reviews 2020, Issue 8. Art. No.: CD013679. DOI: 10.1002/14651858.CD013679.\nAvailable here.","High risk groups (pregnant women)","This Cochrane review aimed to assess the effects of TCC via MD on health behaviour, service use, health, and well‐being for maternal, neonatal and child health (MNCH).\n\nThe reviewers'  included 27 trials (17,463 participants). Trial populations were: pregnant and postpartum women (11 trials conducted in low‐, middle‐ or high‐income countries; pregnant and postpartum women living with HIV (three trials carried out in one lower middle‐income country); and parents of children under the age of five years (13 trials conducted in LMHIC). \n\nOnly two studies within the targeted client communication via mobile device versus digital non-targeted communication fulfilled the criteria of this review:\nOne study (Yudin et al. 2017) found that a mobile phone text message reinforcing that the influenza vaccine is recommended for all pregnant women and safe during pregnancy and breastfeeding compared to standard care/ no intervention, may make little or no difference to attendance for antenatal influenza vaccination (risk ratio (RR) 1.05, 95% confidence interval (CI) 0.71 to 1.58), though the CI encompasses both benefit and harm (low‐certainty evidence). \nAnother study (Lund et al. 2012) found that a multi-component approach combining mobile phone text message with voucher compared to simple health education and appointment reminders to encourage attendance to routine antenatal classes, make little or no difference to attendance for antenatal tetanus vaccine (OR 1.67, 95% CI 0.84 to 3.33). ","The authors conclude that the effect of targeted client communication via mobile devices for most outcomes is uncertain. There may be improvements for some outcomes using targeted communication but these findings were of low certainty. \n\nHigh‐quality, adequately powered trials and cost‐effectiveness analyses are required to reliably ascertain the effects and relative benefits of TCCMD. Future studies should measure potential unintended consequences, such as partner violence or breaches of confidentiality."]
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[null,"Abdullahi  LH et al. Improving vaccination uptake among adolescents. Cochrane Database of Systematic Reviews 2020, Issue 1. Art. No.: CD011895. DOI: 10.1002/14651858.CD011895.pub2.\nAvailable here.","Adults (under 19s)","This Cochrane review aimed to evaluate the effects of interventions to improve vaccine uptake among adolescents.\n\nThe reviewers' included 16 studies (eight individually randomised trials, four cluster randomised trials, three non‐randomised trials, and one controlled before‐after study). Twelve studies were conducted in the USA, while there was one study each from: Australia, Sweden, Tanzania, and the UK. Ten studies had unclear or high risk of bias. They categorised interventions as recipient‐oriented, provider‐oriented, or health systems‐oriented.\n\nThe interventions targeted adolescent boys or girls or both (seven studies), parents (four studies), and providers (two studies). Five studies had mixed participants that included adolescents and parents, adolescents and healthcare providers, and parents and healthcare providers. The outcomes included uptake of human papillomavirus (HPV) (11 studies); hepatitis B (three studies); and tetanus–diphtheria–acellular–pertussis (Tdap), meningococcal, HPV, and influenza (three studies) vaccines among adolescents.\n\nHealth education improves HPV vaccine uptake compared to usual practice (RR 1.43, 95% CI 1.16 to 1.76; I² = 0%; 3 studies, 1054 participants; high‐certainty evidence). In addition, one large study provided evidence that a complex multi‐component health education intervention probably results in little to no difference in hepatitis B vaccine uptake compared to simplified information leaflets on the vaccine (RR 0.98, 95% CI 0.97 to 0.99; 17,411 participants; moderate‐certainty evidence).\n\nFinancial incentives may improve HPV vaccine uptake compared to usual practice (RR 1.45, 95% CI 1.05 to 1.99; 1 study, 500 participants; low‐certainty evidence). However, we are uncertain whether combining health education and financial incentives has an effect on hepatitis B vaccine uptake, compared to usual practice (RR 1.38, 95% CI 0.96 to 2.00; 1 study, 104 participants; very low certainty evidence).\n\nMandatory vaccination probably leads to a large increase in hepatitis B vaccine uptake compared to usual practice (RR 3.92, 95% CI 3.65 to 4.20; 1 study, 6462 participants; moderate‐certainty evidence).\n\nProvider prompts probably make little or no difference compared to usual practice, on completion of Tdap (OR 1.28, 95% CI 0.59 to 2.80; 2 studies, 3296 participants), meningococcal (OR 1.09, 95% CI 0.67 to 1.79; 2 studies, 3219 participants), HPV (OR 0.99, 95% CI 0.55 to 1.81; 2 studies, 859 participants), and influenza (OR 0.91, 95% CI 0.61 to 1.34; 2 studies, 1439 participants) vaccination schedules (moderate‐certainty evidence).\n\nProvider education with performance feedback may increase the proportion of adolescents who are offered and accept HPV vaccination by clinicians, compared to usual practice. Compared to adolescents visiting non‐participating clinicians (in the usual practice group), the adolescents visiting clinicians in the intervention group were more likely to receive the first dose of HPV during preventive visits (5.7 percentage points increase) and during acute visits (0.7 percentage points for the first and 5.6 percentage points for the second doses of HPV) (227 clinicians and more than 200,000 children; low‐certainty evidence).\n\nA class‐based school vaccination strategy probably leads to slightly higher HPV vaccine uptake than an age‐based school vaccination strategy (RR 1.09, 95% CI 1.06 to 1.13; 1 study, 5537 participants; moderate‐certainty evidence).\n\nA multi‐component provider intervention (including an education session, repeated contacts, individualised feedback, and incentives) probably improves uptake of HPV vaccine compared to usual practice (moderate‐certainty evidence).\n\nA multi‐component intervention targeting providers and parents involving social marketing and health education may improve HPV vaccine uptake compared to usual practice (RR 1.41, 95% CI 1.25 to 1.59; 1 study, 25,869 participants; low‐certainty evidence).","The authors conclude that various strategies have been evaluated to improve adolescent vaccination including health education, financial incentives, mandatory vaccination, and class‐based school vaccine delivery. However, most of the evidence is of low to moderate certainty. This implies that while this research provides some indication of the likely effect of these interventions, the likelihood that the effects will be substantially different is high. \n\nTherefore, additional research is needed to further enhance adolescent immunisation strategies, especially in low‐ and middle‐income countries where there are limited adolescent vaccination programmes. In addition, it is critical to understand the factors that influence hesitancy, acceptance, and demand for adolescent vaccination in different settings. This is the topic of an ongoing Cochrane qualitative evidence synthesis, which may help to explain why and how some interventions were more effective than others in increasing adolescent HPV vaccination coverage."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Provider Reminders. The Community Guide; 2015. \nAvailable here.","Adults ","The CPSTF recommends provider reminders on the basis of strong evidence of effectiveness in increasing vaccination rates: (1) among adults, adolescents and children; (2) when used alone or with additional interventions; (3) across a range of intervention characteristics (e.g., computerized or simple reminders, checklists, flowcharts); and (4) in a range of settings and populations.\n\nThe Task Force finding is based on evidence from a Community Guide systematic review completed in 2008 (23 studies, search period 1997–2007) combined with more recent evidence (5 studies, search period 2007–February 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\nThe Task Force considered evidence from 28 studies. Twenty-two studies provided a measurement of change in vaccination rates, with an overall median increase of 10 percentage points (IQI: 6 to 25 percentage points). Of these, seven studies examined provider reminders alone with a median increase of 12 percentage points (IQI: 6 percentage point to 25 percentage points). Fifteen studies examined the impact of provider reminders with additional interventions and observed a median increase of 9 percentage points (IQI: 5 to 25 percentage points). Six additional studies did not provide a common measurement of change in vaccination rates; however, five of the studies provided additional support for the use of provider reminders.\n\nEvidence indicates that provider reminders remain an effective option for consideration in a wide range of clinical settings and populations. A subset of the included evidence, however, suggests that standing orders may be more effective in improving vaccination rates in both inpatient and outpatient settings than provider reminder systems.","Evidence in this CPSTF report indicates that provider reminders are effective in a wide range of contexts. Additional research should focus on system-level implementation of reminder systems, and identify strategies to encourage regular and sustained use. In addition, future research could examine or compare the effectiveness of specific reminder prompts provided as a capability of regional or state-level immunization information systems."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Community-Based Interventions Implemented in Combination. The Community Guide; 2014. \nAvailable here.","Adults","The CPSTF recommends community-based interventions implemented in combination to increase vaccinations in targeted populations, on the basis of strong evidence of effectiveness in increasing vaccination rates.\n\nThe conclusion of strong evidence was based on findings from 18 studies that evaluated coordinated interventions to:\n- Increase community demand\n- Enhance access to vaccination services, and\n- Reduce missed opportunities by vaccination providers\nIn 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.\n\nThe Task Force 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 resources are available.\n\nThis Task Force 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 - 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\n\nAll of the included studies provided a common measure of change and showed a median increase in vacation rates of 14 percentage points (IQI: 7 to 24 percentage points).\n\nThe included studies evaluated a variety of interventions in different combinations. The Task Force examined the evidence of differences attributable to specific interventions and combinations of interventions using different strategic approaches.\nFourteen studies implemented an effective combination of one or more interventions to increase community demand with one or more interventions to enhance access to vaccination services and showed a median increase in vaccination rates of 16 percentage points (IQI: 12 to 26 percentage points).\n\nClient reminder and recall systems were used in most of the evaluated programs (15 study arms). Systems were implemented by vaccination providers, established as one part of a community manual outreach and tracking program, or generated from a regional immunization information system (IIS).","This CPSTF report concludes that coordinated interventions may be especially important in communities that have wide disparities in vaccination coverage. Program planners should consider community characteristics, such as mobility and fragmentation of health care, in the selection and combination of interventions to increase vaccination rates and reduce disparities.\n\nPartnerships between community organizations and vaccination providers are likely to be an essential component of effective, sustained community-based efforts. Most studies involved partnerships with existing vaccination providers in\nthe community to increase access to vaccinations, rather than creating new vaccination services. Coalitions represent one way to establish effective partnerships, with the size of the coalition varying based on the community, targeted population, and scope of the problem. Four studies involved community coalitions that used the principles of community-based participatory research.\n\nMore evidence is needed on the effectiveness of these programs in adolescents, and when implemented in rural settings. More economic information on these interventions is needed, specifically, evaluations on the efficiencies of the resource-intensive components of manual outreach and tracking and home visits. Future research could compare program effectiveness based on differences in the component interventions and strategic combinations. Additional research also should examine ways to sustain these programs, especially when provided by existing community-based organizations."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Health Care System-Based Interventions Implemented in Combination. The Community Guide; 2014. \nAvailable here.","Adults (older: age not specified)","The CPSTF recommends health care system-based interventions implemented in combination on the basis of strong evidence of effectiveness in increasing vaccination rates in targeted client populations.\n\nBased on findings from 37 of the 64 included studies, the Task Force further recommends a combination that includes the following:\nAt least one intervention to increase client demand for vaccinations, such as:\n- Client reminder and recall systems\n- Clinic-based client education\n- Manual outreach and tracking\nAnd one or more interventions that address either, or both, of the following strategies:\n- Interventions to enhance access to vaccinations: Expanded access in health care settings, reduced client out-of-pocket costs, home visits\n- Interventions directed at vaccination providers or systems: Provider reminders, standing orders, provider assessment and feedback\n\nInterventions listed as examples for each strategy were those that showed the greatest effect on vaccination rates.\n\nThe Task Force finding is based on evidence from a Community Guide systematic review completed in 2010 (62 studies; search period 1980-2010) combined with more recent evidence (2 studies; search period 2010-February 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness. \n\nOf the combined 64 included studies (76 study arms), 58 of them (70 study arms) provided a common measure of change in vaccination rates and showed a median increase of 9 percentage points (IQI: 4 to 21 percentage points). In general, changes in vaccination rates were greater when interventions were implemented in settings with low baseline rates.\n\nThe included studies evaluated a variety of interventions in different combinations. The Task Force examined the evidence of differences attributable to specific interventions and combinations of interventions using different strategic approaches. These strategic approaches included the following:\n- Interventions to increase client demand (client reminder and recall systems, clinic-based client education, client\nor family incentives, client-held paper immunization records, case management, and manual outreach and\ntracking)\n- Interventions to enhance access to vaccination services (expanded access in health care settings, reduced client\nout-of-pocket costs, and home visits)\n- Interventions directed at vaccination providers (provider reminder systems, standing orders, provider\nassessment and feedback, provider education, and provider incentives)\n\nThe most common individual interventions implemented in a combined approach were client reminder and recall\nsystems (34 study arms) and provider reminders (31 study arms).\n\nThirty-seven studies (44 study arms) evaluated a combination of interventions across two or three of the strategic approaches and showed a median increase in vaccination rates of 17 percentage points (IQI: 6 to 27 percentage points). In 26 study arms, interventions were combined within only one strategic approach and found a median increase in vaccination rates of 4 percentage points (IQI: 2 to 9 percentage points).\n\nNine studies evaluated combinations of interventions implemented as a part of a health care system quality improvement effort. The most commonly implemented interventions were those directed at vaccination providers (provider education, provider reminders, and provider assessment and feedback). The studies included in this evaluation were typically short in duration and reported mixed results.\n\nEvidence did not show a direct relationship between the number of interventions implemented and changes in vaccination rates. Included studies evaluated combinations of between two and nine interventions. The majority of studies implemented two (31 study arms) or three (18 study arms) interventions.","This CPSTF report concludes that overall, included studies provided evidence of effectiveness for intervention combinations implemented in a range of clinical settings and communities, although evidence from rural settings was limited. Studies also demonstrated effectiveness across a range of client populations and vaccinations, including young children (childhood series, influenza) and older adults (influenza, pneumococcal, and tetanus vaccines). Two of the included studies evaluated interventions targeted at increasing vaccination rates among adolescents. Finally, the included studies demonstrated increases in vaccination rates for populations of low socioeconomic status (22 study arms) and across a range of racial and ethnic groups. Most of the included evidence evaluated client populations with low to moderate baseline vaccination rates,\nand findings are most applicable to these situations.\n\nMore evidence is needed on the effectiveness of these interventions in rural settings and when applied to increase vaccinations recommended for adolescents. Future research on quality improvement activities in these settings should incorporate study periods sufficient to evaluate continuous quality improvement efforts."]

{"sheet":"Other Int","index":11,"n_rows":71,"n_cols":5,"rows_kept":71,"cut":false,"hidden":false,"merged":[[70,1,109,1],[70,2,109,2],[70,3,111,3],[70,4,111,4],[24,1,24,4],[26,1,69,1],[26,2,69,2],[26,3,69,3],[26,4,69,4]]}
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[null,"ADRAN ADOLYGIAD SYSTEMATIG - YMYRAETHAU ERAILL"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau'r awduron:"]
[null,"Lorenc T, Marshall D, Wright K, Sutcliffe K, Sowden A (2018). Seasonal influenza vaccination of healthcare workers: evidence synthesis. London: EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London. \nAvailable here.","Occupational groups (healthcare workers)","This report by EPPI-centre presents the findings from: (1) a synthesis of evidence about seasonal flu vaccination interventions: content and components, processes, and implementation; and (2) a systematic review of qualitative studies investigating HCWs’ views, attitudes and perceptions about seasonal flu vaccination. \n\nThe reviewers identified 60 studies evaluating interventions to promote seasonal flu vaccination among HCWs. Of these, only 13 used an RCT design. The types of strategy, number of studies, strength of evidence and likely effectiveness are presented in the summary table in the full-text. Most of the RCTs focused on increasing awareness, or on education. Few RCTs evaluated strategies to increase access, or incentives, and none assessed mandatory vaccination programmes. Most interventions combined several different elements and this is likely to be the most promising approach, as components are likely to work in different ways, and for different people. Most RCTs were conducted either in hospitals or in long-term care (e.g., nursing homes).\n\nThree studies were conducted in the UK (two RCTs), mainly focusing on increasing awareness or education. Most interventions appear not to have been based on any clear theoretical framework, or on any formative research or substantive engagement with HCWs themselves. Most non-mandatory interventions focused on individual beliefs, rather than on the social or institutional factors which may affect vaccination uptake. Data on implementation indicate that it is important to ensure adequate resources and management support; to address HCWs’ beliefs about vaccination; and to collect accurate data on vaccination coverage.\n\nThe findings from 25 qualitative studies. The data indicated a number of personal beliefs which may be barriers to vaccination, including perceived low risk of influenza, fear of side-effects of the vaccine, and scepticism about vaccine effectiveness. There were serious barriers to the acceptability of some interventions, particularly coercive mandatory policies, but also some educational or awareness-raising strategies.\n","The review concluded that bringing together the findings from the quantitative and qualitative studies, it appears that HCWs have clear views about their needs and priorities in relation to seasonal flu\nvaccination, which were mostly not addressed by the evaluated interventions. \n\nThe key messages were:\n- Promising interventions combine several components, including individual, social and environmental elements\n- Education alone is probably ineffective, but broader awareness-raising strategies appear promising\n- Increasing access to vaccination may be effective, but the evidence is weak with few RCTs\n- Both “soft” and “hard” mandates appear promising, but have yet to be evaluated using robust study designs, and may have limited acceptability\n- Interventions should ideally target everyone working in a healthcare context, but this may be practically difficult\n- The culture and context of the organisation(s), within which interventions are implemented, may have an important influence on outcomes. Evaluators should seek\nto understand interventions within an organisational system\n- Very few interventions engaged with HCWs to understand their needs and priorities\n- Intervention developers/implementers should engage with HCWs to understand their views, conduct formative research and pilot interventions before full-scale evaluation\n- Mixed-methods research to understand the context, in which an intervention will be implemented, and HCWs’ likely responses to an intervention, may be valuable"]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Standing Orders. The Community Guide; 2015. \nAvailable here.","Adults","The Task Force finding is based on evidence from a Community Guide systematic review completed in 2009 (29 studies, search period 1997–2009) combined with more recent evidence (6 studies, search period 2009–February 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\n\nThe Task Force considered evidence from 35 studies. Of these, 27 studies provided a common measurement of change in vaccination rates with a median increase of 24 percentage points (IQI: 12 to 35 percentage points). Nine studies that examined the impact of standing orders alone documented a median increase of 16 percentage points (IQI: 9 to 29 percentage points). Nineteen studies that evaluated standing orders when combined with additional interventions documented a median increase of 27 percentage points (IQI: 13 to 40 percentage points). Seven studies that did not provide a common measure of change for vaccination rates all reported favorable results after implementation of standing orders.\n\nThe reviewed studies evaluated the effectiveness of standing orders across a wide range of clinical vaccination settings, health care personnel, and client populations. Standing orders were found to be effective in various settings including clinics, hospitals, and long-term care facilities. Interventions were effective when used with different vaccination providers including nurses and pharmacists. While most studies looked at adult populations, four examined intervention effectiveness among children and found a median absolute percent increase of 28 percentage points (range: 8 to 49). While no studies specifically evaluated the impact of standing orders for vaccination of adolescents, evidence from this review is likely applicable to this population. In addition, a subset of the included evidence suggests that standing orders may be more effective in improving vaccination rates in both inpatient and outpatient settings when compared to a provider reminder system.\n\nOne paper from the updated search period described the following barriers encountered during implementation of a pneumococcal vaccination standing orders program in three hospitals: gaps in staff education and training; personnel concerns about additional workload; staff reluctance to administer vaccines without a physician's order; attending physicians' resistance to having hospitalized patients vaccinated; and logistical difficulties. Some attending physicians expressed concern that vaccination would interfere with scheduled treatments or procedures. Other attending physicians did not consider inpatient stays to be an appropriate time for vaccinations (Middleton et al. 2005).\n\nAn additional study reported barriers to implementation of influenza and pneumococcal vaccination standing orders in various health care settings. Findings suggested that the adoption of these policies may have been too difficult to administer, staff were unclear or unconvinced of program benefits, and there was perceived physician discomfort with delegating responsibility for immunizations to nursing staff. A few of the respondents also indicated that resources, effectiveness of the vaccine, and time required to administer the vaccine were barriers for adoption. The majority of these barriers were specific to the administration of the influenza vaccine (Goldstein et al. 2005).","This CPSTF report concludes that standing orders were shown to be effective in increasing vaccination rates for influenza and pneumococcal vaccines. Additional research is needed, however, to determine if these interventions are effective for different vaccines (e.g. hepatitis, tetanus and vaccines recommended for adolescents). More evidence is also needed on ways to address barriers to the implementation of standing orders in health systems.\n"]

{"sheet":"Primary care","index":12,"n_rows":561,"n_cols":5,"rows_kept":561,"cut":false,"hidden":false,"merged":[[314,1,334,1],[314,2,334,2],[314,3,334,3],[314,4,334,4],[451,1,473,1],[451,2,473,2],[451,3,474,3],[451,4,473,4],[335,1,358,1],[335,2,358,2],[335,3,358,3],[335,4,358,4],[560,1,619,1],[560,2,619,2],[560,3,619,3],[560,4,619,4],[517,1,559,1],[517,2,559,2],[517,3,559,3],[517,4,559,4],[173,3,192,3],[173,4,192,4],[193,1,250,1],[193,2,250,2],[193,3,250,3],[193,4,250,4],[173,1,192,1],[173,2,192,2],[251,1,280,1],[251,2,280,2],[251,3,280,3],[251,4,280,4],[281,1,313,1],[281,2,313,2],[281,3,313,3],[281,4,313,4],[79,1,79,4],[81,1,96,1],[81,2,96,2],[19,1,19,4],[21,1,49,1],[21,2,49,2],[21,3,49,4],[50,1,67,1],[50,2,67,2],[50,3,67,4],[68,1,77,1],[68,2,77,2],[68,3,77,4],[81,3,96,3],[81,4,96,4],[118,1,172,1],[118,2,172,2],[118,3,172,3],[118,4,172,4],[97,1,117,1],[97,2,117,2],[97,3,117,3],[97,4,117,4],[475,1,514,1],[475,2,514,2],[475,3,516,3],[475,4,516,4],[359,1,394,1],[359,2,394,2],[359,3,394,3],[359,4,394,4],[395,1,425,1],[395,2,425,2],[395,3,425,3],[395,4,425,4],[426,1,450,1],[426,2,450,2],[426,3,450,3],[426,4,450,4]]}
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[null,"ADRAN CANLLAWIAU - GOFAL SYLFAENOL"]
[null,"Ffynhonnell:","Cynulleidfa:","Argymhellion:"]
[null,"National Institute for Health and Care Excellence. Flu vaccination: increasing uptake. NG103. London: NICE; 2018.\nAvailable here.","This guideline is for: \n- Commissioners and providers of primary and secondary healthcare services, including maternity providers and community pharmacies\n- All employers of staff who provide NHS or social-care funded services (including maternity care, domiciliary care and care homes)\n- Local authorities, and community and voluntary sector organisations that employ health and social care workers\n- Occupational health services and infection prevention and control teams\n- NHS England teams and Health Education England teams\n- People using services, their families, carers and other members of the public, in particular those eligible for flu vaccination","This guideline covers how to increase uptake of the free flu vaccination among people who are eligible. It describes ways to increase awareness and how to use all opportunities in primary and secondary care to identify people who should be encouraged to have the vaccination.\n\nIt includes recommendations on:\n- Using a multicomponent approach\n- Raising awareness\n- Offering vaccination\n- Increasing uptake among eligible groups in primary and secondary care\n- Audit, monitoring and feedback\n- Vaccination in carers\n- Increasing uptake in health and social care staff"]
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[null,"National Institute for Health and Care Excellence. Tuberculosis. NG33. London: NICE; 2016.\nAvailable here.\nLast updated in September 2019.","This guideline is for: \n- Healthcare professionals and TB multidisciplinary teams\n- Substance misuse services, prisons and immigration removal centres\n- Local government and commissioners\n- TB control boards, directors of public health and public health consultants\n- Public Health England and NHS England\n- Voluntary sector workers\n- People with TB and their carers","This guideline covers preventing, identifying and managing latent and active tuberculosis (TB) in children, young people and adults. It aims to improve ways of finding people who have TB in the community and recommends that everyone under 65 with latent TB should be treated. It describes how TB services should be organised, including the role of the TB control board.\n\nIt includes recommendations on:\n- Preventing TB, including in under-served groups\n- Diagnosing and managing latent TB, including recommendations specifically for children and young people\n- Diagnosing and managing active TB, including recommendations specifically for children and young people\n- Drug-resistant TB\n- Infection control\n- Case finding and adherence, treatment completion and follow-up, including in under-served groups\n- Service organisation"]
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[null,"National Institute for Health and Care Excellence. Hepatitis B and C testing: people at risk of infection. PH43. London: NICE; 2012.\nAvailable here.\nLast updated in March 2013.","This public health guidance is relevant to:\n- Commissioners and providers\n- People at increased risk of viral hepatitis\n- Members of the public","This guideline covers raising awareness of and testing for hepatitis B and C infection. It aims to ensure that people at increased risk of hepatitis B and C infection are tested.\n\nIt  includes recommendations on:\n- Raising awareness about hepatitis B and C among the general population and people at increased risk of infection\n- Education and training for professionals who provide services for people at increased risk of infection\n- Testing for hepatitis B and C in primary care, prisons and immigration removal centres, drugs services, and sexual health and genitourinary medicine clinics\n- Tracing close contacts of people with hepatitis B infection\n- Neonatal hepatitis B vaccination\n- Commissioning integrated services for testing and treatment and laboratory services for testing"]
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[null,"ADRAN ADOLYGIAD SYSTEMATIG - GOFAL SYLFAENOL"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau'r awduron:"]
[null,"Jia  L et al. Payment methods for healthcare providers working in outpatient healthcare settings. Cochrane Database of Systematic Reviews 2021, Issue 1. Art. No.: CD011865. DOI: 10.1002/14651858.CD011865.pub2. \nAvailable here.","Adults (65 years+)","This Cochrane review aimed to assess the impact of different payment methods for healthcare providers working in outpatient healthcare settings on the quantity and quality of health service provision, patient outcomes, healthcare provider outcomes, cost of service provision, and adverse effects.\n\nThe reviewers' included 27 studies in the review: 12 randomised trials, 13 controlled before‐and‐after studies, one interrupted time series, and one repeated measure study. Only one randomised controlled trial (Kouides et al. 1998) based in USA fulfilled the inclusion criteria of this evidence map. \nPrimary care physicians in the intervention group received a fee for each immunisation of USD 8 and an additional 10% (USD 0.8) or 20% (USD 1.6) reimbursement per shot according to whether they immunised 70% or 85% (respectively) of the eligible population. The primary care physicians in the control group received only the fee for each immunisation of USD 8. The mean immunisation rate with payment for performance plus existing payment methods was 0.34 per cent points higher (0.2 per cent points lower to 0.87 points higher) compared to existing payment methods [MD 0.34 (−0.20 to 0.87)].\n\n\n\n\n\n","Based on the evidence from one study, the authors were uncertain of the effect of payment for performance added to existing payment methods on immunisation rates for the elderly.\n\nThere is a need for further well‐conducted research on payment methods for healthcare providers working in outpatient healthcare settings in low‐ and middle‐income countries; more studies comparing the impacts of different designs of the same payment method; and studies that consider the unintended consequences of payment interventions."]
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[null,"Palmer  MJ et al. Targeted client communication via mobile devices for improving maternal, neonatal, and child health. Cochrane Database of Systematic Reviews 2020, Issue 8. Art. No.: CD013679. DOI: 10.1002/14651858.CD013679.\nAvailable here.","High risk groups (pregnant women)","This Cochrane review aimed to assess the effects of TCC via MD on health behaviour, service use, health, and well‐being for maternal, neonatal and child health (MNCH).\n\nThe reviewers'  included 27 trials (17,463 participants). Trial populations were: pregnant and postpartum women (11 trials conducted in low‐, middle‐ or high‐income countries; pregnant and postpartum women living with HIV (three trials carried out in one lower middle‐income country); and parents of children under the age of five years (13 trials conducted in LMHIC). \n\nOnly two studies within the targeted client communication via mobile device versus digital non-targeted communication fulfilled the criteria of this review:\nOne study (Yudin et al. 2017) found that a mobile phone text message reinforcing that the influenza vaccine is recommended for all pregnant women and safe during pregnancy and breastfeeding compared to standard care/ no intervention, may make little or no difference to attendance for antenatal influenza vaccination (risk ratio (RR) 1.05, 95% confidence interval (CI) 0.71 to 1.58), though the CI encompasses both benefit and harm (low‐certainty evidence). \nAnother study (Lund et al. 2012) found that a multi-component approach combining mobile phone text message with voucher compared to simple health education and appointment reminders to encourage attendance to routine antenatal classes, make little or no difference to attendance for antenatal tetanus vaccine (OR 1.67, 95% CI 0.84 to 3.33). ","The authors conclude that the effect of targeted client communication via mobile devices for most outcomes is uncertain. There may be improvements for some outcomes using targeted communication but these findings were of low certainty. \n\nHigh‐quality, adequately powered trials and cost‐effectiveness analyses are required to reliably ascertain the effects and relative benefits of TCCMD. Future studies should measure potential unintended consequences, such as partner violence or breaches of confidentiality."]
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[null,"Abdullahi  LH et al. Improving vaccination uptake among adolescents. Cochrane Database of Systematic Reviews 2020, Issue 1. Art. No.: CD011895. DOI: 10.1002/14651858.CD011895.pub2.\nAvailable here.","Adults (under 19s)","This Cochrane review aimed to evaluate the effects of interventions to improve vaccine uptake among adolescents.\n\nThe reviewers' included 16 studies (eight individually randomised trials, four cluster randomised trials, three non‐randomised trials, and one controlled before‐after study). Twelve studies were conducted in the USA, while there was one study each from: Australia, Sweden, Tanzania, and the UK. Ten studies had unclear or high risk of bias. They categorised interventions as recipient‐oriented, provider‐oriented, or health systems‐oriented.\n\nThe interventions targeted adolescent boys or girls or both (seven studies), parents (four studies), and providers (two studies). Five studies had mixed participants that included adolescents and parents, adolescents and healthcare providers, and parents and healthcare providers. The outcomes included uptake of human papillomavirus (HPV) (11 studies); hepatitis B (three studies); and tetanus–diphtheria–acellular–pertussis (Tdap), meningococcal, HPV, and influenza (three studies) vaccines among adolescents.\n\nHealth education improves HPV vaccine uptake compared to usual practice (RR 1.43, 95% CI 1.16 to 1.76; I² = 0%; 3 studies, 1054 participants; high‐certainty evidence). In addition, one large study provided evidence that a complex multi‐component health education intervention probably results in little to no difference in hepatitis B vaccine uptake compared to simplified information leaflets on the vaccine (RR 0.98, 95% CI 0.97 to 0.99; 17,411 participants; moderate‐certainty evidence).\n\nFinancial incentives may improve HPV vaccine uptake compared to usual practice (RR 1.45, 95% CI 1.05 to 1.99; 1 study, 500 participants; low‐certainty evidence). However, we are uncertain whether combining health education and financial incentives has an effect on hepatitis B vaccine uptake, compared to usual practice (RR 1.38, 95% CI 0.96 to 2.00; 1 study, 104 participants; very low certainty evidence).\n\nMandatory vaccination probably leads to a large increase in hepatitis B vaccine uptake compared to usual practice (RR 3.92, 95% CI 3.65 to 4.20; 1 study, 6462 participants; moderate‐certainty evidence).\n\nProvider prompts probably make little or no difference compared to usual practice, on completion of Tdap (OR 1.28, 95% CI 0.59 to 2.80; 2 studies, 3296 participants), meningococcal (OR 1.09, 95% CI 0.67 to 1.79; 2 studies, 3219 participants), HPV (OR 0.99, 95% CI 0.55 to 1.81; 2 studies, 859 participants), and influenza (OR 0.91, 95% CI 0.61 to 1.34; 2 studies, 1439 participants) vaccination schedules (moderate‐certainty evidence).\n\nProvider education with performance feedback may increase the proportion of adolescents who are offered and accept HPV vaccination by clinicians, compared to usual practice. Compared to adolescents visiting non‐participating clinicians (in the usual practice group), the adolescents visiting clinicians in the intervention group were more likely to receive the first dose of HPV during preventive visits (5.7 percentage points increase) and during acute visits (0.7 percentage points for the first and 5.6 percentage points for the second doses of HPV) (227 clinicians and more than 200,000 children; low‐certainty evidence).\n\nA class‐based school vaccination strategy probably leads to slightly higher HPV vaccine uptake than an age‐based school vaccination strategy (RR 1.09, 95% CI 1.06 to 1.13; 1 study, 5537 participants; moderate‐certainty evidence).\n\nA multi‐component provider intervention (including an education session, repeated contacts, individualised feedback, and incentives) probably improves uptake of HPV vaccine compared to usual practice (moderate‐certainty evidence).\n\nA multi‐component intervention targeting providers and parents involving social marketing and health education may improve HPV vaccine uptake compared to usual practice (RR 1.41, 95% CI 1.25 to 1.59; 1 study, 25,869 participants; low‐certainty evidence).","The authors conclude that various strategies have been evaluated to improve adolescent vaccination including health education, financial incentives, mandatory vaccination, and class‐based school vaccine delivery. However, most of the evidence is of low to moderate certainty. This implies that while this research provides some indication of the likely effect of these interventions, the likelihood that the effects will be substantially different is high. \n\nTherefore, additional research is needed to further enhance adolescent immunisation strategies, especially in low‐ and middle‐income countries where there are limited adolescent vaccination programmes. In addition, it is critical to understand the factors that influence hesitancy, acceptance, and demand for adolescent vaccination in different settings. This is the topic of an ongoing Cochrane qualitative evidence synthesis, which may help to explain why and how some interventions were more effective than others in increasing adolescent HPV vaccination coverage."]
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[null,"Stormacq C et al. Effects of health literacy interventions on health-related outcomes in socioeconomically disadvantaged adults living in the community: a systematic review. JBI evidence synthesis 2020, Issue 18(7). pp.1389-1469. doi: 10.11124/JBISRIR-D-18-00023.\nAvailable here.","High risk groups (pregnant women)","The objectives of this JBI review were: i) to identify and synthesize the best available evidence on the effectiveness on health-related outcomes of health literacy interventions for enabling socioeconomically disadvantaged people living in the community to access, understand, appraise and apply health information; and ii) to identify components of health literacy interventions associated with improved health-related outcomes.\n\nTwenty-one studies were included in the review. Only one randomised controlled trial fulfilled the criteria of this evidence map (Stockwell et al. 2014). It included 1153 low-income women initiating prenatal care, 576 of whom participated in the experimental group and 577 in the control group. Participants in the experimental group received health information and health education about influenza during pregnancy through five weekly text messages. The text messages covered various topics such as risk of influenza for the pregnant woman and fetus, vaccine safety and vaccine recommendations. Participants in the control group received usual care. At four months follow-up, there was a higher rate of vaccination in the experimental group than in the control group (P = 0.048). Text messages are a simple, convenient and cost-effective tool to send specific health information to a large number of people simultaneously. Text messages can be an effective tool for delivering health information and encouraging the adoption of positive health behaviors within a population with limited access to health information.","The review concluded that mostly, health literacy interventions in the Disease Prevention domain of the health continuum were effective for improving preventive health behaviors and practices such as vaccination and screenings."]
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[null,"Thomas  RE and Lorenzetti  DL. Interventions to increase influenza vaccination rates of those 60 years and older in the community. Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD005188. DOI: 10.1002/14651858.CD005188.pub4. \nAvailable here.","Adults (60 years+)","This Cochrane review aimed to assess access, provider, system, and societal interventions to increase the uptake of influenza vaccination in people aged 60 years and older in the community.\n\nThe reviewers' included 3 new RCTs for this update (total 61 RCTs; 1,055,337 participants). Trials involved people aged 60 years and older living in the community in high‐income countries. Heterogeneity limited some meta‐analyses. They assessed studies as at low risk of bias for randomisation (38%), allocation concealment (11%), blinding (44%), and selective reporting (100%). Half (51%) had missing data. We assessed the evidence as low‐quality. They identified three levels of intervention intensity: low (e.g. postcards), medium (e.g. personalised phone calls), and high (e.g. home visits, facilitators).\n\nIncreasing community demand (12 strategies, 41 trials, 53 study arms, 767,460 participants): One successful intervention that could be meta‐analysed was client reminders or recalls by letter plus leaflet or postcard compared to reminder (OR 1.11, 95% CI 1.07 to 1.15; 3 studies; 64,200 participants). Successful interventions tested by single studies were patient outreach by retired teachers (OR 3.33, 95% CI 1.79 to 6.22); invitations by clinic receptionists (OR 2.72, 95% CI 1.55 to 4.76); nurses or pharmacists educating and nurses vaccinating patients (OR 152.95, 95% CI 9.39 to 2490.67); medical students counselling patients (OR 1.62, 95% CI 1.11 to 2.35); and multiple recall questionnaires (OR 1.13, 95% CI 1.03 to 1.24).\n\nSome interventions could not be meta‐analysed due to significant heterogeneity: 17 studies tested simple reminders (the 95% CI was entirely above unity in 11 trials implying all 11 interventions increased vaccination rates); 16 tested personalised reminders (the 95% CI was entirely above unity in 12 trials implying all 12 interventions increased vaccination rates ); 2 investigated customised compared to form letters (the 95% CI was above unity in both trials implying both interventions increased vaccination rates); and 4 studies examined the impact of health risk appraisals (the 95% CI was above unity in all 4 trials implying all 4 interventions increased vaccination rates). One study of a lottery for free groceries was not effective.\n\nEnhancing vaccination access (6 strategies, 8 trials, 10 arms, 9353 participants): The reviewers meta‐analysed results from 2 studies of home visits (OR 1.30, 95% CI 1.05 to 1.61), and 2 studies that tested free vaccine compared to patient payment for vaccine (OR 2.36, 95% CI 1.98 to 2.82). They were unable to conduct meta‐analyses of 2 studies of home visits by nurses plus a physician care plan (the 95% CI was entirely above unity in both trials implying both interventions increased vaccination rates) and 2 studies of free vaccine compared to no intervention (the 95% CI was entirely above unity in both trials implying both interventions increased vaccination rates). One study of group visits (OR 27.2, 95% CI 1.60 to 463.3) was effective, and 1 study of home visits compared to safety interventions was not.\n\nProvider‐ or system‐based interventions (11 strategies, 15 trials, 17 arms, 278,524 participants): One successful intervention that could be meta‐analysed focused on payments to physicians (OR 2.22, 95% CI 1.77 to 2.77). Successful interventions tested by individual studies were: reminding physicians to vaccinate all patients (OR 2.47, 95% CI 1.53 to 3.99); posters in clinics presenting vaccination rates and encouraging competition between doctors (OR 2.03, 95% CI 1.86 to 2.22); and chart reviews and benchmarking to the rates achieved by the top 10% of physicians (OR 3.43, 95% CI 2.37 to 4.97).\n\nThe reviewers were unable to meta‐analyse 4 studies that looked at physician reminders (the 95% CI was entirely above unity in 3 trials implying all 3 interventions increased vaccination rates) and 3 studies of facilitator encouragement of vaccination (the 95% CI was entirely above unity in 2 trials implying both interventions increased vaccination rates). Interventions that were not effective were: comparing letters on discharge from hospital to letters to general practitioners; posters plus postcards versus posters alone; educational reminders, academic detailing, and peer comparisons compared to mailed educational materials; educational outreach plus feedback to teams versus written feedback; and an intervention to increase staff vaccination rates.\n\nInterventions at the societal level: No studies reported on societal‐level interventions.","The reviewers identified interventions that demonstrated significant positive effects of low (postcards), medium (personalised phone calls), and high (home visits, facilitators) intensity that increase community demand for vaccination, enhance access, and improve provider/system response. The overall GRADE assessment of the evidence was moderate quality. Conclusions are unchanged from the 2014 review."]
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[null,"Jacobson Vann  JC et al. Patient reminder and recall interventions to improve immunization rates. Cochrane Database of Systematic Reviews 2018, Issue 1. Art. No.: CD003941. DOI: 10.1002/14651858.CD003941.pub3. \nAvailable here.","Adults","This Cochrane review aimed to evaluate and compare the effectiveness of various types of patient reminder and recall interventions to improve receipt of immunizations.\n\nThe 75 included studies involved child, adolescent, and adult participants in outpatient, community‐based, primary care, and other settings in 10 countries.\n\nPatient reminder or recall interventions, including telephone and autodialer calls, letters, postcards, text messages, combination of mail or telephone, or a combination of patient reminder or recall with outreach, probably improve the proportion of participants who receive immunization (RR of 1.28, 95% CI 1.23 to 1.35; risk difference of 8%) based on moderate certainty evidence from 55 studies with 138,625 participants.\n\nThree types of single‐method reminders improve receipt of immunizations based on high certainty evidence: the use of postcards (RR 1.18, 95% CI 1.08 to 1.30; eight studies; 27,734 participants), text messages (RR 1.29, 95% CI 1.15 to 1.44; six studies; 7772 participants), and autodialer (RR 1.17, 95% CI 1.03 to 1.32; five studies; 11,947 participants). Two types of single‐method reminders probably improve receipt of immunizations based on moderate certainty evidence: the use of telephone calls (RR 1.75, 95% CI 1.20 to 2.54; seven studies; 9120 participants) and letters to patients (RR 1.29, 95% CI 1.21 to 1.38; 27 studies; 81,100 participants).\n\nBased on high certainty evidence, reminders improve receipt of immunizations for childhood (RR 1.22, 95% CI 1.15 to 1.29; risk difference of 8%; 23 studies; 31,099 participants) and adolescent vaccinations (RR 1.29, 95% CI 1.17 to 1.42; risk difference of 7%; 10 studies; 30,868 participants). Reminders probably improve receipt of vaccinations for childhood influenza (RR 1.51, 95% CI 1.14 to 1.99; risk difference of 22%; five studies; 9265 participants) and adult influenza (RR 1.29, 95% CI 1.17 to 1.43; risk difference of 9%; 15 studies; 59,328 participants) based on moderate certainty evidence. They may improve receipt of vaccinations for adult pneumococcus, tetanus, hepatitis B, and other non‐influenza vaccinations based on low certainty evidence although the confidence interval includes no effect of these interventions (RR 2.08, 95% CI 0.91 to 4.78; four studies; 8065 participants).","The reviewers conclude that patient reminder and recall systems, in primary care settings, are likely to be effective at improving the proportion of the target population who receive immunizations."]
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[null,"Arditi  C et al. Computer‐generated reminders delivered on paper to healthcare professionals: effects on professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD001175. DOI: 10.1002/14651858.CD001175.pub4.\nAvailable here.","Adults","This Cochrane review aimed to evaluate the effects of reminders automatically generated through a computerized system (computer‐generated) and delivered on paper to healthcare professionals on quality of care (outcomes related to healthcare professionals' practice) and patient outcomes (outcomes related to patients' health condition).\n\nReview authors identified 35 studies (30 RCTs trials and five non‐RCTs) and analyzed 34 studies (40 comparisons). Twenty‐nine studies took place in the USA and six studies took place in Canada, France, Israel, and Kenya. All studies except two took place in outpatient care. Reminders were aimed at enhancing compliance with preventive guidelines (e.g. cancer screening tests, vaccination) in half the studies and at enhancing compliance with disease management guidelines for acute or chronic conditions (e.g. annual follow‐ups, laboratory tests, medication adjustment, counseling) in the other half.\n\nComputer‐generated reminders delivered on paper to healthcare professionals, alone or in addition to co‐intervention(s), probably improves quality of care slightly compared with usual care or the co‐intervention(s) without the reminder component (median improvement 6.8% : 3.8% to 17.5%]; 34 studies (40 comparisons); moderate‐certainty evidence).\n\nComputer‐generated reminders delivered on paper to healthcare professionals alone (single‐component intervention) probably improves quality of care compared with usual care (median improvement 11.0% (IQR 5.4% to 20.0%); 27 studies (27 comparisons); moderate‐certainty evidence). Adding computer‐generated reminders delivered on paper to healthcare professionals to one or more co‐interventions (multi‐component intervention) probably improves quality of care slightly compared with the co‐intervention(s) without the reminder component (median improvement 4.0% (IQR 3.0% to 6.0%); 11 studies (13 comparisons); moderate‐certainty evidence). \n\nSub-group analyses revealed largest improvement seen in vaccination, with a median improvement of 13.1% [Interquartile range (IQR) 12.2% to 20.7%].\n\nThe authors are uncertain whether reminders, alone or in addition to co‐intervention(s), improve patient outcomes as the certainty of the evidence is very low (n = 6 studies (seven comparisons)). None of the included studies reported outcomes related to harms or adverse effects of the intervention.","The review concludes that there is moderate‐certainty evidence that computer‐generated reminders delivered on paper to healthcare professionals probably slightly improves quality of care, in terms of compliance with preventive guidelines and compliance with disease management guidelines. It is uncertain whether reminders improve patient outcomes because the certainty of the evidence is very low. The heterogeneity of the reminder interventions included in this review also suggests that reminders can probably improve quality of care in various settings under various conditions."]
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[null,"Posadzki  P et al. Automated telephone communication systems for preventive healthcare and management of long‐term conditions. Cochrane Database of Systematic Reviews 2016, Issue 12. Art. No.: CD009921. DOI: 10.1002/14651858.CD009921.pub2.\nAvailable here.","Adults\n\nHigh risk groups (long-term health conditions)\n","This Cochrane review aimed to assess the effects of automated telephone communication system (ATCS) for preventing disease and managing long‐term conditions on behavioural change, clinical, process, cognitive, patient‐centred and adverse outcomes.\n\nThe review authors found 132 trials with over 4 million participants across preventive healthcare areas and for the management of long‐term conditions.\n\nStudies compared ATCS types in many ways. Some studies reported findings across diseases. For prevention, ATCS probably increase immunisation uptake in children, and slightly in adolescents, but in adults effects are uncertain. \n\nTen studies, all in the USA, evaluated ATCS for promoting immunisation uptake. For preventive healthcare, ATCS (ATCS Plus, IVR, unidirectional) probably increase immunisation uptake in children (risk ratio (RR) 1.25, 95% confidence interval (CI) 1.18 to 1.32; 5 studies, N = 10,454; moderate certainty) and to a lesser extent in adolescents (RR 1.06, 95% CI 1.02 to 1.11; 2 studies, N = 5725; moderate certainty). Based on evidence from 2 studies the effects of ATCS in adults are unclear (RR 2.18, 95% CI 0.53 to 9.02; 2 studies, N = 1743; very low certainty).","The review authors concluded that ATCS interventions can change patients' health behaviours, improve clinical outcomes and increase healthcare uptake with positive effects in several important areas including immunisation, screening, appointment attendance, and adherence to medications or tests. The decision to integrate ATCS interventions in routine healthcare delivery should reflect variations in the certainty of the evidence available and the size of effects across different conditions, together with the varied nature of ATCS interventions assessed. Future research should investigate both the content of ATCS interventions and the mode of delivery; users' experiences, particularly with regard to acceptability; and clarify which ATCS types are most effective and cost‐effective."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Vaccination Programs: Home Visits to Increase Vaccination Rates. The Community Guide; 2017. \nAvailable here.","Adults","This report examines home visits to increase vaccination rates in children and adults, leading to a Community Preventive Services Task Force (CPSTF) recommendation on the subject. 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). \n\nThe Task Force considered evidence from 23 studies of home visits, with 20 studies and 21 study arms using a common measure of change in vaccination rates. The overall effect was a median increase of 11 percentage points (IQR: 5 to 15 percentage points). Meaningful improvements were observed as a result of home visits delivered to all clients (12 study arms) and to only those clients unresponsive to other interventions (9 study arms), home visits focused on vaccination alone (12 study arms) and in combination with other health concerns (9 study arms), and home visits providing on-site vaccinations (8 study arms) and referring clients to vaccination services outside the home (13 study arms). Home visits delivered as the sole intervention (8 study arms) and home visits delivered as part of a larger healthcare system or community-based program (13 study arms) also produced meaningful change in vaccination rates.","The CPSTF report recommends home visits based on strong evidence of their effectiveness in increasing vaccination rates. Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness. The Task Force notes that home visiting interventions are potentially effective in addressing a wide range of public health problems and that the focus of this review is the subset of interventions specifically addressing vaccination rates.\n\nThe report identified that more research is needed on the effectiveness and economic benefits of home visits to increase vaccination rates among adolescents and in rural settings. Additional economic research is needed to estimate the portion of home visits that can be attributed solely to improving vaccination rates when home visits include other activities and objectives."]
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[null,"Till  SR et al. Incentives for increasing prenatal care use by women in order to improve maternal and neonatal outcomes. Cochrane Database of Systematic Reviews 2015, Issue 12. Art. No.: CD009916. DOI: 10.1002/14651858.CD009916.pub2.\nAvailable here.","High risk groups (pregnant women)","This Cochrane review aimed to determine whether incentives are an effective tool to increase utilization of timely prenatal care among women.\n\nThe review authors identified 11 studies (19 reports), six of which we excluded. Five studies, involving 11,935 pregnancies were included, but only 1893 pregnancies contributed data regarding our specified outcomes. Incentives in the studies included cash, gift card, baby carrier, baby blanket or taxicab voucher and were compared with no incentives. Meta‐analysis was performed for only one outcome 'Return for postpartum care' and this outcome was not pre‐specified in their protocol. Other analyses were restricted to data from single studies.\n\nThe five included studies of incentive programs did not report any of this review's primary outcomes: preterm birth, small‐for‐gestational age, or perinatal death.\n\nIn terms of this review's secondary outcomes, pregnant women receiving incentives were no more likely to initiate prenatal care (risk ratio (RR) 1.04, 95% confidence interval (CI) 0.78 to 1.38, one study, 104 pregnancies). Pregnant women receiving incentives were more likely to attend prenatal visits on a frequent basis (RR 1.18, 95% CI 1.01 to 1.38, one study, 606 pregnancies) and obtain adequate prenatal care defined by number of “procedures” such as testing blood sugar or blood pressure, vaccinations and counseling about breastfeeding and birth control (mean difference (MD) 5.84, 95% CI 1.88 to 9.80, one study, 892 pregnancies). In contrast, women who received incentives were more likely to deliver by cesarean section (RR 1.97, 95% CI 1.18 to 3.30, one study, 979 pregnancies) compared to those women who did not receive incentives.","The included studies did not report on this review's main outcomes: preterm birth, small‐for‐gestational age, or perinatal death. There is limited evidence that incentives may increase utilization and quality of prenatal care, but may also increase cesarean rate. Overall, there is insufficient evidence to fully evaluate the impact of incentives on prenatal care initiation. \n\nThere is a need for high‐quality RCTs to determine whether incentive program increase prenatal care use and improve maternal and neonatal outcomes. Incentive programs, in particular cash‐based programs, as suggested in this review and in several observational studies may improve the frequency and ensure adequate quality of prenatal care. No peer‐reviewed data have been made publicly available for one of the largest incentive‐based prenatal programs – the statewide Medicaid‐based programs within the United States. These observational data represent an important starting point for future research with significant implications for policy development and allocation of healthcare resources. The disparate findings related to attending postpartum care should also be further explored as the findings were limited by the number of studies. Future large RCTs are needed to focus on the outcomes of preterm birth, small‐for‐gestational age and perinatal outcomes."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Clinic-based Client Education\nWhen Used Alone. The Community Guide; 2016. \nAvailable here.","Adults (older: age not specified)","This report aimed to determine the effectiveness of clinic-based client education interventions when implemented alone in increasing vaccination rates or reducing rates of vaccine preventable illness and found insufficient evidence. Four of the included studies provided sufficient evidence of effectiveness but were limited to immunizations for pneumococcal polysaccharide vaccine among older adults with very low baseline coverage. The Task Force finding reflects concerns about the intervention's applicability to a broader range vaccinations, populations, and clinic-based settings.\n\nThis Task Force finding is based on evidence from a Community Guide systematic review completed in 2011 (4 studies with 6 study arms, search period 1980-2009) combined with more recent evidence (1 study, search period 2009-2012). Based on the combined evidence, the Task Force reaffirms its finding of insufficient evidence. The combined Task Force review included five studies. Four studies with six study arms providing a common measurement of change in vaccination rates. Although the median change in vaccination rates was an increase of 10 percentage points (IQR: 3 to 19 percentage points), results were dominated by findings from three related study arms focused on increasing pneumococcal polysaccharide vaccinations among older adult patients in one clinical setting. Changes in vaccination rates from the other three study arms were inconsistent and smaller in magnitude. The final study did not evaluate changes in vaccination rates, and found only a very small change in the proportion of tetanus booster doses administered with the use of an audiovisual message in clinic waiting areas.\n\nTwo studies included in this review implemented a potentially useful educational approach to increase vaccination rates by prompting discussions between the client and their vaccination provider. In these studies, an educational brochure distributed to patients in the waiting area included a specific request for a discussion with their provider about the pneumococcal polysaccharide vaccine. In both studies, use of the brochure increased vaccination rates by 16 percentage points in a client population with very low baseline rates. \n\nClinic-based client education can be one component of an effective combined approach to increase vaccination rates. The Task Force finds strong evidence to recommend health care system-based interventions implemented in combination and community-based interventions implemented in combination.","This CPSTF report states that although the evidence identified in this systematic review is small and inconsistent, at least one format demonstrates sufficient evidence of effectiveness. The Task Force considers the applicability of this educational approach to other vaccines and populations an important question for further study.\n"]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Provider Reminders. The Community Guide; 2015. \nAvailable here.","Adults","The CPSTF recommends provider reminders on the basis of strong evidence of effectiveness in increasing vaccination rates: (1) among adults, adolescents and children; (2) when used alone or with additional interventions; (3) across a range of intervention characteristics (e.g., computerized or simple reminders, checklists, flowcharts); and (4) in a range of settings and populations.\n\nThe Task Force finding is based on evidence from a Community Guide systematic review completed in 2008 (23 studies, search period 1997–2007) combined with more recent evidence (5 studies, search period 2007–February 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\nThe Task Force considered evidence from 28 studies. Twenty-two studies provided a measurement of change in vaccination rates, with an overall median increase of 10 percentage points (IQI: 6 to 25 percentage points). Of these, seven studies examined provider reminders alone with a median increase of 12 percentage points (IQI: 6 percentage point to 25 percentage points). Fifteen studies examined the impact of provider reminders with additional interventions and observed a median increase of 9 percentage points (IQI: 5 to 25 percentage points). Six additional studies did not provide a common measurement of change in vaccination rates; however, five of the studies provided additional support for the use of provider reminders.\n\nEvidence indicates that provider reminders remain an effective option for consideration in a wide range of clinical settings and populations. A subset of the included evidence, however, suggests that standing orders may be more effective in improving vaccination rates in both inpatient and outpatient settings than provider reminder systems.","Evidence in this CPSTF report indicates that provider reminders are effective in a wide range of contexts. Additional research should focus on system-level implementation of reminder systems, and identify strategies to encourage regular and sustained use. In addition, future research could examine or compare the effectiveness of specific reminder prompts provided as a capability of regional or state-level immunization information systems."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Client or Family Incentive Rewards. The Community Guide; 2015. \nAvailable here.","Adults","The CPSTF recommends client or family incentive rewards, used alone or in combination with additional interventions, based on sufficient evidence of effectiveness in increasing vaccination rates in children and adults.\n\nThis Task Force finding is based on evidence from a Community Guide systematic review completed in 2011 (6 studies with 7 study arms, search period 1980-2009) combined with more recent evidence (1 study, search period 2009-2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on sufficient evidence of effectiveness.\n\nIncluded studies showed vaccination rates increased by a median of 8 percentage points (interquartile interval [IQI]: 4 to 16 percentage points). Two study arms that assessed the effectiveness of incentive rewards alone showed similar changes in vaccination rates (8.5 and 9.0 percentage points). In the six remaining study arms, incentive rewards were combined with additional interventions.\n\nAmong the studies included in this review, the type of incentive reward offered to clients included 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. \n\nOverall, the Task Force considers the evidence to be applicable to vaccinations for children and adults in a wide range of clinical and community settings, and for various types of incentive rewards.","This CPSTF report concludes that client or family incentive rewards can also be one component of an effective combined approach to increase vaccination rates in both clinical and community settings. Based on updated, concurrent reviews the Task Force finds strong evidence to recommend health care system-based interventions implemented in combination and community-based\ninterventions implemented in combination.\n\nAdditional research could focus on the independent effects of incentive rewards, examine the relationship between the value of the reward and effectiveness, and explore the duration of intervention impact. It also would be useful to have more information about the effectiveness of these interventions with adolescents and adults as most of the included studies examined the use of incentive rewards on vaccination rates for children."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Standing Orders. The Community Guide; 2015. \nAvailable here.","Adults","The Task Force finding is based on evidence from a Community Guide systematic review completed in 2009 (29 studies, search period 1997–2009) combined with more recent evidence (6 studies, search period 2009–February 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\n\nThe Task Force considered evidence from 35 studies. Of these, 27 studies provided a common measurement of change in vaccination rates with a median increase of 24 percentage points (IQI: 12 to 35 percentage points). Nine studies that examined the impact of standing orders alone documented a median increase of 16 percentage points (IQI: 9 to 29 percentage points). Nineteen studies that evaluated standing orders when combined with additional interventions documented a median increase of 27 percentage points (IQI: 13 to 40 percentage points). Seven studies that did not provide a common measure of change for vaccination rates all reported favorable results after implementation of standing orders.\n\nThe reviewed studies evaluated the effectiveness of standing orders across a wide range of clinical vaccination settings, health care personnel, and client populations. Standing orders were found to be effective in various settings including clinics, hospitals, and long-term care facilities. Interventions were effective when used with different vaccination providers including nurses and pharmacists. While most studies looked at adult populations, four examined intervention effectiveness among children and found a median absolute percent increase of 28 percentage points (range: 8 to 49). While no studies specifically evaluated the impact of standing orders for vaccination of adolescents, evidence from this review is likely applicable to this population. In addition, a subset of the included evidence suggests that standing orders may be more effective in improving vaccination rates in both inpatient and outpatient settings when compared to a provider reminder system.\n\nOne paper from the updated search period described the following barriers encountered during implementation of a pneumococcal vaccination standing orders program in three hospitals: gaps in staff education and training; personnel concerns about additional workload; staff reluctance to administer vaccines without a physician's order; attending physicians' resistance to having hospitalized patients vaccinated; and logistical difficulties. Some attending physicians expressed concern that vaccination would interfere with scheduled treatments or procedures. Other attending physicians did not consider inpatient stays to be an appropriate time for vaccinations (Middleton et al. 2005).\n\nAn additional study reported barriers to implementation of influenza and pneumococcal vaccination standing orders in various health care settings. Findings suggested that the adoption of these policies may have been too difficult to administer, staff were unclear or unconvinced of program benefits, and there was perceived physician discomfort with delegating responsibility for immunizations to nursing staff. A few of the respondents also indicated that resources, effectiveness of the vaccine, and time required to administer the vaccine were barriers for adoption. The majority of these barriers were specific to the administration of the influenza vaccine (Goldstein et al. 2005).","This CPSTF report concludes that standing orders were shown to be effective in increasing vaccination rates for influenza and pneumococcal vaccines. Additional research is needed, however, to determine if these interventions are effective for different vaccines (e.g. hepatitis, tetanus and vaccines recommended for adolescents). More evidence is also needed on ways to address barriers to the implementation of standing orders in health systems.\n"]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Community-Based Interventions Implemented in Combination. The Community Guide; 2014. \nAvailable here.","Adults","The CPSTF recommends community-based interventions implemented in combination to increase vaccinations in targeted populations, on the basis of strong evidence of effectiveness in increasing vaccination rates.\n\nThe conclusion of strong evidence was based on findings from 18 studies that evaluated coordinated interventions to:\n- Increase community demand\n- Enhance access to vaccination services, and\n- Reduce missed opportunities by vaccination providers\nIn 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.\n\nThe Task Force 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 resources are available.\n\nThis Task Force 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 - 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\n\nAll of the included studies provided a common measure of change and showed a median increase in vacation rates of 14 percentage points (IQI: 7 to 24 percentage points).\n\nThe included studies evaluated a variety of interventions in different combinations. The Task Force examined the evidence of differences attributable to specific interventions and combinations of interventions using different strategic approaches.\nFourteen studies implemented an effective combination of one or more interventions to increase community demand with one or more interventions to enhance access to vaccination services and showed a median increase in vaccination rates of 16 percentage points (IQI: 12 to 26 percentage points).\n\nClient reminder and recall systems were used in most of the evaluated programs (15 study arms). Systems were implemented by vaccination providers, established as one part of a community manual outreach and tracking program, or generated from a regional immunization information system (IIS).","This CPSTF report concludes that coordinated interventions may be especially important in communities that have wide disparities in vaccination coverage. Program planners should consider community characteristics, such as mobility and fragmentation of health care, in the selection and combination of interventions to increase vaccination rates and reduce disparities.\n\nPartnerships between community organizations and vaccination providers are likely to be an essential component of effective, sustained community-based efforts. Most studies involved partnerships with existing vaccination providers in\nthe community to increase access to vaccinations, rather than creating new vaccination services. Coalitions represent one way to establish effective partnerships, with the size of the coalition varying based on the community, targeted population, and scope of the problem. Four studies involved community coalitions that used the principles of community-based participatory research.\n\nMore evidence is needed on the effectiveness of these programs in adolescents, and when implemented in rural settings. More economic information on these interventions is needed, specifically, evaluations on the efficiencies of the resource-intensive components of manual outreach and tracking and home visits. Future research could compare program effectiveness based on differences in the component interventions and strategic combinations. Additional research also should examine ways to sustain these programs, especially when provided by existing community-based organizations."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Health Care System-Based Interventions Implemented in Combination. The Community Guide; 2014. \nAvailable here.","Adults (older: age not specified)\n","The CPSTF recommends health care system-based interventions implemented in combination on the basis of strong evidence of effectiveness in increasing vaccination rates in targeted client populations.\n\nBased on findings from 37 of the 64 included studies, the Task Force further recommends a combination that includes the following:\nAt least one intervention to increase client demand for vaccinations, such as:\n- Client reminder and recall systems\n- Clinic-based client education\n- Manual outreach and tracking\nAnd one or more interventions that address either, or both, of the following strategies:\n- Interventions to enhance access to vaccinations: Expanded access in health care settings, reduced client out-of-pocket costs, home visits\n- Interventions directed at vaccination providers or systems: Provider reminders, standing orders, provider assessment and feedback\n\nInterventions listed as examples for each strategy were those that showed the greatest effect on vaccination rates.\n\nThe Task Force finding is based on evidence from a Community Guide systematic review completed in 2010 (62 studies; search period 1980-2010) combined with more recent evidence (2 studies; search period 2010-February 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness. \n\nOf the combined 64 included studies (76 study arms), 58 of them (70 study arms) provided a common measure of change in vaccination rates and showed a median increase of 9 percentage points (IQI: 4 to 21 percentage points). In general, changes in vaccination rates were greater when interventions were implemented in settings with low baseline rates.\n\nThe included studies evaluated a variety of interventions in different combinations. The Task Force examined the evidence of differences attributable to specific interventions and combinations of interventions using different strategic approaches. These strategic approaches included the following:\n- Interventions to increase client demand (client reminder and recall systems, clinic-based client education, client\nor family incentives, client-held paper immunization records, case management, and manual outreach and\ntracking)\n- Interventions to enhance access to vaccination services (expanded access in health care settings, reduced client\nout-of-pocket costs, and home visits)\n- Interventions directed at vaccination providers (provider reminder systems, standing orders, provider\nassessment and feedback, provider education, and provider incentives)\n\nThe most common individual interventions implemented in a combined approach were client reminder and recall\nsystems (34 study arms) and provider reminders (31 study arms).\n\nThirty-seven studies (44 study arms) evaluated a combination of interventions across two or three of the strategic approaches and showed a median increase in vaccination rates of 17 percentage points (IQI: 6 to 27 percentage points). In 26 study arms, interventions were combined within only one strategic approach and found a median increase in vaccination rates of 4 percentage points (IQI: 2 to 9 percentage points).\n\nNine studies evaluated combinations of interventions implemented as a part of a health care system quality improvement effort. The most commonly implemented interventions were those directed at vaccination providers (provider education, provider reminders, and provider assessment and feedback). The studies included in this evaluation were typically short in duration and reported mixed results.\n\nEvidence did not show a direct relationship between the number of interventions implemented and changes in vaccination rates. Included studies evaluated combinations of between two and nine interventions. The majority of studies implemented two (31 study arms) or three (18 study arms) interventions.","This CPSTF report concludes that overall, included studies provided evidence of effectiveness for intervention combinations implemented in a range of clinical settings and communities, although evidence from rural settings was limited. Studies also demonstrated effectiveness across a range of client populations and vaccinations, including young children (childhood series, influenza) and older adults (influenza, pneumococcal, and tetanus vaccines). Two of the included studies evaluated interventions targeted at increasing vaccination rates among adolescents. Finally, the included studies demonstrated increases in vaccination rates for populations of low socioeconomic status (22 study arms) and across a range of racial and ethnic groups. Most of the included evidence evaluated client populations with low to moderate baseline vaccination rates,\nand findings are most applicable to these situations.\n\nMore evidence is needed on the effectiveness of these interventions in rural settings and when applied to increase vaccinations recommended for adolescents. Future research on quality improvement activities in these settings should incorporate study periods sufficient to evaluate continuous quality improvement efforts."]

{"sheet":"Sec care","index":13,"n_rows":184,"n_cols":5,"rows_kept":184,"cut":false,"hidden":false,"merged":[[20,1,20,4],[22,1,50,1],[22,2,50,2],[22,3,50,4],[51,1,60,1],[51,2,60,2],[51,3,60,4],[84,4,113,4],[64,1,83,1],[64,2,83,2],[64,3,83,3],[64,4,83,4],[183,1,222,1],[183,2,222,2],[183,3,224,3],[183,4,224,4],[62,1,62,4],[158,1,182,1],[158,2,182,2],[158,3,182,3],[158,4,182,4],[114,1,157,1],[114,2,157,2],[114,3,157,3],[114,4,157,4],[84,1,113,1],[84,2,113,2],[84,3,113,3]]}
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[null,"ADRAN CANLLAWIAU - GOFAL EILAIDD"]
[null,"Ffynhonnell:","Cynulleidfa:","Argymhellion:"]
[null,"National Institute for Health and Care Excellence. Flu vaccination: increasing uptake. NG103. London: NICE; 2018.\nAvailable here.","This guideline is for: \n- Commissioners and providers of primary and secondary healthcare services, including maternity providers and community pharmacies\n- All employers of staff who provide NHS or social-care funded services (including maternity care, domiciliary care and care homes)\n- Local authorities, and community and voluntary sector organisations that employ health and social care workers\n- Occupational health services and infection prevention and control teams\n- NHS England teams and Health Education England teams\n- People using services, their families, carers and other members of the public, in particular those eligible for flu vaccination","This guideline covers how to increase uptake of the free flu vaccination among people who are eligible. It describes ways to increase awareness and how to use all opportunities in primary and secondary care to identify people who should be encouraged to have the vaccination.\n\nIt includes recommendations on:\n- Using a multicomponent approach\n- Raising awareness\n- Offering vaccination\n- Increasing uptake among eligible groups in primary and secondary care\n- Audit, monitoring and feedback\n- Vaccination in carers\n- Increasing uptake in health and social care staff"]
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[null,"National Institute for Health and Care Excellence. Hepatitis B and C testing: people at risk of infection. PH43. London: NICE; 2012.\nAvailable here.\nLast updated in March 2013.","This public health guidance is relevant to:\n- Commissioners and providers\n- People at increased risk of viral hepatitis\n- Members of the public","This guideline covers raising awareness of and testing for hepatitis B and C infection. It aims to ensure that people at increased risk of hepatitis B and C infection are tested.\n\nIt  includes recommendations on:\n- Raising awareness about hepatitis B and C among the general population and people at increased risk of infection\n- Education and training for professionals who provide services for people at increased risk of infection\n- Testing for hepatitis B and C in primary care, prisons and immigration removal centres, drugs services, and sexual health and genitourinary medicine clinics\n- Tracing close contacts of people with hepatitis B infection\n- Neonatal hepatitis B vaccination\n- Commissioning integrated services for testing and treatment and laboratory services for testing"]
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[null,"ADRAN ADOLYGIAD SYSTEMATIG - GOFAL EILAIDD"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau'r awduron:"]
[null,"Palmer  MJ et al. Free  C. Targeted client communication via mobile devices for improving maternal, neonatal, and child health. Cochrane Database of Systematic Reviews 2020, Issue 8. Art. No.: CD013679. DOI: 10.1002/14651858.CD013679.\nAvailable here.","High risk groups (pregnant women)","This Cochrane review aimed to assess the effects of TCC via MD on health behaviour, service use, health, and well‐being for maternal, neonatal and child health (MNCH).\n\nThe reviewers'  included 27 trials (17,463 participants). Trial populations were: pregnant and postpartum women (11 trials conducted in low‐, middle‐ or high‐income countries; pregnant and postpartum women living with HIV (three trials carried out in one lower middle‐income country); and parents of children under the age of five years (13 trials conducted in LMHIC). \n\nOnly two studies within the targeted client communication via mobile device versus digital non-targeted communication fulfilled the criteria of this review:\nOne RCT (Yudin et al. 2017) found that a mobile phone text message reinforcing that the influenza vaccine is recommended for all pregnant women and safe during pregnancy and breastfeeding compared to standard care/ no intervention, may make little or no difference to attendance for antenatal influenza vaccination (risk ratio (RR) 1.05, 95% confidence interval (CI) 0.71 to 1.58), though the CI encompasses both benefit and harm (low‐certainty evidence). \nOne cluster-RCT (Lund et al. 2012) found that a multi-component approach combining mobile phone text message with voucher compared to simple health education and appointment reminders to encourage attendance to routine antenatal classes, make little or no difference to attendance for antenatal tetanus vaccine (OR 1.67, 95% CI 0.84 to 3.33). ","The authors conclude that the effect of targeted client communication via mobile devices for most outcomes is uncertain. There may be improvements for some outcomes using targeted communication but these findings were of low certainty. \n\nHigh‐quality, adequately powered trials and cost‐effectiveness analyses are required to reliably ascertain the effects and relative benefits of TCCMD. Future studies should measure potential unintended consequences, such as partner violence or breaches of confidentiality."]
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[null,"Jacobson Vann  JC et al. Patient reminder and recall interventions to improve immunization rates. Cochrane Database of Systematic Reviews 2018, Issue 1. Art. No.: CD003941. DOI: 10.1002/14651858.CD003941.pub3. \nAvailable here.","Adults","This Cochrane review aimed to evaluate and compare the effectiveness of various types of patient reminder and recall interventions to improve receipt of immunizations.\n\nThe 75 included studies involved child, adolescent, and adult participants in outpatient, community‐based, primary care, and other settings in 10 countries.\n\nPatient reminder or recall interventions, including telephone and autodialer calls, letters, postcards, text messages, combination of mail or telephone, or a combination of patient reminder or recall with outreach, probably improve the proportion of participants who receive immunization (RR of 1.28, 95% CI 1.23 to 1.35; risk difference of 8%) based on moderate certainty evidence from 55 studies with 138,625 participants.\n\nThree types of single‐method reminders improve receipt of immunizations based on high certainty evidence: the use of postcards (RR 1.18, 95% CI 1.08 to 1.30; eight studies; 27,734 participants), text messages (RR 1.29, 95% CI 1.15 to 1.44; six studies; 7772 participants), and autodialer (RR 1.17, 95% CI 1.03 to 1.32; five studies; 11,947 participants). Two types of single‐method reminders probably improve receipt of immunizations based on moderate certainty evidence: the use of telephone calls (RR 1.75, 95% CI 1.20 to 2.54; seven studies; 9120 participants) and letters to patients (RR 1.29, 95% CI 1.21 to 1.38; 27 studies; 81,100 participants).\n\nBased on high certainty evidence, reminders improve receipt of immunizations for childhood (RR 1.22, 95% CI 1.15 to 1.29; risk difference of 8%; 23 studies; 31,099 participants) and adolescent vaccinations (RR 1.29, 95% CI 1.17 to 1.42; risk difference of 7%; 10 studies; 30,868 participants). Reminders probably improve receipt of vaccinations for childhood influenza (RR 1.51, 95% CI 1.14 to 1.99; risk difference of 22%; five studies; 9265 participants) and adult influenza (RR 1.29, 95% CI 1.17 to 1.43; risk difference of 9%; 15 studies; 59,328 participants) based on moderate certainty evidence. They may improve receipt of vaccinations for adult pneumococcus, tetanus, hepatitis B, and other non‐influenza vaccinations based on low certainty evidence although the confidence interval includes no effect of these interventions (RR 2.08, 95% CI 0.91 to 4.78; four studies; 8065 participants).","The reviewers conclude that patient reminder and recall systems, in primary care settings, are likely to be effective at improving the proportion of the target population who receive immunizations."]
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[null,"Lorenc T, Marshall D, Wright K, Sutcliffe K, Sowden A (2018). Seasonal influenza vaccination of healthcare workers: evidence synthesis. London: EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London. \nAvailable here.","Occupational groups (healthcare workers)","This report by EPPI-centre presents the findings from: (1) a synthesis of evidence about seasonal flu vaccination interventions: content and components, processes, and implementation; and (2) a systematic review of qualitative studies investigating HCWs’ views, attitudes and perceptions about seasonal flu vaccination. \n\nThe reviewers identified 60 studies evaluating interventions to promote seasonal flu vaccination among HCWs. Of these, only 13 used an RCT design. The types of strategy, number of studies, strength of evidence and likely effectiveness are presented in the summary table, overleaf. Most of the RCTs focused on increasing awareness, or on education. Few RCTs evaluated strategies to increase access, or incentives, and none assessed mandatory vaccination programmes. Most interventions combined several different elements and this is likely to be the most promising approach, as components are likely to work in different ways, and for different people. Most RCTs were conducted either in hospitals or in long-term care (e.g., nursing homes).\n\nThree studies were conducted in the UK (two RCTs), mainly focusing on increasing awareness or education. Most interventions appear not to have been based on any clear theoretical framework, or on any formative research or substantive engagement with HCWs themselves. Most non-mandatory interventions focused on individual beliefs, rather than on the social or institutional factors which may affect vaccination uptake. Data on implementation indicate that it is important to ensure adequate resources and management support; to address HCWs’ beliefs about vaccination; and to collect accurate data on vaccination coverage.\n\nThe findings from 25 qualitative studies. The data indicated a number of personal beliefs which may be barriers to vaccination, including perceived low risk of influenza, fear of side-effects of the vaccine, and scepticism about vaccine effectiveness. There were serious barriers to the acceptability of some interventions, particularly coercive mandatory policies, but also some educational or awareness-raising strategies.\n","The review concluded that bringing together the findings from the quantitative and qualitative studies, it appears that HCWs have clear views about their needs and priorities in relation to seasonal flu\nvaccination, which were mostly not addressed by the evaluated interventions. \n\nThe key messages were:\n- Promising interventions combine several components, including individual, social and environmental elements\n- Education alone is probably ineffective, but broader awareness-raising strategies appear promising\n- Increasing access to vaccination may be effective, but the evidence is weak with few RCTs\n- Both “soft” and “hard” mandates appear promising, but have yet to be evaluated using robust study designs, and may have limited acceptability\n- Interventions should ideally target everyone working in a healthcare context, but this may be practically difficult\n- The culture and context of the organisation(s), within which interventions are implemented, may have an important influence on outcomes. Evaluators should seek\nto understand interventions within an organisational system\n- Very few interventions engaged with HCWs to understand their needs and priorities\n- Intervention developers/implementers should engage with HCWs to understand their views, conduct formative research and pilot interventions before full-scale evaluation\n- Mixed-methods research to understand the context, in which an intervention will be implemented, and HCWs’ likely responses to an intervention, may be valuable"]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Provider Reminders. The Community Guide; 2015. \nAvailable here.","Adults ","The CPSTF recommends provider reminders on the basis of strong evidence of effectiveness in increasing vaccination rates: (1) among adults, adolescents and children; (2) when used alone or with additional interventions; (3) across a range of intervention characteristics (e.g., computerized or simple reminders, checklists, flowcharts); and (4) in a range of settings and populations.\n\nThe Task Force finding is based on evidence from a Community Guide systematic review completed in 2008 (23 studies, search period 1997–2007) combined with more recent evidence (5 studies, search period 2007–February 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\nThe Task Force considered evidence from 28 studies. Twenty-two studies provided a measurement of change in vaccination rates, with an overall median increase of 10 percentage points (IQI: 6 to 25 percentage points). Of these, seven studies examined provider reminders alone with a median increase of 12 percentage points (IQI: 6 percentage point to 25 percentage points). Fifteen studies examined the impact of provider reminders with additional interventions and observed a median increase of 9 percentage points (IQI: 5 to 25 percentage points). Six additional studies did not provide a common measurement of change in vaccination rates; however, five of the studies provided additional support for the use of provider reminders.\n\nEvidence indicates that provider reminders remain an effective option for consideration in a wide range of clinical settings and populations. A subset of the included evidence, however, suggests that standing orders may be more effective in improving vaccination rates in both inpatient and outpatient settings than provider reminder systems.","Evidence in this CPSTF report indicates that provider reminders are effective in a wide range of contexts. Additional research should focus on system-level implementation of reminder systems, and identify strategies to encourage regular and sustained use. In addition, future research could examine or compare the effectiveness of specific reminder prompts provided as a capability of regional or state-level immunization information systems."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Standing Orders. The Community Guide; 2015. \nAvailable here.","Adults","The Task Force finding is based on evidence from a Community Guide systematic review completed in 2009 (29 studies, search period 1997–2009) combined with more recent evidence (6 studies, search period 2009–February 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\n\nThe Task Force considered evidence from 35 studies. Of these, 27 studies provided a common measurement of change in vaccination rates with a median increase of 24 percentage points (IQI: 12 to 35 percentage points). Nine studies that examined the impact of standing orders alone documented a median increase of 16 percentage points (IQI: 9 to 29 percentage points). Nineteen studies that evaluated standing orders when combined with additional interventions documented a median increase of 27 percentage points (IQI: 13 to 40 percentage points). Seven studies that did not provide a common measure of change for vaccination rates all reported favorable results after implementation of standing orders.\n\nThe reviewed studies evaluated the effectiveness of standing orders across a wide range of clinical vaccination settings, health care personnel, and client populations. Standing orders were found to be effective in various settings including clinics, hospitals, and long-term care facilities. Interventions were effective when used with different vaccination providers including nurses and pharmacists. While most studies looked at adult populations, four examined intervention effectiveness among children and found a median absolute percent increase of 28 percentage points (range: 8 to 49). While no studies specifically evaluated the impact of standing orders for vaccination of adolescents, evidence from this review is likely applicable to this population. In addition, a subset of the included evidence suggests that standing orders may be more effective in improving vaccination rates in both inpatient and outpatient settings when compared to a provider reminder system.\n\nOne paper from the updated search period described the following barriers encountered during implementation of a pneumococcal vaccination standing orders program in three hospitals: gaps in staff education and training; personnel concerns about additional workload; staff reluctance to administer vaccines without a physician's order; attending physicians' resistance to having hospitalized patients vaccinated; and logistical difficulties. Some attending physicians expressed concern that vaccination would interfere with scheduled treatments or procedures. Other attending physicians did not consider inpatient stays to be an appropriate time for vaccinations (Middleton et al. 2005).\n\nAn additional study reported barriers to implementation of influenza and pneumococcal vaccination standing orders in various health care settings. Findings suggested that the adoption of these policies may have been too difficult to administer, staff were unclear or unconvinced of program benefits, and there was perceived physician discomfort with delegating responsibility for immunizations to nursing staff. A few of the respondents also indicated that resources, effectiveness of the vaccine, and time required to administer the vaccine were barriers for adoption. The majority of these barriers were specific to the administration of the influenza vaccine (Goldstein et al. 2005).","This CPSTF report concludes that standing orders were shown to be effective in increasing vaccination rates for influenza and pneumococcal vaccines. Additional research is needed, however, to determine if these interventions are effective for different vaccines (e.g. hepatitis, tetanus and vaccines recommended for adolescents). More evidence is also needed on ways to address barriers to the implementation of standing orders in health systems.\n"]

{"sheet":"Other set","index":14,"n_rows":357,"n_cols":5,"rows_kept":357,"cut":false,"hidden":false,"merged":[[356,1,383,1],[356,2,383,2],[356,3,385,3],[356,4,383,4],[22,1,39,1],[22,2,39,2],[22,3,39,4],[85,2,139,2],[85,3,139,3],[85,4,139,4],[170,1,227,1],[170,2,227,2],[170,3,227,3],[170,4,227,4],[50,1,64,1],[50,2,64,2],[20,1,20,4],[40,1,49,1],[40,2,49,2],[40,3,49,4],[140,1,169,1],[140,2,169,2],[140,3,169,3],[140,4,169,4],[85,1,139,1],[50,3,64,4],[65,1,81,1],[65,2,81,2],[65,3,81,4],[83,1,83,4],[314,1,353,1],[314,2,353,2],[314,3,355,3],[314,4,355,4],[228,1,272,1],[228,2,272,2],[228,3,272,3],[228,4,272,4],[273,1,313,1],[273,2,313,2],[273,3,313,3],[273,4,313,4]]}
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[null,"ADRAN CANLLAWIAU - LLEOLIADAU ERAILL"]
[null,"Ffynhonnell:","Cynulleidfa:","Argymhellion:"]
[null,"National Institute for Health and Care Excellence. Tuberculosis. NG33. London: NICE; 2016.\nAvailable here.\nLast updated in September 2019.","This guideline is for: \n- Healthcare professionals and TB multidisciplinary teams\n- Substance misuse services, prisons and immigration removal centres\n- Local government and commissioners\n- TB control boards, directors of public health and public health consultants\n- Public Health England and NHS England\n- Voluntary sector workers\n- People with TB and their carers","This guideline covers preventing, identifying and managing latent and active tuberculosis (TB) in children, young people and adults. It aims to improve ways of finding people who have TB in the community and recommends that everyone under 65 with latent TB should be treated. It describes how TB services should be organised, including the role of the TB control board.\n\nIt includes recommendations on:\n- Preventing TB, including in under-served groups\n- Diagnosing and managing latent TB, including recommendations specifically for children and young people\n- Diagnosing and managing active TB, including recommendations specifically for children and young people\n- Drug-resistant TB\n- Infection control\n- Case finding and adherence, treatment completion and follow-up, including in under-served groups\n- Service organisation"]
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[null,"National Institute for Health and Care Excellence. Hepatitis B and C testing: people at risk of infection. PH43. London: NICE; 2012.\nAvailable here.\nLast updated in March 2013.","This public health guidance is relevant to:\n- Commissioners and providers\n- People at increased risk of viral hepatitis\n- Members of the public","This guideline covers raising awareness of and testing for hepatitis B and C infection. It aims to ensure that people at increased risk of hepatitis B and C infection are tested.\n\nIt  includes recommendations on:\n- Raising awareness about hepatitis B and C among the general population and people at increased risk of infection\n- Education and training for professionals who provide services for people at increased risk of infection\n- Testing for hepatitis B and C in primary care, prisons and immigration removal centres, drugs services, and sexual health and genitourinary medicine clinics\n- Tracing close contacts of people with hepatitis B infection\n- Neonatal hepatitis B vaccination\n- Commissioning integrated services for testing and treatment and laboratory services for testing"]
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[null,"National Institute for Health and Care Excellence. Immunisations: reducing differences in uptake in under 19s. PH21. London: NICE; 2009.\nAvailable here.\nLast updated in September 2017.","This public health guidance is relevant to:\n- Healthcare professionals\n- Commissioners and providers\n- People who work in children’s services and local authorities\n- People who work in schools, colleges and workplaces\n- People who work in the private, voluntary and community sectors\n- Parents, carers and young people","This guideline covers increasing immunisation uptake among children and young people aged under 19 years in groups and settings where immunisation coverage is low. It aims to improve access to immunisation services and increase timely immunisation of children and young people. It also aims to ensure babies born to mothers infected with hepatitis B are immunised.\n\nIt includes recommendations on:\n- Immunisation programmes\n- Information systems for recording immunisation status\n- Training for staff involved in immunisation services\n- Contribution of nurseries, schools and further education colleges\n- Targeting groups at risk of not being fully immunised\n- Hepatitis B immunisation for infants"]
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[null,"National Institute for Health and Care Excellence. Drug misuse in over 16s: psychosocial interventions. CG51. London: NICE; 2007.\nAvailable here.\nLast checked in July 2016.","This clinical guidance is relevant to:\n- Healthcare professionals\n- Commissioners and providers\n- People who work in specialist residential and community-based treatment settings\n- People who work in prisons and criminal justice settings\n- Adults and young people over 16 who misuse opioids, stimulants or cannabis and their families and carers","This guideline covers using psychosocial interventions to treat adults and young people over 16 who have a problem with or are dependent on opioids, stimulants or cannabis. It aims to reduce illicit drug use and improve people’s physical and mental health, relationships and employment.\n\nIt includes recommendations on:\n- Principles for supporting people who misuse drugs and their families and carers\n- Identification and assessment of drug misuse\n- Brief interventions and self-help\n- Formal psychosocial interventions\n- Residential, prison and inpatient care"]
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[null,"ADRAN ADOLYGIAD SYSTEMATIG - LLEOLIADAU ERAILL"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau'r awduron:"]
[null,"Abdullahi  LH et al. Improving vaccination uptake among adolescents. Cochrane Database of Systematic Reviews 2020, Issue 1. Art. No.: CD011895. DOI: 10.1002/14651858.CD011895.pub2.\nAvailable here.","Adults (under 19s)","This Cochrane review aimed to evaluate the effects of interventions to improve vaccine uptake among adolescents.\n\nThe reviewers' included 16 studies (eight individually randomised trials, four cluster randomised trials, three non‐randomised trials, and one controlled before‐after study). Twelve studies were conducted in the USA, while there was one study each from: Australia, Sweden, Tanzania, and the UK. Ten studies had unclear or high risk of bias. They categorised interventions as recipient‐oriented, provider‐oriented, or health systems‐oriented.\n\nThe interventions targeted adolescent boys or girls or both (seven studies), parents (four studies), and providers (two studies). Five studies had mixed participants that included adolescents and parents, adolescents and healthcare providers, and parents and healthcare providers. The outcomes included uptake of human papillomavirus (HPV) (11 studies); hepatitis B (three studies); and tetanus–diphtheria–acellular–pertussis (Tdap), meningococcal, HPV, and influenza (three studies) vaccines among adolescents.\n\nHealth education improves HPV vaccine uptake compared to usual practice (RR 1.43, 95% CI 1.16 to 1.76; I² = 0%; 3 studies, 1054 participants; high‐certainty evidence). In addition, one large study provided evidence that a complex multi‐component health education intervention probably results in little to no difference in hepatitis B vaccine uptake compared to simplified information leaflets on the vaccine (RR 0.98, 95% CI 0.97 to 0.99; 17,411 participants; moderate‐certainty evidence).\n\nFinancial incentives may improve HPV vaccine uptake compared to usual practice (RR 1.45, 95% CI 1.05 to 1.99; 1 study, 500 participants; low‐certainty evidence). However, we are uncertain whether combining health education and financial incentives has an effect on hepatitis B vaccine uptake, compared to usual practice (RR 1.38, 95% CI 0.96 to 2.00; 1 study, 104 participants; very low certainty evidence).\n\nMandatory vaccination probably leads to a large increase in hepatitis B vaccine uptake compared to usual practice (RR 3.92, 95% CI 3.65 to 4.20; 1 study, 6462 participants; moderate‐certainty evidence).\n\nProvider prompts probably make little or no difference compared to usual practice, on completion of Tdap (OR 1.28, 95% CI 0.59 to 2.80; 2 studies, 3296 participants), meningococcal (OR 1.09, 95% CI 0.67 to 1.79; 2 studies, 3219 participants), HPV (OR 0.99, 95% CI 0.55 to 1.81; 2 studies, 859 participants), and influenza (OR 0.91, 95% CI 0.61 to 1.34; 2 studies, 1439 participants) vaccination schedules (moderate‐certainty evidence).\n\nProvider education with performance feedback may increase the proportion of adolescents who are offered and accept HPV vaccination by clinicians, compared to usual practice. Compared to adolescents visiting non‐participating clinicians (in the usual practice group), the adolescents visiting clinicians in the intervention group were more likely to receive the first dose of HPV during preventive visits (5.7 percentage points increase) and during acute visits (0.7 percentage points for the first and 5.6 percentage points for the second doses of HPV) (227 clinicians and more than 200,000 children; low‐certainty evidence).\n\nA class‐based school vaccination strategy probably leads to slightly higher HPV vaccine uptake than an age‐based school vaccination strategy (RR 1.09, 95% CI 1.06 to 1.13; 1 study, 5537 participants; moderate‐certainty evidence).\n\nA multi‐component provider intervention (including an education session, repeated contacts, individualised feedback, and incentives) probably improves uptake of HPV vaccine compared to usual practice (moderate‐certainty evidence).\n\nA multi‐component intervention targeting providers and parents involving social marketing and health education may improve HPV vaccine uptake compared to usual practice (RR 1.41, 95% CI 1.25 to 1.59; 1 study, 25,869 participants; low‐certainty evidence).","The authors conclude that various strategies have been evaluated to improve adolescent vaccination including health education, financial incentives, mandatory vaccination, and class‐based school vaccine delivery. However, most of the evidence is of low to moderate certainty. This implies that while this research provides some indication of the likely effect of these interventions, the likelihood that the effects will be substantially different is high. \n\nTherefore, additional research is needed to further enhance adolescent immunisation strategies, especially in low‐ and middle‐income countries where there are limited adolescent vaccination programmes. In addition, it is critical to understand the factors that influence hesitancy, acceptance, and demand for adolescent vaccination in different settings. This is the topic of an ongoing Cochrane qualitative evidence synthesis, which may help to explain why and how some interventions were more effective than others in increasing adolescent HPV vaccination coverage."]
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[null,"Jacobson Vann  JC et al. Patient reminder and recall interventions to improve immunization rates. Cochrane Database of Systematic Reviews 2018, Issue 1. Art. No.: CD003941. DOI: 10.1002/14651858.CD003941.pub3. \nAvailable here.","Adults","This Cochrane review aimed to evaluate and compare the effectiveness of various types of patient reminder and recall interventions to improve receipt of immunizations.\n\nThe 75 included studies involved child, adolescent, and adult participants in outpatient, community‐based, primary care, and other settings in 10 countries.\n\nPatient reminder or recall interventions, including telephone and autodialer calls, letters, postcards, text messages, combination of mail or telephone, or a combination of patient reminder or recall with outreach, probably improve the proportion of participants who receive immunization (RR of 1.28, 95% CI 1.23 to 1.35; risk difference of 8%) based on moderate certainty evidence from 55 studies with 138,625 participants.\n\nThree types of single‐method reminders improve receipt of immunizations based on high certainty evidence: the use of postcards (RR 1.18, 95% CI 1.08 to 1.30; eight studies; 27,734 participants), text messages (RR 1.29, 95% CI 1.15 to 1.44; six studies; 7772 participants), and autodialer (RR 1.17, 95% CI 1.03 to 1.32; five studies; 11,947 participants). Two types of single‐method reminders probably improve receipt of immunizations based on moderate certainty evidence: the use of telephone calls (RR 1.75, 95% CI 1.20 to 2.54; seven studies; 9120 participants) and letters to patients (RR 1.29, 95% CI 1.21 to 1.38; 27 studies; 81,100 participants).\n\nBased on high certainty evidence, reminders improve receipt of immunizations for childhood (RR 1.22, 95% CI 1.15 to 1.29; risk difference of 8%; 23 studies; 31,099 participants) and adolescent vaccinations (RR 1.29, 95% CI 1.17 to 1.42; risk difference of 7%; 10 studies; 30,868 participants). Reminders probably improve receipt of vaccinations for childhood influenza (RR 1.51, 95% CI 1.14 to 1.99; risk difference of 22%; five studies; 9265 participants) and adult influenza (RR 1.29, 95% CI 1.17 to 1.43; risk difference of 9%; 15 studies; 59,328 participants) based on moderate certainty evidence. They may improve receipt of vaccinations for adult pneumococcus, tetanus, hepatitis B, and other non‐influenza vaccinations based on low certainty evidence although the confidence interval includes no effect of these interventions (RR 2.08, 95% CI 0.91 to 4.78; four studies; 8065 participants).","The reviewers conclude that patient reminder and recall systems, in primary care settings, are likely to be effective at improving the proportion of the target population who receive immunizations."]
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[null,"Thomas  RE and Lorenzetti  DL. Interventions to increase influenza vaccination rates of those 60 years and older in the community. Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD005188. DOI: 10.1002/14651858.CD005188.pub4. \nAvailable here.","Adults (60 years+)","This Cochrane review aimed to assess access, provider, system, and societal interventions to increase the uptake of influenza vaccination in people aged 60 years and older in the community.\n\nThe reviewers' included 3 new RCTs for this update (total 61 RCTs; 1,055,337 participants). Trials involved people aged 60 years and older living in the community in high‐income countries. Heterogeneity limited some meta‐analyses. They assessed studies as at low risk of bias for randomisation (38%), allocation concealment (11%), blinding (44%), and selective reporting (100%). Half (51%) had missing data. We assessed the evidence as low‐quality. They identified three levels of intervention intensity: low (e.g. postcards), medium (e.g. personalised phone calls), and high (e.g. home visits, facilitators).\n\nIncreasing community demand (12 strategies, 41 trials, 53 study arms, 767,460 participants): One successful intervention that could be meta‐analysed was client reminders or recalls by letter plus leaflet or postcard compared to reminder (OR 1.11, 95% CI 1.07 to 1.15; 3 studies; 64,200 participants). Successful interventions tested by single studies were patient outreach by retired teachers (OR 3.33, 95% CI 1.79 to 6.22); invitations by clinic receptionists (OR 2.72, 95% CI 1.55 to 4.76); nurses or pharmacists educating and nurses vaccinating patients (OR 152.95, 95% CI 9.39 to 2490.67); medical students counselling patients (OR 1.62, 95% CI 1.11 to 2.35); and multiple recall questionnaires (OR 1.13, 95% CI 1.03 to 1.24).\n\nSome interventions could not be meta‐analysed due to significant heterogeneity: 17 studies tested simple reminders (the 95% CI was entirely above unity in 11 trials implying all 11 interventions increased vaccination rates); 16 tested personalised reminders (the 95% CI was entirely above unity in 12 trials implying all 12 interventions increased vaccination rates ); 2 investigated customised compared to form letters (the 95% CI was above unity in both trials implying both interventions increased vaccination rates); and 4 studies examined the impact of health risk appraisals (the 95% CI was above unity in all 4 trials implying all 4 interventions increased vaccination rates). One study of a lottery for free groceries was not effective.\n\nEnhancing vaccination access (6 strategies, 8 trials, 10 arms, 9353 participants): The reviewers meta‐analysed results from 2 studies of home visits (OR 1.30, 95% CI 1.05 to 1.61), and 2 studies that tested free vaccine compared to patient payment for vaccine (OR 2.36, 95% CI 1.98 to 2.82). They were unable to conduct meta‐analyses of 2 studies of home visits by nurses plus a physician care plan (the 95% CI was entirely above unity in both trials implying both interventions increased vaccination rates) and 2 studies of free vaccine compared to no intervention (the 95% CI was entirely above unity in both trials implying both interventions increased vaccination rates). One study of group visits (OR 27.2, 95% CI 1.60 to 463.3) was effective, and 1 study of home visits compared to safety interventions was not.\n\nProvider‐ or system‐based interventions (11 strategies, 15 trials, 17 arms, 278,524 participants): One successful intervention that could be meta‐analysed focused on payments to physicians (OR 2.22, 95% CI 1.77 to 2.77). Successful interventions tested by individual studies were: reminding physicians to vaccinate all patients (OR 2.47, 95% CI 1.53 to 3.99); posters in clinics presenting vaccination rates and encouraging competition between doctors (OR 2.03, 95% CI 1.86 to 2.22); and chart reviews and benchmarking to the rates achieved by the top 10% of physicians (OR 3.43, 95% CI 2.37 to 4.97).\n\nThe reviewers were unable to meta‐analyse 4 studies that looked at physician reminders (the 95% CI was entirely above unity in 3 trials implying all 3 interventions increased vaccination rates) and 3 studies of facilitator encouragement of vaccination (the 95% CI was entirely above unity in 2 trials implying both interventions increased vaccination rates). Interventions that were not effective were: comparing letters on discharge from hospital to letters to general practitioners; posters plus postcards versus posters alone; educational reminders, academic detailing, and peer comparisons compared to mailed educational materials; educational outreach plus feedback to teams versus written feedback; and an intervention to increase staff vaccination rates.\n\nInterventions at the societal level: No studies reported on societal‐level interventions.","The reviewers identified interventions that demonstrated significant positive effects of low (postcards), medium (personalised phone calls), and high (home visits, facilitators) intensity that increase community demand for vaccination, enhance access, and improve provider/system response. The overall GRADE assessment of the evidence was moderate quality. Conclusions are unchanged from the 2014 review."]
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[null,"Lorenc T, Marshall D, Wright K, Sutcliffe K, Sowden A (2018). Seasonal influenza vaccination of healthcare workers: evidence synthesis. London: EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London. \nAvailable here.","Occupational groups (healthcare workers)","This report by EPPI-centre presents the findings from: (1) a synthesis of evidence about seasonal flu vaccination interventions: content and components, processes, and implementation; and (2) a systematic review of qualitative studies investigating HCWs’ views, attitudes and perceptions about seasonal flu vaccination. \n\nThe reviewers identified 60 studies evaluating interventions to promote seasonal flu vaccination among HCWs. Of these, only 13 used an RCT design. The types of strategy, number of studies, strength of evidence and likely effectiveness are presented in the summary table, overleaf. Most of the RCTs focused on increasing awareness, or on education. Few RCTs evaluated strategies to increase access, or incentives, and none assessed mandatory vaccination programmes. Most interventions combined several different elements and this is likely to be the most promising approach, as components are likely to work in different ways, and for different people. Most RCTs were conducted either in hospitals or in long-term care (e.g., nursing homes).\n\nThree studies were conducted in the UK (two RCTs), mainly focusing on increasing awareness or education. Most interventions appear not to have been based on any clear theoretical framework, or on any formative research or substantive engagement with HCWs themselves. Most non-mandatory interventions focused on individual beliefs, rather than on the social or institutional factors which may affect vaccination uptake. Data on implementation indicate that it is important to ensure adequate resources and management support; to address HCWs’ beliefs about vaccination; and to collect accurate data on vaccination coverage.\n\nThe findings from 25 qualitative studies. The data indicated a number of personal beliefs which may be barriers to vaccination, including perceived low risk of influenza, fear of side-effects of the vaccine, and scepticism about vaccine effectiveness. There were serious barriers to the acceptability of some interventions, particularly coercive mandatory policies, but also some educational or awareness-raising strategies.\n","The review concluded that bringing together the findings from the quantitative and qualitative studies, it appears that HCWs have clear views about their needs and priorities in relation to seasonal flu\nvaccination, which were mostly not addressed by the evaluated interventions. \n\nThe key messages were:\n- Promising interventions combine several components, including individual, social and environmental elements\n- Education alone is probably ineffective, but broader awareness-raising strategies appear promising\n- Increasing access to vaccination may be effective, but the evidence is weak with few RCTs\n- Both “soft” and “hard” mandates appear promising, but have yet to be evaluated using robust study designs, and may have limited acceptability\n- Interventions should ideally target everyone working in a healthcare context, but this may be practically difficult\n- The culture and context of the organisation(s), within which interventions are implemented, may have an important influence on outcomes. Evaluators should seek\nto understand interventions within an organisational system\n- Very few interventions engaged with HCWs to understand their needs and priorities\n- Intervention developers/implementers should engage with HCWs to understand their views, conduct formative research and pilot interventions before full-scale evaluation\n- Mixed-methods research to understand the context, in which an intervention will be implemented, and HCWs’ likely responses to an intervention, may be valuable"]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Community-Wide Education When Used Alone. The Community Guide; 2015. \nAvailable here.","Adults (older: age not specified)","This report aimed to determine the effectiveness of community-wide education interventions when implemented alone in increasing vaccination rates or reducing rates of vaccine preventable illness and found insufficient evidence. Evidence is considered insufficient due to inconsistent results and concerns about the applicability of evidence to more diverse communities in the United States where improvements in vaccination rates are needed.\n\nThis Task Force finding is based on evidence from a Community Guide systematic review completed in 2010 (6 studies with 8 study arms, search period 1980-2009) combined with more recent evidence (1 study, search period 2009- February 2012). Based on the combined evidence, the Task Force reaffirms its finding of insufficient evidence.\n\nThe Task Force considered evidence from 7 studies with 9 study arms. Among the studies providing a common measure of change in vaccination rates (4 studies with 6 arms) there was a median increase of 6 percentage points (range of values: 0.4 to 12.2 percentage points).\n\nThree studies evaluated mass media activities using different measures of change. In a targeted community in Australia, pneumococcal vaccines dispatched to service providers increased during the period of a mass media campaign. In Finland, a mass media campaign briefly increased MMR vaccine receipt for children 6 years of age, though changes were not reported for younger children. In the U.S., a mass media campaign addressing flu-related topics among a nationally representative population of older adults found a positive association between flu-related media reports and influenza vaccination rates in the weeks following the campaign (annual vaccination rates increased by 2.3-7.9 percentage points, p<0.001).\n\nOne U.S. study observed moderate increases in vaccination rates for hepatitis B vaccine following intensive communitywide educational efforts in two Vietnamese-American communities. Characteristics of the study communities that may have contributed to intervention effectiveness included: (1) popular Vietnamese-language media, (2) established Vietnamese service organizations, and (3) culturally appropriate strategies and materials.\n\nCommunity-wide education is commonly implemented in combination with additional interventions (such as efforts to expand and enhance access to vaccinations). In another review, the Task Force found strong evidence of effectiveness for community-based interventions implemented in combination to increase vaccination rates, and five of the included studies used community-wide education in the combination of interventions.","This CPSTF report states that although the evidence identified in this systematic review is insufficient to determine the effectiveness of community-wide education when implemented alone, two studies suggest that these interventions may be useful with certain communities. More research is needed to understand the potential applicability of these interventions to other populations, and for other vaccines.\n\nThe Task Force acknowledges an important role for mass media (and the potential role of social media) in disseminating\ninformation to large audiences and shaping public attitudes and behaviours.\n\nVaccine manufacturers have been increasing direct-to-consumer mass and small media advertising to promote new vaccines. While evidence from private sector marketing campaigns on vaccine uptake was not included in this review, the Task Force considered the applicability of these marketing experiences to public health efforts. They determined that community-wide educational efforts may have greater impact when used to inform members of the community about new vaccines (such as HPV), or new recommendations (such as the universal recommendation for seasonal influenza), and in situations of public health urgency (such as the H1N1 pandemic). The effectiveness of community-wide education to increase vaccination rates in these circumstances remains an important issue for further evaluation research.\n"]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Standing Orders. The Community Guide; 2015. \nAvailable here.","Adults","The Task Force finding is based on evidence from a Community Guide systematic review completed in 2009 (29 studies, search period 1997–2009) combined with more recent evidence (6 studies, search period 2009–February 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\n\nThe Task Force considered evidence from 35 studies. Of these, 27 studies provided a common measurement of change in vaccination rates with a median increase of 24 percentage points (IQI: 12 to 35 percentage points). Nine studies that examined the impact of standing orders alone documented a median increase of 16 percentage points (IQI: 9 to 29 percentage points). Nineteen studies that evaluated standing orders when combined with additional interventions documented a median increase of 27 percentage points (IQI: 13 to 40 percentage points). Seven studies that did not provide a common measure of change for vaccination rates all reported favorable results after implementation of standing orders.\n\nThe reviewed studies evaluated the effectiveness of standing orders across a wide range of clinical vaccination settings, health care personnel, and client populations. Standing orders were found to be effective in various settings including clinics, hospitals, and long-term care facilities. Interventions were effective when used with different vaccination providers including nurses and pharmacists. While most studies looked at adult populations, four examined intervention effectiveness among children and found a median absolute percent increase of 28 percentage points (range: 8 to 49). While no studies specifically evaluated the impact of standing orders for vaccination of adolescents, evidence from this review is likely applicable to this population. In addition, a subset of the included evidence suggests that standing orders may be more effective in improving vaccination rates in both inpatient and outpatient settings when compared to a provider reminder system.\n\nOne paper from the updated search period described the following barriers encountered during implementation of a pneumococcal vaccination standing orders program in three hospitals: gaps in staff education and training; personnel concerns about additional workload; staff reluctance to administer vaccines without a physician's order; attending physicians' resistance to having hospitalized patients vaccinated; and logistical difficulties. Some attending physicians expressed concern that vaccination would interfere with scheduled treatments or procedures. Other attending physicians did not consider inpatient stays to be an appropriate time for vaccinations (Middleton et al. 2005).\n\nAn additional study reported barriers to implementation of influenza and pneumococcal vaccination standing orders in various health care settings. Findings suggested that the adoption of these policies may have been too difficult to administer, staff were unclear or unconvinced of program benefits, and there was perceived physician discomfort with delegating responsibility for immunizations to nursing staff. A few of the respondents also indicated that resources, effectiveness of the vaccine, and time required to administer the vaccine were barriers for adoption. The majority of these barriers were specific to the administration of the influenza vaccine (Goldstein et al. 2005).","This CPSTF report concludes that standing orders were shown to be effective in increasing vaccination rates for influenza and pneumococcal vaccines. Additional research is needed, however, to determine if these interventions are effective for different vaccines (e.g. hepatitis, tetanus and vaccines recommended for adolescents). More evidence is also needed on ways to address barriers to the implementation of standing orders in health systems.\n"]
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[null,"Stokes G, Richardson M, Brunton G, Khatwa M, Thomas J (2015) Review 3: Community engagement for health via coalitions, collaborations and partnerships (on-line social media and social networks) – a systematic review and metaanalysis. London: EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London.\nAvailable here.","Adults \n\nOccupational groups (university staff)","This systematic review sought to answer the following research question:\nWhat health issues and populations have been studied using online social media/social networking?\n\nThere is evidence of health issues focused on healthy eating/physical activity, cancer detection and screening, diabetes, general wellbeing and lifestyle, sexual health, flu immunisation, food safety. However there were a low number of studies for each health topic and population. There is evidence of studies focused on populations under 25 years of age or on those over 40 years of age, but gaps in evaluated interventions in those aged under 16, 30 to 40 and over 60. There is inconsistent evidence of studies targeting women only and no evidence of studies targeting men specifically. There is inconsistent evidence of social media/social networking interventions directed to minority ethnic groups.\n\nThe studies included in this review focused on a broad range of health topics, only one RCT focussed amongst Australian university students and staff focused on influenza immunisation (Lau et al. 2012). For their study into the impact of a web-based personally controlled health management system entitled Healthy.me on influenza vaccination and health service utilisation rates, Lau et al. (2012) incorporated social forums and messaging to allow consumers to interact with each other and with healthcare professionals. \n\nThe provider of the additional potentially active content was either automated or anonymous. The content was also provided by the health professional experts. The study described the use of a mandatory five-minute session on how to use a website. Primary analysis examined differences in the proportion of participants obtaining influenza vaccination during the study in the waitlist and PCHMS groups using the c2 test, including participants who had the opportunity to use the PCHMS but did not\ndo so. \n\nThe extent of community engagement was low (0.48 95% CI: 0.09 to 0.87). The review concluded that there is weak evidence that employing either peers or professionals to facilitate online discussions forums is seen more often to have effective outcomes. ","In summary, although the effect sizes are very small overall, QCA demonstrated that including a facilitator in the delivery of social media/social networking interventions demonstrated higher effect sizes for studies not focused on healthy eating and physical activity and which did not employ the use of theory in intervention development. Nonhealthy eating/physical activity topics focused on sexually transmitted infection prevention, cancer screening/prevention, influenza immunization and mental health promotion. The use of this combination of conditions is conceptually well supported, lending confidence to its findings. However, it must be considered that these findings are exploratory in nature and should be evaluated robustly in future intervention development and evaluation."]

{"sheet":"Flu","index":15,"n_rows":642,"n_cols":5,"rows_kept":642,"cut":false,"hidden":false,"merged":[[493,1,520,1],[493,2,520,2],[493,3,522,3],[493,4,520,4],[641,1,699,1],[641,2,699,2],[641,3,700,3],[641,4,699,4],[565,1,596,1],[565,2,596,2],[565,3,597,3],[565,4,596,4],[598,1,640,1],[598,2,640,2],[598,3,640,3],[598,4,640,4],[466,4,492,4],[442,4,465,4],[376,1,416,1],[376,2,416,2],[376,3,416,3],[376,4,416,4],[417,1,441,1],[417,2,441,2],[417,3,441,3],[417,4,441,4],[442,1,464,1],[442,2,464,2],[442,3,465,3],[466,1,490,1],[466,2,490,2],[466,3,492,3],[166,1,223,1],[166,2,223,2],[166,3,223,3],[166,4,223,4],[224,1,253,1],[224,2,253,2],[224,3,253,3],[224,4,253,4],[52,1,52,4],[54,1,69,1],[54,2,69,2],[54,3,69,3],[54,4,69,4],[70,1,90,1],[70,2,90,2],[70,3,90,3],[70,4,90,4],[254,1,297,1],[254,2,297,2],[254,3,297,3],[254,4,297,4],[146,1,165,1],[146,2,165,2],[146,3,165,3],[146,4,165,4],[91,1,145,1],[91,2,145,2],[91,3,145,3],[91,4,145,4],[298,1,330,1],[298,2,330,2],[298,3,330,3],[298,4,330,4],[523,1,562,1],[523,2,562,2],[523,3,564,3],[523,4,564,4],[355,1,375,1],[355,2,375,2],[355,3,375,3],[355,4,375,4],[331,1,354,1],[331,2,354,2],[331,3,354,3],[331,4,354,4],[22,1,50,1],[22,2,50,2],[22,3,50,4],[17,1,18,4],[20,1,20,4]]}
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[null,"BRECHLYN FFLIW"]
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[null,"ADRAN CANLLAWIAU - BRECHLYN FFLIW"]
[null,"Ffynhonnell:","Cynulleidfa:","Argymhellion:"]
[null,"National Institute for Health and Care Excellence. Flu vaccination: increasing uptake. NG103. London: NICE; 2018.\nAvailable here.","This guideline is for: \n- Commissioners and providers of primary and secondary healthcare services, including maternity providers and community pharmacies\n- All employers of staff who provide NHS or social-care funded services (including maternity care, domiciliary care and care homes)\n- Local authorities, and community and voluntary sector organisations that employ health and social care workers\n- Occupational health services and infection prevention and control teams\n- NHS England teams and Health Education England teams\n- People using services, their families, carers and other members of the public, in particular those eligible for flu vaccination","This guideline covers how to increase uptake of the free flu vaccination among people who are eligible. It describes ways to increase awareness and how to use all opportunities in primary and secondary care to identify people who should be encouraged to have the vaccination.\n\nIt includes recommendations on:\n- Using a multicomponent approach\n- Raising awareness\n- Offering vaccination\n- Increasing uptake among eligible groups in primary and secondary care\n- Audit, monitoring and feedback\n- Vaccination in carers\n- Increasing uptake in health and social care staff"]
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[null,"ADRAN ADOLYGIAD SYSTEMATIG - BRECHLYN FFLIW"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau'r awduron:"]
[null,"Jia  L et al. Payment methods for healthcare providers working in outpatient healthcare settings. Cochrane Database of Systematic Reviews 2021, Issue 1. Art. No.: CD011865. DOI: 10.1002/14651858.CD011865.pub2. \nAvailable here.","Adults (65 years+)","This Cochrane review aimed to assess the impact of different payment methods for healthcare providers working in outpatient healthcare settings on the quantity and quality of health service provision, patient outcomes, healthcare provider outcomes, cost of service provision, and adverse effects.\n\nThe reviewers' included 27 studies in the review: 12 randomised trials, 13 controlled before‐and‐after studies, one interrupted time series, and one repeated measure study. Only one randomised controlled trial (Kouides et al. 1998) based in USA fulfilled the inclusion criteria of this evidence map. \nPrimary care physicians in the intervention group received a fee for each immunisation of USD 8 and an additional 10% (USD 0.8) or 20% (USD 1.6) reimbursement per shot according to whether they immunised 70% or 85% (respectively) of the eligible population. The primary care physicians in the control group received only the fee for each immunisation of USD 8. The mean immunisation rate with payment for performance plus existing payment methods was 0.34 per cent points higher (0.2 per cent points lower to 0.87 points higher) compared to existing payment methods [MD 0.34 (−0.20 to 0.87)].\n\n\n\n\n\n","Based on the evidence from one study, the authors were uncertain of the effect of payment for performance added to existing payment methods on immunisation rates for the elderly.\n\nThere is a need for further well‐conducted research on payment methods for healthcare providers working in outpatient healthcare settings in low‐ and middle‐income countries; more studies comparing the impacts of different designs of the same payment method; and studies that consider the unintended consequences of payment interventions."]
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[null,"Palmer  MJ et al. Targeted client communication via mobile devices for improving maternal, neonatal, and child health. Cochrane Database of Systematic Reviews 2020, Issue 8. Art. No.: CD013679. DOI: 10.1002/14651858.CD013679.\nAvailable here.","High risk groups (pregnant women)","This Cochrane review aimed to assess the effects of TCC via MD on health behaviour, service use, health, and well‐being for maternal, neonatal and child health (MNCH).\n\nThe reviewers'  included 27 trials (17,463 participants). Trial populations were: pregnant and postpartum women (11 trials conducted in low‐, middle‐ or high‐income countries; pregnant and postpartum women living with HIV (three trials carried out in one lower middle‐income country); and parents of children under the age of five years (13 trials conducted in LMHIC). \n\nOnly two studies within the targeted client communication via mobile device versus digital non-targeted communication fulfilled the criteria of this review:\nOne study (Yudin et al. 2017) found that a mobile phone text message reinforcing that the influenza vaccine is recommended for all pregnant women and safe during pregnancy and breastfeeding compared to standard care/ no intervention, may make little or no difference to attendance for antenatal influenza vaccination (risk ratio (RR) 1.05, 95% confidence interval (CI) 0.71 to 1.58), though the CI encompasses both benefit and harm (low‐certainty evidence). \nAnother study (Lund et al. 2012) found that a multi-component approach combining mobile phone text message with voucher compared to simple health education and appointment reminders to encourage attendance to routine antenatal classes, make little or no difference to attendance for antenatal tetanus vaccine (OR 1.67, 95% CI 0.84 to 3.33). ","The authors conclude that the effect of targeted client communication via mobile devices for most outcomes is uncertain. There may be improvements for some outcomes using targeted communication but these findings were of low certainty. \n\nHigh‐quality, adequately powered trials and cost‐effectiveness analyses are required to reliably ascertain the effects and relative benefits of TCCMD. Future studies should measure potential unintended consequences, such as partner violence or breaches of confidentiality."]
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[null,"Abdullahi  LH et al. Improving vaccination uptake among adolescents. Cochrane Database of Systematic Reviews 2020, Issue 1. Art. No.: CD011895. DOI: 10.1002/14651858.CD011895.pub2.\nAvailable here.","Adults (under 19s)","This Cochrane review aimed to evaluate the effects of interventions to improve vaccine uptake among adolescents.\n\nThe reviewers' included 16 studies (eight individually randomised trials, four cluster randomised trials, three non‐randomised trials, and one controlled before‐after study). Twelve studies were conducted in the USA, while there was one study each from: Australia, Sweden, Tanzania, and the UK. Ten studies had unclear or high risk of bias. They categorised interventions as recipient‐oriented, provider‐oriented, or health systems‐oriented.\n\nThe interventions targeted adolescent boys or girls or both (seven studies), parents (four studies), and providers (two studies). Five studies had mixed participants that included adolescents and parents, adolescents and healthcare providers, and parents and healthcare providers. The outcomes included uptake of human papillomavirus (HPV) (11 studies); hepatitis B (three studies); and tetanus–diphtheria–acellular–pertussis (Tdap), meningococcal, HPV, and influenza (three studies) vaccines among adolescents.\n\nHealth education improves HPV vaccine uptake compared to usual practice (RR 1.43, 95% CI 1.16 to 1.76; I² = 0%; 3 studies, 1054 participants; high‐certainty evidence). In addition, one large study provided evidence that a complex multi‐component health education intervention probably results in little to no difference in hepatitis B vaccine uptake compared to simplified information leaflets on the vaccine (RR 0.98, 95% CI 0.97 to 0.99; 17,411 participants; moderate‐certainty evidence).\n\nFinancial incentives may improve HPV vaccine uptake compared to usual practice (RR 1.45, 95% CI 1.05 to 1.99; 1 study, 500 participants; low‐certainty evidence). However, we are uncertain whether combining health education and financial incentives has an effect on hepatitis B vaccine uptake, compared to usual practice (RR 1.38, 95% CI 0.96 to 2.00; 1 study, 104 participants; very low certainty evidence).\n\nMandatory vaccination probably leads to a large increase in hepatitis B vaccine uptake compared to usual practice (RR 3.92, 95% CI 3.65 to 4.20; 1 study, 6462 participants; moderate‐certainty evidence).\n\nProvider prompts probably make little or no difference compared to usual practice, on completion of Tdap (OR 1.28, 95% CI 0.59 to 2.80; 2 studies, 3296 participants), meningococcal (OR 1.09, 95% CI 0.67 to 1.79; 2 studies, 3219 participants), HPV (OR 0.99, 95% CI 0.55 to 1.81; 2 studies, 859 participants), and influenza (OR 0.91, 95% CI 0.61 to 1.34; 2 studies, 1439 participants) vaccination schedules (moderate‐certainty evidence).\n\nProvider education with performance feedback may increase the proportion of adolescents who are offered and accept HPV vaccination by clinicians, compared to usual practice. Compared to adolescents visiting non‐participating clinicians (in the usual practice group), the adolescents visiting clinicians in the intervention group were more likely to receive the first dose of HPV during preventive visits (5.7 percentage points increase) and during acute visits (0.7 percentage points for the first and 5.6 percentage points for the second doses of HPV) (227 clinicians and more than 200,000 children; low‐certainty evidence).\n\nA class‐based school vaccination strategy probably leads to slightly higher HPV vaccine uptake than an age‐based school vaccination strategy (RR 1.09, 95% CI 1.06 to 1.13; 1 study, 5537 participants; moderate‐certainty evidence).\n\nA multi‐component provider intervention (including an education session, repeated contacts, individualised feedback, and incentives) probably improves uptake of HPV vaccine compared to usual practice (moderate‐certainty evidence).\n\nA multi‐component intervention targeting providers and parents involving social marketing and health education may improve HPV vaccine uptake compared to usual practice (RR 1.41, 95% CI 1.25 to 1.59; 1 study, 25,869 participants; low‐certainty evidence).","The authors conclude that various strategies have been evaluated to improve adolescent vaccination including health education, financial incentives, mandatory vaccination, and class‐based school vaccine delivery. However, most of the evidence is of low to moderate certainty. This implies that while this research provides some indication of the likely effect of these interventions, the likelihood that the effects will be substantially different is high. \n\nTherefore, additional research is needed to further enhance adolescent immunisation strategies, especially in low‐ and middle‐income countries where there are limited adolescent vaccination programmes. In addition, it is critical to understand the factors that influence hesitancy, acceptance, and demand for adolescent vaccination in different settings. This is the topic of an ongoing Cochrane qualitative evidence synthesis, which may help to explain why and how some interventions were more effective than others in increasing adolescent HPV vaccination coverage."]
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[null,"Stormacq C et al. Effects of health literacy interventions on health-related outcomes in socioeconomically disadvantaged adults living in the community: a systematic review. JBI evidence synthesis 2020, Issue 18(7). pp.1389-1469. doi: 10.11124/JBISRIR-D-18-00023.\nAvailable here.","High risk groups (pregnant women)","The objectives of this JBI review were: i) to identify and synthesize the best available evidence on the effectiveness on health-related outcomes of health literacy interventions for enabling socioeconomically disadvantaged people living in the community to access, understand, appraise and apply health information; and ii) to identify components of health literacy interventions associated with improved health-related outcomes.\n\nTwenty-one studies were included in the review. Only one randomised controlled trial fulfilled the criteria of this evidence map (Stockwell et al. 2014). It included 1153 low-income women initiating prenatal care, 576 of whom participated in the experimental group and 577 in the control group. Participants in the experimental group received health information and health education about influenza during pregnancy through five weekly text messages. The text messages covered various topics such as risk of influenza for the pregnant woman and fetus, vaccine safety and vaccine recommendations. Participants in the control group received usual care. At four months follow-up, there was a higher rate of vaccination in the experimental group than in the control group (P = 0.048). Text messages are a simple, convenient and cost-effective tool to send specific health information to a large number of people simultaneously. Text messages can be an effective tool for delivering health information and encouraging the adoption of positive health behaviors within a population with limited access to health information.","The review concluded that mostly, health literacy interventions in the Disease Prevention domain of the health continuum were effective for improving preventive health behaviors and practices such as vaccination and screenings."]
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[null,"Thomas  RE and Lorenzetti  DL. Interventions to increase influenza vaccination rates of those 60 years and older in the community. Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD005188. DOI: 10.1002/14651858.CD005188.pub4. \nAvailable here.","Adults (60 years+)","This Cochrane review aimed to assess access, provider, system, and societal interventions to increase the uptake of influenza vaccination in people aged 60 years and older in the community.\n\nThe reviewers' included 3 new RCTs for this update (total 61 RCTs; 1,055,337 participants). Trials involved people aged 60 years and older living in the community in high‐income countries. Heterogeneity limited some meta‐analyses. They assessed studies as at low risk of bias for randomisation (38%), allocation concealment (11%), blinding (44%), and selective reporting (100%). Half (51%) had missing data. We assessed the evidence as low‐quality. They identified three levels of intervention intensity: low (e.g. postcards), medium (e.g. personalised phone calls), and high (e.g. home visits, facilitators).\n\nIncreasing community demand (12 strategies, 41 trials, 53 study arms, 767,460 participants): One successful intervention that could be meta‐analysed was client reminders or recalls by letter plus leaflet or postcard compared to reminder (OR 1.11, 95% CI 1.07 to 1.15; 3 studies; 64,200 participants). Successful interventions tested by single studies were patient outreach by retired teachers (OR 3.33, 95% CI 1.79 to 6.22); invitations by clinic receptionists (OR 2.72, 95% CI 1.55 to 4.76); nurses or pharmacists educating and nurses vaccinating patients (OR 152.95, 95% CI 9.39 to 2490.67); medical students counselling patients (OR 1.62, 95% CI 1.11 to 2.35); and multiple recall questionnaires (OR 1.13, 95% CI 1.03 to 1.24).\n\nSome interventions could not be meta‐analysed due to significant heterogeneity: 17 studies tested simple reminders (the 95% CI was entirely above unity in 11 trials implying all 11 interventions increased vaccination rates); 16 tested personalised reminders (the 95% CI was entirely above unity in 12 trials implying all 12 interventions increased vaccination rates ); 2 investigated customised compared to form letters (the 95% CI was above unity in both trials implying both interventions increased vaccination rates); and 4 studies examined the impact of health risk appraisals (the 95% CI was above unity in all 4 trials implying all 4 interventions increased vaccination rates). One study of a lottery for free groceries was not effective.\n\nEnhancing vaccination access (6 strategies, 8 trials, 10 arms, 9353 participants): The reviewers meta‐analysed results from 2 studies of home visits (OR 1.30, 95% CI 1.05 to 1.61), and 2 studies that tested free vaccine compared to patient payment for vaccine (OR 2.36, 95% CI 1.98 to 2.82). They were unable to conduct meta‐analyses of 2 studies of home visits by nurses plus a physician care plan (the 95% CI was entirely above unity in both trials implying both interventions increased vaccination rates) and 2 studies of free vaccine compared to no intervention (the 95% CI was entirely above unity in both trials implying both interventions increased vaccination rates). One study of group visits (OR 27.2, 95% CI 1.60 to 463.3) was effective, and 1 study of home visits compared to safety interventions was not.\n\nProvider‐ or system‐based interventions (11 strategies, 15 trials, 17 arms, 278,524 participants): One successful intervention that could be meta‐analysed focused on payments to physicians (OR 2.22, 95% CI 1.77 to 2.77). Successful interventions tested by individual studies were: reminding physicians to vaccinate all patients (OR 2.47, 95% CI 1.53 to 3.99); posters in clinics presenting vaccination rates and encouraging competition between doctors (OR 2.03, 95% CI 1.86 to 2.22); and chart reviews and benchmarking to the rates achieved by the top 10% of physicians (OR 3.43, 95% CI 2.37 to 4.97).\n\nThe reviewers were unable to meta‐analyse 4 studies that looked at physician reminders (the 95% CI was entirely above unity in 3 trials implying all 3 interventions increased vaccination rates) and 3 studies of facilitator encouragement of vaccination (the 95% CI was entirely above unity in 2 trials implying both interventions increased vaccination rates). Interventions that were not effective were: comparing letters on discharge from hospital to letters to general practitioners; posters plus postcards versus posters alone; educational reminders, academic detailing, and peer comparisons compared to mailed educational materials; educational outreach plus feedback to teams versus written feedback; and an intervention to increase staff vaccination rates.\n\nInterventions at the societal level: No studies reported on societal‐level interventions.","The reviewers identified interventions that demonstrated significant positive effects of low (postcards), medium (personalised phone calls), and high (home visits, facilitators) intensity that increase community demand for vaccination, enhance access, and improve provider/system response. The overall GRADE assessment of the evidence was moderate quality. Conclusions are unchanged from the 2014 review."]
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[null,"Jacobson Vann  JC et al. Patient reminder and recall interventions to improve immunization rates. Cochrane Database of Systematic Reviews 2018, Issue 1. Art. No.: CD003941. DOI: 10.1002/14651858.CD003941.pub3. \nAvailable here.","Adults","This Cochrane review aimed to evaluate and compare the effectiveness of various types of patient reminder and recall interventions to improve receipt of immunizations.\n\nThe 75 included studies involved child, adolescent, and adult participants in outpatient, community‐based, primary care, and other settings in 10 countries.\n\nPatient reminder or recall interventions, including telephone and autodialer calls, letters, postcards, text messages, combination of mail or telephone, or a combination of patient reminder or recall with outreach, probably improve the proportion of participants who receive immunization (RR of 1.28, 95% CI 1.23 to 1.35; risk difference of 8%) based on moderate certainty evidence from 55 studies with 138,625 participants.\n\nThree types of single‐method reminders improve receipt of immunizations based on high certainty evidence: the use of postcards (RR 1.18, 95% CI 1.08 to 1.30; eight studies; 27,734 participants), text messages (RR 1.29, 95% CI 1.15 to 1.44; six studies; 7772 participants), and autodialer (RR 1.17, 95% CI 1.03 to 1.32; five studies; 11,947 participants). Two types of single‐method reminders probably improve receipt of immunizations based on moderate certainty evidence: the use of telephone calls (RR 1.75, 95% CI 1.20 to 2.54; seven studies; 9120 participants) and letters to patients (RR 1.29, 95% CI 1.21 to 1.38; 27 studies; 81,100 participants).\n\nBased on high certainty evidence, reminders improve receipt of immunizations for childhood (RR 1.22, 95% CI 1.15 to 1.29; risk difference of 8%; 23 studies; 31,099 participants) and adolescent vaccinations (RR 1.29, 95% CI 1.17 to 1.42; risk difference of 7%; 10 studies; 30,868 participants). Reminders probably improve receipt of vaccinations for childhood influenza (RR 1.51, 95% CI 1.14 to 1.99; risk difference of 22%; five studies; 9265 participants) and adult influenza (RR 1.29, 95% CI 1.17 to 1.43; risk difference of 9%; 15 studies; 59,328 participants) based on moderate certainty evidence. They may improve receipt of vaccinations for adult pneumococcus, tetanus, hepatitis B, and other non‐influenza vaccinations based on low certainty evidence although the confidence interval includes no effect of these interventions (RR 2.08, 95% CI 0.91 to 4.78; four studies; 8065 participants).","The reviewers conclude that patient reminder and recall systems, in primary care settings, are likely to be effective at improving the proportion of the target population who receive immunizations."]
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[null,"Lorenc T, Marshall D, Wright K, Sutcliffe K, Sowden A (2018). Seasonal influenza vaccination of healthcare workers: evidence synthesis. London: EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London. \nAvailable here.","Occupational groups (healthcare workers)","This report by EPPI-centre presents the findings from: (1) a synthesis of evidence about seasonal flu vaccination interventions: content and components, processes, and implementation; and (2) a systematic review of qualitative studies investigating HCWs’ views, attitudes and perceptions about seasonal flu vaccination. \n\nThe reviewers identified 60 studies evaluating interventions to promote seasonal flu vaccination among HCWs. Of these, only 13 used an RCT design. The types of strategy, number of studies, strength of evidence and likely effectiveness are presented in the summary table, overleaf. Most of the RCTs focused on increasing awareness, or on education. Few RCTs evaluated strategies to increase access, or incentives, and none assessed mandatory vaccination programmes. Most interventions combined several different elements and this is likely to be the most promising approach, as components are likely to work in different ways, and for different people. Most RCTs were conducted either in hospitals or in long-term care (e.g., nursing homes).\n\nThree studies were conducted in the UK (two RCTs), mainly focusing on increasing awareness or education. Most interventions appear not to have been based on any clear theoretical framework, or on any formative research or substantive engagement with HCWs themselves. Most non-mandatory interventions focused on individual beliefs, rather than on the social or institutional factors which may affect vaccination uptake. Data on implementation indicate that it is important to ensure adequate resources and management support; to address HCWs’ beliefs about vaccination; and to collect accurate data on vaccination coverage.\n\nThe findings from 25 qualitative studies. The data indicated a number of personal beliefs which may be barriers to vaccination, including perceived low risk of influenza, fear of side-effects of the vaccine, and scepticism about vaccine effectiveness. There were serious barriers to the acceptability of some interventions, particularly coercive mandatory policies, but also some educational or awareness-raising strategies.\n","The review concluded that bringing together the findings from the quantitative and qualitative studies, it appears that HCWs have clear views about their needs and priorities in relation to seasonal flu\nvaccination, which were mostly not addressed by the evaluated interventions. \n\nThe key messages were:\n- Promising interventions combine several components, including individual, social and environmental elements\n- Education alone is probably ineffective, but broader awareness-raising strategies appear promising\n- Increasing access to vaccination may be effective, but the evidence is weak with few RCTs\n- Both “soft” and “hard” mandates appear promising, but have yet to be evaluated using robust study designs, and may have limited acceptability\n- Interventions should ideally target everyone working in a healthcare context, but this may be practically difficult\n- The culture and context of the organisation(s), within which interventions are implemented, may have an important influence on outcomes. Evaluators should seek\nto understand interventions within an organisational system\n- Very few interventions engaged with HCWs to understand their needs and priorities\n- Intervention developers/implementers should engage with HCWs to understand their views, conduct formative research and pilot interventions before full-scale evaluation\n- Mixed-methods research to understand the context, in which an intervention will be implemented, and HCWs’ likely responses to an intervention, may be valuable"]
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[null,"Arditi  C et al. Computer‐generated reminders delivered on paper to healthcare professionals: effects on professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD001175. DOI: 10.1002/14651858.CD001175.pub4.\nAvailable here.","Adults","This Cochrane review aimed to evaluate the effects of reminders automatically generated through a computerized system (computer‐generated) and delivered on paper to healthcare professionals on quality of care (outcomes related to healthcare professionals' practice) and patient outcomes (outcomes related to patients' health condition).\n\nReview authors identified 35 studies (30 RCTs trials and five non‐RCTs) and analyzed 34 studies (40 comparisons). Twenty‐nine studies took place in the USA and six studies took place in Canada, France, Israel, and Kenya. All studies except two took place in outpatient care. Reminders were aimed at enhancing compliance with preventive guidelines (e.g. cancer screening tests, vaccination) in half the studies and at enhancing compliance with disease management guidelines for acute or chronic conditions (e.g. annual follow‐ups, laboratory tests, medication adjustment, counseling) in the other half.\n\nComputer‐generated reminders delivered on paper to healthcare professionals, alone or in addition to co‐intervention(s), probably improves quality of care slightly compared with usual care or the co‐intervention(s) without the reminder component (median improvement 6.8% : 3.8% to 17.5%]; 34 studies (40 comparisons); moderate‐certainty evidence).\n\nComputer‐generated reminders delivered on paper to healthcare professionals alone (single‐component intervention) probably improves quality of care compared with usual care (median improvement 11.0% (IQR 5.4% to 20.0%); 27 studies (27 comparisons); moderate‐certainty evidence). Adding computer‐generated reminders delivered on paper to healthcare professionals to one or more co‐interventions (multi‐component intervention) probably improves quality of care slightly compared with the co‐intervention(s) without the reminder component (median improvement 4.0% (IQR 3.0% to 6.0%); 11 studies (13 comparisons); moderate‐certainty evidence). \n\nSub-group analyses revealed largest improvement seen in vaccination, with a median improvement of 13.1% [Interquartile range (IQR) 12.2% to 20.7%].\n\nThe authors are uncertain whether reminders, alone or in addition to co‐intervention(s), improve patient outcomes as the certainty of the evidence is very low (n = 6 studies (seven comparisons)). None of the included studies reported outcomes related to harms or adverse effects of the intervention.","The review concludes that there is moderate‐certainty evidence that computer‐generated reminders delivered on paper to healthcare professionals probably slightly improves quality of care, in terms of compliance with preventive guidelines and compliance with disease management guidelines. It is uncertain whether reminders improve patient outcomes because the certainty of the evidence is very low. The heterogeneity of the reminder interventions included in this review also suggests that reminders can probably improve quality of care in various settings under various conditions."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Vaccination Programs: Home Visits to Increase Vaccination Rates. The Community Guide; 2017. \nAvailable here.","Adults","This report examines home visits to increase vaccination rates in children and adults, leading to a Community Preventive Services Task Force (CPSTF) recommendation on the subject. 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). \n\nThe Task Force considered evidence from 23 studies of home visits, with 20 studies and 21 study arms using a common measure of change in vaccination rates. The overall effect was a median increase of 11 percentage points (IQR: 5 to 15 percentage points). Meaningful improvements were observed as a result of home visits delivered to all clients (12 study arms) and to only those clients unresponsive to other interventions (9 study arms), home visits focused on vaccination alone (12 study arms) and in combination with other health concerns (9 study arms), and home visits providing on-site vaccinations (8 study arms) and referring clients to vaccination services outside the home (13 study arms). Home visits delivered as the sole intervention (8 study arms) and home visits delivered as part of a larger healthcare system or community-based program (13 study arms) also produced meaningful change in vaccination rates.","The CPSTF recommends home visits based on strong evidence of their effectiveness in increasing vaccination rates. Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness. The Task Force notes that home visiting interventions are potentially effective in addressing a wide range of public health problems and that the focus of this review is the subset of interventions specifically addressing vaccination rates.\n\nThe report identified that more research is needed on the effectiveness and economic benefits of home visits to increase vaccination rates among adolescents and in rural settings. Additional economic research is needed to estimate the portion of home visits that can be attributed solely to improving vaccination rates when home visits include other activities and objectives."]
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[null,"Posadzki  P et al. Automated telephone communication systems for preventive healthcare and management of long‐term conditions. Cochrane Database of Systematic Reviews 2016, Issue 12. Art. No.: CD009921. DOI: 10.1002/14651858.CD009921.pub2.\nAvailable here.","Adults\n\nHigh risk groups (long-term health conditions)\n","This Cochrane review aimed to assess the effects of automated telephone communication system (ATCS) for preventing disease and managing long‐term conditions on behavioural change, clinical, process, cognitive, patient‐centred and adverse outcomes.\n\nThe review authors found 132 trials with over 4 million participants across preventive healthcare areas and for the management of long‐term conditions.\n\nStudies compared ATCS types in many ways. Some studies reported findings across diseases. For prevention, ATCS probably increase immunisation uptake in children, and slightly in adolescents, but in adults effects are uncertain. \n\nTen studies, all in the USA, evaluated ATCS for promoting immunisation uptake. For preventive healthcare, ATCS (ATCS Plus, IVR, unidirectional) probably increase immunisation uptake in children (risk ratio (RR) 1.25, 95% confidence interval (CI) 1.18 to 1.32; 5 studies, N = 10,454; moderate certainty) and to a lesser extent in adolescents (RR 1.06, 95% CI 1.02 to 1.11; 2 studies, N = 5725; moderate certainty). Based on evidence from 2 studies the effects of ATCS in adults are unclear (RR 2.18, 95% CI 0.53 to 9.02; 2 studies, N = 1743; very low certainty).","The review authors concluded that ATCS interventions can change patients' health behaviours, improve clinical outcomes and increase healthcare uptake with positive effects in several important areas including immunisation, screening, appointment attendance, and adherence to medications or tests. The decision to integrate ATCS interventions in routine healthcare delivery should reflect variations in the certainty of the evidence available and the size of effects across different conditions, together with the varied nature of ATCS interventions assessed. Future research should investigate both the content of ATCS interventions and the mode of delivery; users' experiences, particularly with regard to acceptability; and clarify which ATCS types are most effective and cost‐effective."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Community-Wide Education When Used Alone. The Community Guide; 2015. \nAvailable here.","Adults (older: age not specified)","This report aimed to determine the effectiveness of community-wide education interventions when implemented alone in increasing vaccination rates or reducing rates of vaccine preventable illness and found insufficient evidence. Evidence is considered insufficient due to inconsistent results and concerns about the applicability of evidence to more diverse communities in the United States where improvements in vaccination rates are needed.\n\nThis Task Force finding is based on evidence from a Community Guide systematic review completed in 2010 (6 studies with 8 study arms, search period 1980-2009) combined with more recent evidence (1 study, search period 2009- February 2012). Based on the combined evidence, the Task Force reaffirms its finding of insufficient evidence.\n\nThe Task Force considered evidence from 7 studies with 9 study arms. Among the studies providing a common measure of change in vaccination rates (4 studies with 6 arms) there was a median increase of 6 percentage points (range of values: 0.4 to 12.2 percentage points).\n\nThree studies evaluated mass media activities using different measures of change. In a targeted community in Australia, pneumococcal vaccines dispatched to service providers increased during the period of a mass media campaign. In Finland, a mass media campaign briefly increased MMR vaccine receipt for children 6 years of age, though changes were not reported for younger children. In the U.S., a mass media campaign addressing flu-related topics among a nationally representative population of older adults found a positive association between flu-related media reports and influenza vaccination rates in the weeks following the campaign (annual vaccination rates increased by 2.3-7.9 percentage points, p<0.001).\n\nOne U.S. study observed moderate increases in vaccination rates for hepatitis B vaccine following intensive communitywide educational efforts in two Vietnamese-American communities. Characteristics of the study communities that may have contributed to intervention effectiveness included: (1) popular Vietnamese-language media, (2) established Vietnamese service organizations, and (3) culturally appropriate strategies and materials.\n\nCommunity-wide education is commonly implemented in combination with additional interventions (such as efforts to expand and enhance access to vaccinations). In another review, the Task Force found strong evidence of effectiveness for community-based interventions implemented in combination to increase vaccination rates, and five of the included studies used community-wide education in the combination of interventions.","This CPSTF report states that although the evidence identified in this systematic review is insufficient to determine the effectiveness of community-wide education when implemented alone, two studies suggest that these interventions may be useful with certain communities. More research is needed to understand the potential applicability of these interventions to other populations, and for other vaccines.\n\nThe Task Force acknowledges an important role for mass media (and the potential role of social media) in disseminating\ninformation to large audiences and shaping public attitudes and behaviours.\n\nVaccine manufacturers have been increasing direct-to-consumer mass and small media advertising to promote new vaccines. While evidence from private sector marketing campaigns on vaccine uptake was not included in this review, the Task Force considered the applicability of these marketing experiences to public health efforts. They determined that community-wide educational efforts may have greater impact when used to inform members of the community about new vaccines (such as HPV), or new recommendations (such as the universal recommendation for seasonal influenza), and in situations of public health urgency (such as the H1N1 pandemic). The effectiveness of community-wide education to increase vaccination rates in these circumstances remains an important issue for further evaluation research.\n"]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Provider Reminders. The Community Guide; 2015. \nAvailable here.","Adults ","The CPSTF recommends provider reminders on the basis of strong evidence of effectiveness in increasing vaccination rates: (1) among adults, adolescents and children; (2) when used alone or with additional interventions; (3) across a range of intervention characteristics (e.g., computerized or simple reminders, checklists, flowcharts); and (4) in a range of settings and populations.\n\nThe Task Force finding is based on evidence from a Community Guide systematic review completed in 2008 (23 studies, search period 1997–2007) combined with more recent evidence (5 studies, search period 2007–February 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\nThe Task Force considered evidence from 28 studies. Twenty-two studies provided a measurement of change in vaccination rates, with an overall median increase of 10 percentage points (IQI: 6 to 25 percentage points). Of these, seven studies examined provider reminders alone with a median increase of 12 percentage points (IQI: 6 percentage point to 25 percentage points). Fifteen studies examined the impact of provider reminders with additional interventions and observed a median increase of 9 percentage points (IQI: 5 to 25 percentage points). Six additional studies did not provide a common measurement of change in vaccination rates; however, five of the studies provided additional support for the use of provider reminders.\n\nEvidence indicates that provider reminders remain an effective option for consideration in a wide range of clinical settings and populations. A subset of the included evidence, however, suggests that standing orders may be more effective in improving vaccination rates in both inpatient and outpatient settings than provider reminder systems.","Evidence in this CPSTF report indicates that provider reminders are effective in a wide range of contexts. Additional research should focus on system-level implementation of reminder systems, and identify strategies to encourage regular and sustained use. In addition, future research could examine or compare the effectiveness of specific reminder prompts provided as a capability of regional or state-level immunization information systems."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Client or Family Incentive Rewards. The Community Guide; 2015. \nAvailable here.","Adults","The CPSTF recommends client or family incentive rewards, used alone or in combination with additional interventions, based on sufficient evidence of effectiveness in increasing vaccination rates in children and adults.\n\nThis Task Force finding is based on evidence from a Community Guide systematic review completed in 2011 (6 studies with 7 study arms, search period 1980-2009) combined with more recent evidence (1 study, search period 2009-2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on sufficient evidence of effectiveness.\n\nIncluded studies showed vaccination rates increased by a median of 8 percentage points (interquartile interval [IQI]: 4 to 16 percentage points). Two study arms that assessed the effectiveness of incentive rewards alone showed similar changes in vaccination rates (8.5 and 9.0 percentage points). In the six remaining study arms, incentive rewards were combined with additional interventions.\n\nAmong the studies included in this review, the type of incentive reward offered to clients included 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. \n\nOverall, the Task Force considers the evidence to be applicable to vaccinations for children and adults in a wide range of clinical and community settings, and for various types of incentive rewards.","This CPSTF report concludes that client or family incentive rewards can also be one component of an effective combined approach to increase vaccination rates in both clinical and community settings. Based on updated, concurrent reviews the Task Force finds strong evidence to recommend health care system-based interventions implemented in combination and community-based\ninterventions implemented in combination.\n\nAdditional research could focus on the independent effects of incentive rewards, examine the relationship between the value of the reward and effectiveness, and explore the duration of intervention impact. It also would be useful to have more information about the effectiveness of these interventions with adolescents and adults as most of the included studies examined the use of incentive rewards on vaccination rates for children."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Client Reminder and Recall Systems. The Community Guide; 2015. \nAvailable here.","Adults ","The CPSTF recommends client reminder and recall interventions based on strong evidence of effectiveness in improving vaccination rates: (1) in children, adolescents 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.\n\nThis Task Force finding is based on evidence from a Community Guide systematic review completed in 2008 (19 studies, search period 1997-2007) combined with more recent evidence (10 studies, search period 2007-2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\n\nIncluded studies showed vaccination rates increased by a median of 11 percentage points (IQI: 4 to 17 percentage points). Client reminder and recall interventions used alone resulted in a median increase of 6 percentage points (IQI: 3 to 13 percentage points; 14 studies), and interventions implemented with additional components led to a median increase of 12 percentage points (IQI: 10 to 30 percentage points; 15 studies).\n\nThe included studies evaluated the effectiveness of client reminder and recall interventions for a wide range of client and provider populations, settings, vaccinations and delivery methods. Based on the evidence, the Task Force finding should be broadly applicable to all patient populations, in both clinical and community settings, and for the range of vaccines and delivery methods.\n","This CPSTF report concludes that client reminder and recall systems can also be important, effective components of combined approaches to increase vaccination rates. Based on updated, concurrent reviews, the Task Force finds strong evidence to recommend health care system-based interventions implemented in combination and community-based interventions implemented in combination. Immunization information systems, which can also generate client reminder or recall notices provide an additional implementation option.\n\nMore research is needed on effective implementation, sustainability, and expansion of reminder and recall interventions. Future research should also examine the effectiveness of reminder and recall notices using emerging communication technologies (i.e. text message, email). Additional studies should also examine the effectiveness of client reminder and recall interventions on adolescent vaccines such as the human papilloma virus (HPV).\n"]
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[null,"Stokes G, Richardson M, Brunton G, Khatwa M, Thomas J (2015) Review 3: Community engagement for health via coalitions, collaborations and partnerships (on-line social media and social networks) – a systematic review and metaanalysis. London: EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London.\nAvailable here.","Adults \n\nOccupational groups (university staff)","This systematic review sought to answer the following research question:\nWhat health issues and populations have been studied using online social media/social networking?\n\nThere is evidence of health issues focused on healthy eating/physical activity, cancer detection and screening, diabetes, general wellbeing and lifestyle, sexual health, flu immunisation, food safety. However there were a low number of studies for each health topic and population. There is evidence of studies focused on populations under 25 years of age or on those over 40 years of age, but gaps in evaluated interventions in those aged under 16, 30 to 40 and over 60. There is inconsistent evidence of studies targeting women only and no evidence of studies targeting men specifically. There is inconsistent evidence of social media/social networking interventions directed to minority ethnic groups.\n\nThe studies included in this review focused on a broad range of health topics, only one RCT focussed amongst Australian university students and staff focused on influenza immunisation (Lau et al. 2012). For their study into the impact of a web-based personally controlled health management system entitled Healthy.me on influenza vaccination and health service utilisation rates, Lau et al. (2012) incorporated social forums and messaging to allow consumers to interact with each other and with healthcare professionals. \n\nThe provider of the additional potentially active content was either automated or anonymous. The content was also provided by the health professional experts. The study described the use of a mandatory five-minute session on how to use a website. Primary analysis examined differences in the proportion of participants obtaining influenza vaccination during the study in the waitlist and PCHMS groups using the c2 test, including participants who had the opportunity to use the PCHMS but did not\ndo so. \n\nThe extent of community engagement was low (0.48 95% CI: 0.09 to 0.87). The review concluded that there is weak evidence that employing either peers or professionals to facilitate online discussions forums is seen more often to have effective outcomes. ","In summary, although the effect sizes are very small overall, QCA demonstrated that including a facilitator in the delivery of social media/social networking interventions demonstrated higher effect sizes for studies not focused on healthy eating and physical activity and which did not employ the use of theory in intervention development. Nonhealthy eating/physical activity topics focused on sexually transmitted infection prevention, cancer screening/prevention, influenza immunization and mental health promotion. The use of this combination of conditions is conceptually well supported, lending confidence to its findings. However, it must be considered that these findings are exploratory in nature and should be evaluated robustly in future intervention development and evaluation."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Standing Orders. The Community Guide; 2015. \nAvailable here.","Adults","The Task Force finding is based on evidence from a Community Guide systematic review completed in 2009 (29 studies, search period 1997–2009) combined with more recent evidence (6 studies, search period 2009–February 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\n\nThe Task Force considered evidence from 35 studies. Of these, 27 studies provided a common measurement of change in vaccination rates with a median increase of 24 percentage points (IQI: 12 to 35 percentage points). Nine studies that examined the impact of standing orders alone documented a median increase of 16 percentage points (IQI: 9 to 29 percentage points). Nineteen studies that evaluated standing orders when combined with additional interventions documented a median increase of 27 percentage points (IQI: 13 to 40 percentage points). Seven studies that did not provide a common measure of change for vaccination rates all reported favorable results after implementation of standing orders.\n\nThe reviewed studies evaluated the effectiveness of standing orders across a wide range of clinical vaccination settings, health care personnel, and client populations. Standing orders were found to be effective in various settings including clinics, hospitals, and long-term care facilities. Interventions were effective when used with different vaccination providers including nurses and pharmacists. While most studies looked at adult populations, four examined intervention effectiveness among children and found a median absolute percent increase of 28 percentage points (range: 8 to 49). While no studies specifically evaluated the impact of standing orders for vaccination of adolescents, evidence from this review is likely applicable to this population. In addition, a subset of the included evidence suggests that standing orders may be more effective in improving vaccination rates in both inpatient and outpatient settings when compared to a provider reminder system.\n\nOne paper from the updated search period described the following barriers encountered during implementation of a pneumococcal vaccination standing orders program in three hospitals: gaps in staff education and training; personnel concerns about additional workload; staff reluctance to administer vaccines without a physician's order; attending physicians' resistance to having hospitalized patients vaccinated; and logistical difficulties. Some attending physicians expressed concern that vaccination would interfere with scheduled treatments or procedures. Other attending physicians did not consider inpatient stays to be an appropriate time for vaccinations (Middleton et al. 2005).\n\nAn additional study reported barriers to implementation of influenza and pneumococcal vaccination standing orders in various health care settings. Findings suggested that the adoption of these policies may have been too difficult to administer, staff were unclear or unconvinced of program benefits, and there was perceived physician discomfort with delegating responsibility for immunizations to nursing staff. A few of the respondents also indicated that resources, effectiveness of the vaccine, and time required to administer the vaccine were barriers for adoption. The majority of these barriers were specific to the administration of the influenza vaccine (Goldstein et al. 2005).","This CPSTF report concludes that standing orders were shown to be effective in increasing vaccination rates for influenza and pneumococcal vaccines. Additional research is needed, however, to determine if these interventions are effective for different vaccines (e.g. hepatitis, tetanus and vaccines recommended for adolescents). More evidence is also needed on ways to address barriers to the implementation of standing orders in health systems.\n"]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Reducing Client Out-of-Pocket Costs for Vaccinations. The Community Guide; 2014. \nAvailable here.","Adults","The CPSTF recommends interventions that reduce client out-of-pocket costs based on strong evidence of effectiveness in improving vaccination rates. The effectiveness of these interventions has been demonstrated among children, adolescents, and adults, in a range of settings and populations, when applied in varying levels of scale from individual clinical settings to statewide programs to national efforts, and whether used alone or as part of a multi-component intervention.\n\nThis Task Force finding is based on evidence from a Community Guide systematic review completed in 2009 (15 studies; search period 1997 - 2009) combined with more recent evidence (5 studies, search period 2009 - 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\n\nEleven studies provided a common measurement of change in vaccination rates and showed a median increase of 22 percentage points (IQI: 6 to 33 percentage points). Six studies examined the impact of reducing client out-of-pocket costs alone (median increase of 28 percentage points; IQI: 2 to 47 percentage points) and 5 studies examined reducing client out-of-pocket costs as part of a multi-component strategy (median increase of 20 percentage points; IQI: 6 to 20 percentage points). The nine qualifying studies that did not provide a common measurement of change also reported overall increases in vaccinations received or administered.\n\nIncluded studies evaluated intervention effects on childhood vaccination series (3 studies), influenza (9 studies), pneumococcal (6 studies), hepatitis B (2 studies), and human papilloma virus (1 study). The reviewed studies evaluated the effectiveness of interventions that reduced client out-of-pocket costs in a range of client and provider populations and settings.\n\nPolicies adopted in the United States, including the Federal Vaccines for Children Program and the Affordable Care Act, have expanded access to many vaccines at reduced out-of-pocket cost. Barriers to expanded implementation of efforts include the adequacy and timeliness of reimbursement for the costs of vaccines, storage, and administration. In the United States, the ability of health care systems and providers to implement these interventions may depend on the adequacy and timeliness of reimbursement for the costs of the vaccines, storage, and administration.","This CPSTF report concludes that additional research is needed to determine the effectiveness of reducing client out-of-pocket cost interventions to increase rates of recommended vaccinations for adolescents (e.g., HPV, meningococcal, influenza). In addition, the Task Force suggests additional research to determine if these interventions are effective options to increase receipt of annual influenza vaccinations. Future research should also examine whether reducing client out-of-pocket cost interventions are essential components of school-based vaccination programs and on-site vaccination programs in general."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Community-Based Interventions Implemented in Combination. The Community Guide; 2014. \nAvailable here.","Adults","The CPSTF recommends community-based interventions implemented in combination to increase vaccinations in targeted populations, on the basis of strong evidence of effectiveness in increasing vaccination rates.\n\nThe conclusion of strong evidence was based on findings from 18 studies that evaluated coordinated interventions to:\n- Increase community demand\n- Enhance access to vaccination services, and\n- Reduce missed opportunities by vaccination providers\nIn 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.\n\nThe Task Force 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 resources are available.\n\nThis Task Force 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 - 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\n\nAll of the included studies provided a common measure of change and showed a median increase in vacation rates of 14 percentage points (IQI: 7 to 24 percentage points).\n\nThe included studies evaluated a variety of interventions in different combinations. The Task Force examined the evidence of differences attributable to specific interventions and combinations of interventions using different strategic approaches.\nFourteen studies implemented an effective combination of one or more interventions to increase community demand with one or more interventions to enhance access to vaccination services and showed a median increase in vaccination rates of 16 percentage points (IQI: 12 to 26 percentage points).\n\nClient reminder and recall systems were used in most of the evaluated programs (15 study arms). Systems were implemented by vaccination providers, established as one part of a community manual outreach and tracking program, or generated from a regional immunization information system (IIS).","This CPSTF report concludes that coordinated interventions may be especially important in communities that have wide disparities in vaccination coverage. Program planners should consider community characteristics, such as mobility and fragmentation of health care, in the selection and combination of interventions to increase vaccination rates and reduce disparities.\n\nPartnerships between community organizations and vaccination providers are likely to be an essential component of effective, sustained community-based efforts. Most studies involved partnerships with existing vaccination providers in\nthe community to increase access to vaccinations, rather than creating new vaccination services. Coalitions represent one way to establish effective partnerships, with the size of the coalition varying based on the community, targeted population, and scope of the problem. Four studies involved community coalitions that used the principles of community-based participatory research.\n\nMore evidence is needed on the effectiveness of these programs in adolescents, and when implemented in rural settings. More economic information on these interventions is needed, specifically, evaluations on the efficiencies of the resource-intensive components of manual outreach and tracking and home visits. Future research could compare program effectiveness based on differences in the component interventions and strategic combinations. Additional research also should examine ways to sustain these programs, especially when provided by existing community-based organizations."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Health Care System-Based Interventions Implemented in Combination. The Community Guide; 2014. \nAvailable here.","Adults (older: age not specified)\n","The CPSTF recommends health care system-based interventions implemented in combination on the basis of strong evidence of effectiveness in increasing vaccination rates in targeted client populations.\n\nBased on findings from 37 of the 64 included studies, the Task Force further recommends a combination that includes the following:\nAt least one intervention to increase client demand for vaccinations, such as:\n- Client reminder and recall systems\n- Clinic-based client education\n- Manual outreach and tracking\nAnd one or more interventions that address either, or both, of the following strategies:\n- Interventions to enhance access to vaccinations: Expanded access in health care settings, reduced client out-of-pocket costs, home visits\n- Interventions directed at vaccination providers or systems: Provider reminders, standing orders, provider assessment and feedback\n\nInterventions listed as examples for each strategy were those that showed the greatest effect on vaccination rates.\n\nThe Task Force finding is based on evidence from a Community Guide systematic review completed in 2010 (62 studies; search period 1980-2010) combined with more recent evidence (2 studies; search period 2010-February 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness. \n\nOf the combined 64 included studies (76 study arms), 58 of them (70 study arms) provided a common measure of change in vaccination rates and showed a median increase of 9 percentage points (IQI: 4 to 21 percentage points). In general, changes in vaccination rates were greater when interventions were implemented in settings with low baseline rates.\n\nThe included studies evaluated a variety of interventions in different combinations. The Task Force examined the evidence of differences attributable to specific interventions and combinations of interventions using different strategic approaches. These strategic approaches included the following:\n- Interventions to increase client demand (client reminder and recall systems, clinic-based client education, client\nor family incentives, client-held paper immunization records, case management, and manual outreach and\ntracking)\n- Interventions to enhance access to vaccination services (expanded access in health care settings, reduced client\nout-of-pocket costs, and home visits)\n- Interventions directed at vaccination providers (provider reminder systems, standing orders, provider\nassessment and feedback, provider education, and provider incentives)\n\nThe most common individual interventions implemented in a combined approach were client reminder and recall\nsystems (34 study arms) and provider reminders (31 study arms).\n\nThirty-seven studies (44 study arms) evaluated a combination of interventions across two or three of the strategic approaches and showed a median increase in vaccination rates of 17 percentage points (IQI: 6 to 27 percentage points). In 26 study arms, interventions were combined within only one strategic approach and found a median increase in vaccination rates of 4 percentage points (IQI: 2 to 9 percentage points).\n\nNine studies evaluated combinations of interventions implemented as a part of a health care system quality improvement effort. The most commonly implemented interventions were those directed at vaccination providers (provider education, provider reminders, and provider assessment and feedback). The studies included in this evaluation were typically short in duration and reported mixed results.\n\nEvidence did not show a direct relationship between the number of interventions implemented and changes in vaccination rates. Included studies evaluated combinations of between two and nine interventions. The majority of studies implemented two (31 study arms) or three (18 study arms) interventions.","This CPSTF report concludes that overall, included studies provided evidence of effectiveness for intervention combinations implemented in a range of clinical settings and communities, although evidence from rural settings was limited. Studies also demonstrated effectiveness across a range of client populations and vaccinations, including young children (childhood series, influenza) and older adults (influenza, pneumococcal, and tetanus vaccines). Two of the included studies evaluated interventions targeted at increasing vaccination rates among adolescents. Finally, the included studies demonstrated increases in vaccination rates for populations of low socioeconomic status (22 study arms) and across a range of racial and ethnic groups. Most of the included evidence evaluated client populations with low to moderate baseline vaccination rates,\nand findings are most applicable to these situations.\n\nMore evidence is needed on the effectiveness of these interventions in rural settings and when applied to increase vaccinations recommended for adolescents. Future research on quality improvement activities in these settings should incorporate study periods sufficient to evaluate continuous quality improvement efforts."]

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[null,"BRECHLYNNAU ERAILL"]
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[null,"ADRAN CANLLAWIAU - BRECHLYNNAU ERAILL"]
[null,"Ffynhonnell:","Cynulleidfa:","Argymhellion:"]
[null,"National Institute for Health and Care Excellence. Tuberculosis. NG33. London: NICE; 2016.\nAvailable here.\nLast updated in September 2019.","This guideline is for: \n- Healthcare professionals and TB multidisciplinary teams\n- Substance misuse services, prisons and immigration removal centres\n- Local government and commissioners\n- TB control boards, directors of public health and public health consultants\n- Public Health England and NHS England\n- Voluntary sector workers\n- People with TB and their carers","This guideline covers preventing, identifying and managing latent and active tuberculosis (TB) in children, young people and adults. It aims to improve ways of finding people who have TB in the community and recommends that everyone under 65 with latent TB should be treated. It describes how TB services should be organised, including the role of the TB control board.\n\nIt  includes recommendations on:\n- Preventing TB, including in under-served groups\n- Diagnosing and managing latent TB, including recommendations specifically for children and young people\n- Diagnosing and managing active TB, including recommendations specifically for children and young people\n- Drug-resistant TB\n- Infection control\n- Case finding and adherence, treatment completion and follow-up, including in under-served groups\n- Service organisation"]
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[null,"National Institute for Health and Care Excellence. Hepatitis B and C testing: people at risk of infection. PH43. London: NICE; 2012.\nAvailable here.\nLast updated in March 2013.","This public health guidance is relevant to:\n- Commissioners and providers\n- People at increased risk of viral hepatitis\n- Members of the public","This guideline covers raising awareness of and testing for hepatitis B and C infection. It aims to ensure that people at increased risk of hepatitis B and C infection are tested.\n\nIt  includes recommendations on:\n- Raising awareness about hepatitis B and C among the general population and people at increased risk of infection\n- Education and training for professionals who provide services for people at increased risk of infection\n- Testing for hepatitis B and C in primary care, prisons and immigration removal centres, drugs services, and sexual health and genitourinary medicine clinics\n- Tracing close contacts of people with hepatitis B infection\n- Neonatal hepatitis B vaccination\n- Commissioning integrated services for testing and treatment and laboratory services for testing"]
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[null,"National Institute for Health and Care Excellence. Immunisations: reducing differences in uptake in under 19s. PH21. London: NICE; 2009.\nAvailable here.\nLast updated in September 2017.","This public health guidance is relevant to:\n- Healthcare professionals\n- Commissioners and providers\n- People who work in children’s services and local authorities\n- People who work in schools, colleges and workplaces\n- People who work in the private, voluntary and community sectors\n- Parents, carers and young people","This guideline covers increasing immunisation uptake among children and young people aged under 19 years in groups and settings where immunisation coverage is low. It aims to improve access to immunisation services and increase timely immunisation of children and young people. It also aims to ensure babies born to mothers infected with hepatitis B are immunised.\n\nIt includes recommendations on:\n- Immunisation programmes\n- Information systems for recording immunisation status\n- Training for staff involved in immunisation services\n- Contribution of nurseries, schools and further education colleges\n- Targeting groups at risk of not being fully immunised\n- Hepatitis B immunisation for infants"]
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[null,"National Institute for Health and Care Excellence. Drug misuse in over 16s: psychosocial interventions. CG51. London: NICE; 2007.\nAvailable here.\nLast checked in July 2016.","This clinical guidance is relevant to:\n- Healthcare professionals\n- Commissioners and providers\n- People who work in specialist residential and community-based treatment settings\n- People who work in prisons and criminal justice settings\n- Adults and young people over 16 who misuse opioids, stimulants or cannabis and their families and carers","This guideline covers using psychosocial interventions to treat adults and young people over 16 who have a problem with or are dependent on opioids, stimulants or cannabis. It aims to reduce illicit drug use and improve people’s physical and mental health, relationships and employment.\n\nIt includes recommendations on:\n- Principles for supporting people who misuse drugs and their families and carers\n- Identification and assessment of drug misuse\n- Brief interventions and self-help\n- Formal psychosocial interventions\n- Residential, prison and inpatient care"]
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[null,"ADRAN ADOLYGIAD SYSTEMATIG - BRECHLYNNAU ERAILL"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau'r awduron:"]
[null,"Palmer  MJ et al. Targeted client communication via mobile devices for improving maternal, neonatal, and child health. Cochrane Database of Systematic Reviews 2020, Issue 8. Art. No.: CD013679. DOI: 10.1002/14651858.CD013679.\nAvailable here.","High risk groups (pregnant women)","This Cochrane review aimed to assess the effects of targeted client communication (TCC) via mobile device (MD) on health behaviour, service use, health, and well‐being for maternal, neonatal and child health (MNCH).\n\nThe reviewers'  included 27 trials (17,463 participants). Trial populations were: pregnant and postpartum women (11 trials conducted in low‐, middle‐ or high‐income countries; pregnant and postpartum women living with HIV (three trials carried out in one lower middle‐income country); and parents of children under the age of five years (13 trials conducted in LMHIC). \n\nOnly two studies within the targeted client communication via mobile device versus digital non-targeted communication fulfilled the criteria of this review:\nOne study (Yudin et al. 2017) found that a mobile phone text message reinforcing that the influenza vaccine is recommended for all pregnant women and safe during pregnancy and breastfeeding compared to standard care/ no intervention, may make little or no difference to attendance for antenatal influenza vaccination (risk ratio (RR) 1.05, 95% confidence interval (CI) 0.71 to 1.58), though the CI encompasses both benefit and harm (low‐certainty evidence). \nAnother study (Lund et al. 2012) found that a multi-component approach combining mobile phone text message with voucher compared to simple health education and appointment reminders to encourage attendance to routine antenatal classes, make little or no difference to attendance for antenatal tetanus vaccine (OR 1.67, 95% CI 0.84 to 3.33). ","The authors conclude that the effect of targeted client communication via mobile devices for most outcomes is uncertain. There may be improvements for some outcomes using targeted communication but these findings were of low certainty. \n\nHigh‐quality, adequately powered trials and cost‐effectiveness analyses are required to reliably ascertain the effects and relative benefits of TCCMD. Future studies should measure potential unintended consequences, such as partner violence or breaches of confidentiality."]
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[null,"Abdullahi  LH et al. Improving vaccination uptake among adolescents. Cochrane Database of Systematic Reviews 2020, Issue 1. Art. No.: CD011895. DOI: 10.1002/14651858.CD011895.pub2.\nAvailable here.","Adults (under 19s)","This Cochrane review aimed to evaluate the effects of interventions to improve vaccine uptake among adolescents.\n\nThe reviewers' included 16 studies (eight individually randomised trials, four cluster randomised trials, three non‐randomised trials, and one controlled before‐after study). Twelve studies were conducted in the USA, while there was one study each from: Australia, Sweden, Tanzania, and the UK. Ten studies had unclear or high risk of bias. They categorised interventions as recipient‐oriented, provider‐oriented, or health systems‐oriented.\n\nThe interventions targeted adolescent boys or girls or both (seven studies), parents (four studies), and providers (two studies). Five studies had mixed participants that included adolescents and parents, adolescents and healthcare providers, and parents and healthcare providers. The outcomes included uptake of human papillomavirus (HPV) (11 studies); hepatitis B (three studies); and tetanus–diphtheria–acellular–pertussis (Tdap), meningococcal, HPV, and influenza (three studies) vaccines among adolescents.\n\nHealth education improves HPV vaccine uptake compared to usual practice (RR 1.43, 95% CI 1.16 to 1.76; I² = 0%; 3 studies, 1054 participants; high‐certainty evidence). In addition, one large study provided evidence that a complex multi‐component health education intervention probably results in little to no difference in hepatitis B vaccine uptake compared to simplified information leaflets on the vaccine (RR 0.98, 95% CI 0.97 to 0.99; 17,411 participants; moderate‐certainty evidence).\n\nFinancial incentives may improve HPV vaccine uptake compared to usual practice (RR 1.45, 95% CI 1.05 to 1.99; 1 study, 500 participants; low‐certainty evidence). However, we are uncertain whether combining health education and financial incentives has an effect on hepatitis B vaccine uptake, compared to usual practice (RR 1.38, 95% CI 0.96 to 2.00; 1 study, 104 participants; very low certainty evidence).\n\nMandatory vaccination probably leads to a large increase in hepatitis B vaccine uptake compared to usual practice (RR 3.92, 95% CI 3.65 to 4.20; 1 study, 6462 participants; moderate‐certainty evidence).\n\nProvider prompts probably make little or no difference compared to usual practice, on completion of Tdap (OR 1.28, 95% CI 0.59 to 2.80; 2 studies, 3296 participants), meningococcal (OR 1.09, 95% CI 0.67 to 1.79; 2 studies, 3219 participants), HPV (OR 0.99, 95% CI 0.55 to 1.81; 2 studies, 859 participants), and influenza (OR 0.91, 95% CI 0.61 to 1.34; 2 studies, 1439 participants) vaccination schedules (moderate‐certainty evidence).\n\nProvider education with performance feedback may increase the proportion of adolescents who are offered and accept HPV vaccination by clinicians, compared to usual practice. Compared to adolescents visiting non‐participating clinicians (in the usual practice group), the adolescents visiting clinicians in the intervention group were more likely to receive the first dose of HPV during preventive visits (5.7 percentage points increase) and during acute visits (0.7 percentage points for the first and 5.6 percentage points for the second doses of HPV) (227 clinicians and more than 200,000 children; low‐certainty evidence).\n\nA class‐based school vaccination strategy probably leads to slightly higher HPV vaccine uptake than an age‐based school vaccination strategy (RR 1.09, 95% CI 1.06 to 1.13; 1 study, 5537 participants; moderate‐certainty evidence).\n\nA multi‐component provider intervention (including an education session, repeated contacts, individualised feedback, and incentives) probably improves uptake of HPV vaccine compared to usual practice (moderate‐certainty evidence).\n\nA multi‐component intervention targeting providers and parents involving social marketing and health education may improve HPV vaccine uptake compared to usual practice (RR 1.41, 95% CI 1.25 to 1.59; 1 study, 25,869 participants; low‐certainty evidence).","The authors conclude that various strategies have been evaluated to improve adolescent vaccination including health education, financial incentives, mandatory vaccination, and class‐based school vaccine delivery. However, most of the evidence is of low to moderate certainty. This implies that while this research provides some indication of the likely effect of these interventions, the likelihood that the effects will be substantially different is high. \n\nTherefore, additional research is needed to further enhance adolescent immunisation strategies, especially in low‐ and middle‐income countries where there are limited adolescent vaccination programmes. In addition, it is critical to understand the factors that influence hesitancy, acceptance, and demand for adolescent vaccination in different settings. This is the topic of an ongoing Cochrane qualitative evidence synthesis, which may help to explain why and how some interventions were more effective than others in increasing adolescent HPV vaccination coverage."]
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[null,"Jacobson Vann  JC et al. Patient reminder and recall interventions to improve immunization rates. Cochrane Database of Systematic Reviews 2018, Issue 1. Art. No.: CD003941. DOI: 10.1002/14651858.CD003941.pub3. \nAvailable here.","Adults","This Cochrane review aimed to evaluate and compare the effectiveness of various types of patient reminder and recall interventions to improve receipt of immunizations.\n\nThe 75 included studies involved child, adolescent, and adult participants in outpatient, community‐based, primary care, and other settings in 10 countries.\n\nPatient reminder or recall interventions, including telephone and autodialer calls, letters, postcards, text messages, combination of mail or telephone, or a combination of patient reminder or recall with outreach, probably improve the proportion of participants who receive immunization (RR of 1.28, 95% CI 1.23 to 1.35; risk difference of 8%) based on moderate certainty evidence from 55 studies with 138,625 participants.\n\nThree types of single‐method reminders improve receipt of immunizations based on high certainty evidence: the use of postcards (RR 1.18, 95% CI 1.08 to 1.30; eight studies; 27,734 participants), text messages (RR 1.29, 95% CI 1.15 to 1.44; six studies; 7772 participants), and autodialer (RR 1.17, 95% CI 1.03 to 1.32; five studies; 11,947 participants). Two types of single‐method reminders probably improve receipt of immunizations based on moderate certainty evidence: the use of telephone calls (RR 1.75, 95% CI 1.20 to 2.54; seven studies; 9120 participants) and letters to patients (RR 1.29, 95% CI 1.21 to 1.38; 27 studies; 81,100 participants).\n\nBased on high certainty evidence, reminders improve receipt of immunizations for childhood (RR 1.22, 95% CI 1.15 to 1.29; risk difference of 8%; 23 studies; 31,099 participants) and adolescent vaccinations (RR 1.29, 95% CI 1.17 to 1.42; risk difference of 7%; 10 studies; 30,868 participants). Reminders probably improve receipt of vaccinations for childhood influenza (RR 1.51, 95% CI 1.14 to 1.99; risk difference of 22%; five studies; 9265 participants) and adult influenza (RR 1.29, 95% CI 1.17 to 1.43; risk difference of 9%; 15 studies; 59,328 participants) based on moderate certainty evidence. They may improve receipt of vaccinations for adult pneumococcus, tetanus, hepatitis B, and other non‐influenza vaccinations based on low certainty evidence although the confidence interval includes no effect of these interventions (RR 2.08, 95% CI 0.91 to 4.78; four studies; 8065 participants).","The reviewers conclude that patient reminder and recall systems, in primary care settings, are likely to be effective at improving the proportion of the target population who receive immunizations."]
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[null,"Arditi  C et al. Computer‐generated reminders delivered on paper to healthcare professionals: effects on professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD001175. DOI: 10.1002/14651858.CD001175.pub4.\nAvailable here.","Adults","This Cochrane review aimed to evaluate the effects of reminders automatically generated through a computerized system (computer‐generated) and delivered on paper to healthcare professionals on quality of care (outcomes related to healthcare professionals' practice) and patient outcomes (outcomes related to patients' health condition).\n\nReview authors identified 35 studies (30 RCTs trials and five non‐RCTs) and analyzed 34 studies (40 comparisons). Twenty‐nine studies took place in the USA and six studies took place in Canada, France, Israel, and Kenya. All studies except two took place in outpatient care. Reminders were aimed at enhancing compliance with preventive guidelines (e.g. cancer screening tests, vaccination) in half the studies and at enhancing compliance with disease management guidelines for acute or chronic conditions (e.g. annual follow‐ups, laboratory tests, medication adjustment, counseling) in the other half.\n\nComputer‐generated reminders delivered on paper to healthcare professionals, alone or in addition to co‐intervention(s), probably improves quality of care slightly compared with usual care or the co‐intervention(s) without the reminder component (median improvement 6.8% : 3.8% to 17.5%]; 34 studies (40 comparisons); moderate‐certainty evidence).\n\nComputer‐generated reminders delivered on paper to healthcare professionals alone (single‐component intervention) probably improves quality of care compared with usual care (median improvement 11.0% (IQR 5.4% to 20.0%); 27 studies (27 comparisons); moderate‐certainty evidence). Adding computer‐generated reminders delivered on paper to healthcare professionals to one or more co‐interventions (multi‐component intervention) probably improves quality of care slightly compared with the co‐intervention(s) without the reminder component (median improvement 4.0% (IQR 3.0% to 6.0%); 11 studies (13 comparisons); moderate‐certainty evidence). \n\nSub-group analyses revealed largest improvement seen in vaccination, with a median improvement of 13.1% [Interquartile range (IQR) 12.2% to 20.7%].\n\nThe authors are uncertain whether reminders, alone or in addition to co‐intervention(s), improve patient outcomes as the certainty of the evidence is very low (n = 6 studies (seven comparisons)). None of the included studies reported outcomes related to harms or adverse effects of the intervention.","The review concludes that there is moderate‐certainty evidence that computer‐generated reminders delivered on paper to healthcare professionals probably slightly improves quality of care, in terms of compliance with preventive guidelines and compliance with disease management guidelines. It is uncertain whether reminders improve patient outcomes because the certainty of the evidence is very low. The heterogeneity of the reminder interventions included in this review also suggests that reminders can probably improve quality of care in various settings under various conditions."]
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[null,"Posadzki  P et al. Automated telephone communication systems for preventive healthcare and management of long‐term conditions. Cochrane Database of Systematic Reviews 2016, Issue 12. Art. No.: CD009921. DOI: 10.1002/14651858.CD009921.pub2.\nAvailable here.","Adults\n\nHigh risk groups (long-term health conditions)\n","This Cochrane review aimed to assess the effects of automated telephone communication system (ATCS) for preventing disease and managing long‐term conditions on behavioural change, clinical, process, cognitive, patient‐centred and adverse outcomes.\n\nThe review authors found 132 trials with over 4 million participants across preventive healthcare areas and for the management of long‐term conditions.\n\nStudies compared ATCS types in many ways. Some studies reported findings across diseases. For prevention, ATCS probably increase immunisation uptake in children, and slightly in adolescents, but in adults effects are uncertain. \n\nTen studies, all in the USA, evaluated ATCS for promoting immunisation uptake. For preventive healthcare, ATCS (ATCS Plus, IVR, unidirectional) probably increase immunisation uptake in children (risk ratio (RR) 1.25, 95% confidence interval (CI) 1.18 to 1.32; 5 studies, N = 10,454; moderate certainty) and to a lesser extent in adolescents (RR 1.06, 95% CI 1.02 to 1.11; 2 studies, N = 5725; moderate certainty). Based on evidence from 2 studies the effects of ATCS in adults are unclear (RR 2.18, 95% CI 0.53 to 9.02; 2 studies, N = 1743; very low certainty).","The review authors concluded that ATCS interventions can change patients' health behaviours, improve clinical outcomes and increase healthcare uptake with positive effects in several important areas including immunisation, screening, appointment attendance, and adherence to medications or tests. The decision to integrate ATCS interventions in routine healthcare delivery should reflect variations in the certainty of the evidence available and the size of effects across different conditions, together with the varied nature of ATCS interventions assessed. Future research should investigate both the content of ATCS interventions and the mode of delivery; users' experiences, particularly with regard to acceptability; and clarify which ATCS types are most effective and cost‐effective."]
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[null,"Till  SR et al. Incentives for increasing prenatal care use by women in order to improve maternal and neonatal outcomes. Cochrane Database of Systematic Reviews 2015, Issue 12. Art. No.: CD009916. DOI: 10.1002/14651858.CD009916.pub2.\nAvailable here.","High risk groups (pregnant women)","This Cochrane review aimed to determine whether incentives are an effective tool to increase utilization of timely prenatal care among women.\n\nThe review authors identified 11 studies (19 reports), six of which we excluded. Five studies, involving 11,935 pregnancies were included, but only 1893 pregnancies contributed data regarding our specified outcomes. Incentives in the studies included cash, gift card, baby carrier, baby blanket or taxicab voucher and were compared with no incentives. Meta‐analysis was performed for only one outcome 'Return for postpartum care' and this outcome was not pre‐specified in their protocol. Other analyses were restricted to data from single studies.\n\nThe five included studies of incentive programs did not report any of this review's primary outcomes: preterm birth, small‐for‐gestational age, or perinatal death.\n\nIn terms of this review's secondary outcomes, pregnant women receiving incentives were no more likely to initiate prenatal care (risk ratio (RR) 1.04, 95% confidence interval (CI) 0.78 to 1.38, one study, 104 pregnancies). Pregnant women receiving incentives were more likely to attend prenatal visits on a frequent basis (RR 1.18, 95% CI 1.01 to 1.38, one study, 606 pregnancies) and obtain adequate prenatal care defined by number of “procedures” such as testing blood sugar or blood pressure, vaccinations and counseling about breastfeeding and birth control (mean difference (MD) 5.84, 95% CI 1.88 to 9.80, one study, 892 pregnancies). In contrast, women who received incentives were more likely to deliver by cesarean section (RR 1.97, 95% CI 1.18 to 3.30, one study, 979 pregnancies) compared to those women who did not receive incentives.","The included studies did not report on this review's main outcomes: preterm birth, small‐for‐gestational age, or perinatal death. There is limited evidence that incentives may increase utilization and quality of prenatal care, but may also increase cesarean rate. Overall, there is insufficient evidence to fully evaluate the impact of incentives on prenatal care initiation. \n\nThere is a need for high‐quality RCTs to determine whether incentive program increase prenatal care use and improve maternal and neonatal outcomes. Incentive programs, in particular cash‐based programs, as suggested in this review and in several observational studies may improve the frequency and ensure adequate quality of prenatal care. No peer‐reviewed data have been made publicly available for one of the largest incentive‐based prenatal programs – the statewide Medicaid‐based programs within the United States. These observational data represent an important starting point for future research with significant implications for policy development and allocation of healthcare resources. The disparate findings related to attending postpartum care should also be further explored as the findings were limited by the number of studies. Future large RCTs are needed to focus on the outcomes of preterm birth, small‐for‐gestational age and perinatal outcomes."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Clinic-based Client Education\nWhen Used Alone. The Community Guide; 2016. \nAvailable here.","Adults (older: age not specified)","This report aimed to determine the effectiveness of clinic-based client education interventions when implemented alone in increasing vaccination rates or reducing rates of vaccine preventable illness and found insufficient evidence. Four of the included studies provided sufficient evidence of effectiveness but were limited to immunizations for pneumococcal polysaccharide vaccine among older adults with very low baseline coverage. The Task Force finding reflects concerns about the intervention's applicability to a broader range vaccinations, populations, and clinic-based settings.\n\nThis Task Force finding is based on evidence from a Community Guide systematic review completed in 2011 (4 studies with 6 study arms, search period 1980-2009) combined with more recent evidence (1 study, search period 2009-2012). Based on the combined evidence, the Task Force reaffirms its finding of insufficient evidence. The combined Task Force review included five studies. Four studies with six study arms providing a common measurement of change in vaccination rates. Although the median change in vaccination rates was an increase of 10 percentage points (IQR: 3 to 19 percentage points), results were dominated by findings from three related study arms focused on increasing pneumococcal polysaccharide vaccinations among older adult patients in one clinical setting. Changes in vaccination rates from the other three study arms were inconsistent and smaller in magnitude. The final study did not evaluate changes in vaccination rates, and found only a very small change in the proportion of tetanus booster doses administered with the use of an audiovisual message in clinic waiting areas.\n\nTwo studies included in this review implemented a potentially useful educational approach to increase vaccination rates by prompting discussions between the client and their vaccination provider. In these studies, an educational brochure distributed to patients in the waiting area included a specific request for a discussion with their provider about the pneumococcal polysaccharide vaccine. In both studies, use of the brochure increased vaccination rates by 16 percentage points in a client population with very low baseline rates. \n\nClinic-based client education can be one component of an effective combined approach to increase vaccination rates. The Task Force finds strong evidence to recommend health care system-based interventions implemented in combination and community-based interventions implemented in combination.","This CPSTF report states that although the evidence identified in this systematic review is small and inconsistent, at least one format demonstrates sufficient evidence of effectiveness. The Task Force considers the applicability of this educational approach to other vaccines and populations an important question for further study.\n"]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Provider Reminders. The Community Guide; 2015. \nAvailable here.","Adults ","The CPSTF recommends provider reminders on the basis of strong evidence of effectiveness in increasing vaccination rates: (1) among adults, adolescents and children; (2) when used alone or with additional interventions; (3) across a range of intervention characteristics (e.g., computerized or simple reminders, checklists, flowcharts); and (4) in a range of settings and populations.\n\nThe Task Force finding is based on evidence from a Community Guide systematic review completed in 2008 (23 studies, search period 1997–2007) combined with more recent evidence (5 studies, search period 2007–February 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\nThe Task Force considered evidence from 28 studies. Twenty-two studies provided a measurement of change in vaccination rates, with an overall median increase of 10 percentage points (IQI: 6 to 25 percentage points). Of these, seven studies examined provider reminders alone with a median increase of 12 percentage points (IQI: 6 percentage point to 25 percentage points). Fifteen studies examined the impact of provider reminders with additional interventions and observed a median increase of 9 percentage points (IQI: 5 to 25 percentage points). Six additional studies did not provide a common measurement of change in vaccination rates; however, five of the studies provided additional support for the use of provider reminders.\n\nEvidence indicates that provider reminders remain an effective option for consideration in a wide range of clinical settings and populations. A subset of the included evidence, however, suggests that standing orders may be more effective in improving vaccination rates in both inpatient and outpatient settings than provider reminder systems.","Evidence in this CPSTF report indicates that provider reminders are effective in a wide range of contexts. Additional research should focus on system-level implementation of reminder systems, and identify strategies to encourage regular and sustained use. In addition, future research could examine or compare the effectiveness of specific reminder prompts provided as a capability of regional or state-level immunization information systems."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Client Reminder and Recall Systems. The Community Guide; 2015. \nAvailable here.","Adults","The CPSTF recommends client reminder and recall interventions based on strong evidence of effectiveness in improving vaccination rates: (1) in children, adolescents 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.\n\nThis Task Force finding is based on evidence from a Community Guide systematic review completed in 2008 (19 studies, search period 1997-2007) combined with more recent evidence (10 studies, search period 2007-2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\n\nIncluded studies showed vaccination rates increased by a median of 11 percentage points (IQI: 4 to 17 percentage points). Client reminder and recall interventions used alone resulted in a median increase of 6 percentage points (IQI: 3 to 13 percentage points; 14 studies), and interventions implemented with additional components led to a median increase of 12 percentage points (IQI: 10 to 30 percentage points; 15 studies).\n\nThe included studies evaluated the effectiveness of client reminder and recall interventions for a wide range of client and provider populations, settings, vaccinations and delivery methods. Based on the evidence, the Task Force finding should be broadly applicable to all patient populations, in both clinical and community settings, and for the range of vaccines and delivery methods.\n","This CPSTF report concludes that client reminder and recall systems can also be important, effective components of combined approaches to increase vaccination rates. Based on updated, concurrent reviews, the Task Force finds strong evidence to recommend health care system-based interventions implemented in combination and community-based interventions implemented in combination. Immunization information systems, which can also generate client reminder or recall notices provide an additional implementation option.\n\nMore research is needed on effective implementation, sustainability, and expansion of reminder and recall interventions. Future research should also examine the effectiveness of reminder and recall notices using emerging communication technologies (i.e. text message, email). Additional studies should also examine the effectiveness of client reminder and recall interventions on adolescent vaccines such as the human papilloma virus (HPV).\n"]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Standing Orders. The Community Guide; 2015. \nAvailable here.","Adults","The Task Force finding is based on evidence from a Community Guide systematic review completed in 2009 (29 studies, search period 1997–2009) combined with more recent evidence (6 studies, search period 2009–February 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\n\nThe Task Force considered evidence from 35 studies. Of these, 27 studies provided a common measurement of change in vaccination rates with a median increase of 24 percentage points (IQI: 12 to 35 percentage points). Nine studies that examined the impact of standing orders alone documented a median increase of 16 percentage points (IQI: 9 to 29 percentage points). Nineteen studies that evaluated standing orders when combined with additional interventions documented a median increase of 27 percentage points (IQI: 13 to 40 percentage points). Seven studies that did not provide a common measure of change for vaccination rates all reported favorable results after implementation of standing orders.\n\nThe reviewed studies evaluated the effectiveness of standing orders across a wide range of clinical vaccination settings, health care personnel, and client populations. Standing orders were found to be effective in various settings including clinics, hospitals, and long-term care facilities. Interventions were effective when used with different vaccination providers including nurses and pharmacists. While most studies looked at adult populations, four examined intervention effectiveness among children and found a median absolute percent increase of 28 percentage points (range: 8 to 49). While no studies specifically evaluated the impact of standing orders for vaccination of adolescents, evidence from this review is likely applicable to this population. In addition, a subset of the included evidence suggests that standing orders may be more effective in improving vaccination rates in both inpatient and outpatient settings when compared to a provider reminder system.\n\nOne paper from the updated search period described the following barriers encountered during implementation of a pneumococcal vaccination standing orders program in three hospitals: gaps in staff education and training; personnel concerns about additional workload; staff reluctance to administer vaccines without a physician's order; attending physicians' resistance to having hospitalized patients vaccinated; and logistical difficulties. Some attending physicians expressed concern that vaccination would interfere with scheduled treatments or procedures. Other attending physicians did not consider inpatient stays to be an appropriate time for vaccinations (Middleton et al. 2005).\n\nAn additional study reported barriers to implementation of influenza and pneumococcal vaccination standing orders in various health care settings. Findings suggested that the adoption of these policies may have been too difficult to administer, staff were unclear or unconvinced of program benefits, and there was perceived physician discomfort with delegating responsibility for immunizations to nursing staff. A few of the respondents also indicated that resources, effectiveness of the vaccine, and time required to administer the vaccine were barriers for adoption. The majority of these barriers were specific to the administration of the influenza vaccine (Goldstein et al. 2005).","This CPSTF report concludes that standing orders were shown to be effective in increasing vaccination rates for influenza and pneumococcal vaccines. Additional research is needed, however, to determine if these interventions are effective for different vaccines (e.g. hepatitis, tetanus and vaccines recommended for adolescents). More evidence is also needed on ways to address barriers to the implementation of standing orders in health systems.\n"]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Reducing Client Out-of-Pocket Costs for Vaccinations. The Community Guide; 2014. \nAvailable here.","Adults ","The CPSTF recommends interventions that reduce client out-of-pocket costs based on strong evidence of effectiveness in improving vaccination rates. The effectiveness of these interventions has been demonstrated among children, adolescents, and adults, in a range of settings and populations, when applied in varying levels of scale from individual clinical settings to statewide programs to national efforts, and whether used alone or as part of a multi-component intervention.\n\nThis Task Force finding is based on evidence from a Community Guide systematic review completed in 2009 (15 studies; search period 1997 - 2009) combined with more recent evidence (5 studies, search period 2009 - 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\n\nEleven studies provided a common measurement of change in vaccination rates and showed a median increase of 22 percentage points (IQI: 6 to 33 percentage points). Six studies examined the impact of reducing client out-of-pocket costs alone (median increase of 28 percentage points; IQI: 2 to 47 percentage points) and 5 studies examined reducing client out-of-pocket costs as part of a multi-component strategy (median increase of 20 percentage points; IQI: 6 to 20 percentage points). The nine qualifying studies that did not provide a common measurement of change also reported overall increases in vaccinations received or administered.\n\nIncluded studies evaluated intervention effects on childhood vaccination series (3 studies), influenza (9 studies), pneumococcal (6 studies), hepatitis B (2 studies), and human papilloma virus (1 study). The reviewed studies evaluated the effectiveness of interventions that reduced client out-of-pocket costs in a range of client and provider populations and settings.\n\nPolicies adopted in the United States, including the Federal Vaccines for Children Program and the Affordable Care Act, have expanded access to many vaccines at reduced out-of-pocket cost. Barriers to expanded implementation of efforts include the adequacy and timeliness of reimbursement for the costs of vaccines, storage, and administration. In the United States, the ability of health care systems and providers to implement these interventions may depend on the adequacy and timeliness of reimbursement for the costs of the vaccines, storage, and administration.","This CPSTF report concludes that additional research is needed to determine the effectiveness of reducing client out-of-pocket cost interventions to increase rates of recommended vaccinations for adolescents (e.g., HPV, meningococcal, influenza). In addition, the Task Force suggests additional research to determine if these interventions are effective options to increase receipt of annual influenza vaccinations. Future research should also examine whether reducing client out-of-pocket cost interventions are essential components of school-based vaccination programs and on-site vaccination programs in general."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Community-Based Interventions Implemented in Combination. The Community Guide; 2014. \nAvailable here.","Adults","The CPSTF recommends community-based interventions implemented in combination to increase vaccinations in targeted populations, on the basis of strong evidence of effectiveness in increasing vaccination rates.\n\nThe conclusion of strong evidence was based on findings from 18 studies that evaluated coordinated interventions to:\n- Increase community demand\n- Enhance access to vaccination services, and\n- Reduce missed opportunities by vaccination providers\nIn 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.\n\nThe Task Force 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 resources are available.\n\nThis Task Force 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 - 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness.\n\nAll of the included studies provided a common measure of change and showed a median increase in vacation rates of 14 percentage points (IQI: 7 to 24 percentage points).\n\nThe included studies evaluated a variety of interventions in different combinations. The Task Force examined the evidence of differences attributable to specific interventions and combinations of interventions using different strategic approaches.\nFourteen studies implemented an effective combination of one or more interventions to increase community demand with one or more interventions to enhance access to vaccination services and showed a median increase in vaccination rates of 16 percentage points (IQI: 12 to 26 percentage points).\n\nClient reminder and recall systems were used in most of the evaluated programs (15 study arms). Systems were implemented by vaccination providers, established as one part of a community manual outreach and tracking program, or generated from a regional immunization information system (IIS).","This CPSTF report concludes that coordinated interventions may be especially important in communities that have wide disparities in vaccination coverage. Program planners should consider community characteristics, such as mobility and fragmentation of health care, in the selection and combination of interventions to increase vaccination rates and reduce disparities.\n\nPartnerships between community organizations and vaccination providers are likely to be an essential component of effective, sustained community-based efforts. Most studies involved partnerships with existing vaccination providers in\nthe community to increase access to vaccinations, rather than creating new vaccination services. Coalitions represent one way to establish effective partnerships, with the size of the coalition varying based on the community, targeted population, and scope of the problem. Four studies involved community coalitions that used the principles of community-based participatory research.\n\nMore evidence is needed on the effectiveness of these programs in adolescents, and when implemented in rural settings. More economic information on these interventions is needed, specifically, evaluations on the efficiencies of the resource-intensive components of manual outreach and tracking and home visits. Future research could compare program effectiveness based on differences in the component interventions and strategic combinations. Additional research also should examine ways to sustain these programs, especially when provided by existing community-based organizations."]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Increasing Appropriate Vaccination: Health Care System-Based Interventions Implemented in Combination. The Community Guide; 2014. \nAvailable here.","Adults (older: age not specified)\n","The CPSTF recommends health care system-based interventions implemented in combination on the basis of strong evidence of effectiveness in increasing vaccination rates in targeted client populations.\n\nBased on findings from 37 of the 64 included studies, the Task Force further recommends a combination that includes the following:\nAt least one intervention to increase client demand for vaccinations, such as:\n- Client reminder and recall systems\n- Clinic-based client education\n- Manual outreach and tracking\nAnd one or more interventions that address either, or both, of the following strategies:\n- Interventions to enhance access to vaccinations: Expanded access in health care settings, reduced client out-of-pocket costs, home visits\n- Interventions directed at vaccination providers or systems: Provider reminders, standing orders, provider assessment and feedback\n\nInterventions listed as examples for each strategy were those that showed the greatest effect on vaccination rates.\n\nThe Task Force finding is based on evidence from a Community Guide systematic review completed in 2010 (62 studies; search period 1980-2010) combined with more recent evidence (2 studies; search period 2010-February 2012). Based on the combined evidence, the Task Force reaffirms its recommendation based on strong evidence of effectiveness. \n\nOf the combined 64 included studies (76 study arms), 58 of them (70 study arms) provided a common measure of change in vaccination rates and showed a median increase of 9 percentage points (IQI: 4 to 21 percentage points). In general, changes in vaccination rates were greater when interventions were implemented in settings with low baseline rates.\n\nThe included studies evaluated a variety of interventions in different combinations. The Task Force examined the evidence of differences attributable to specific interventions and combinations of interventions using different strategic approaches. These strategic approaches included the following:\n- Interventions to increase client demand (client reminder and recall systems, clinic-based client education, client\nor family incentives, client-held paper immunization records, case management, and manual outreach and\ntracking)\n- Interventions to enhance access to vaccination services (expanded access in health care settings, reduced client\nout-of-pocket costs, and home visits)\n- Interventions directed at vaccination providers (provider reminder systems, standing orders, provider\nassessment and feedback, provider education, and provider incentives)\n\nThe most common individual interventions implemented in a combined approach were client reminder and recall\nsystems (34 study arms) and provider reminders (31 study arms).\n\nThirty-seven studies (44 study arms) evaluated a combination of interventions across two or three of the strategic approaches and showed a median increase in vaccination rates of 17 percentage points (IQI: 6 to 27 percentage points). In 26 study arms, interventions were combined within only one strategic approach and found a median increase in vaccination rates of 4 percentage points (IQI: 2 to 9 percentage points).\n\nNine studies evaluated combinations of interventions implemented as a part of a health care system quality improvement effort. The most commonly implemented interventions were those directed at vaccination providers (provider education, provider reminders, and provider assessment and feedback). The studies included in this evaluation were typically short in duration and reported mixed results.\n\nEvidence did not show a direct relationship between the number of interventions implemented and changes in vaccination rates. Included studies evaluated combinations of between two and nine interventions. The majority of studies implemented two (31 study arms) or three (18 study arms) interventions.","This CPSTF report concludes that overall, included studies provided evidence of effectiveness for intervention combinations implemented in a range of clinical settings and communities, although evidence from rural settings was limited. Studies also demonstrated effectiveness across a range of client populations and vaccinations, including young children (childhood series, influenza) and older adults (influenza, pneumococcal, and tetanus vaccines). Two of the included studies evaluated interventions targeted at increasing vaccination rates among adolescents. Finally, the included studies demonstrated increases in vaccination rates for populations of low socioeconomic status (22 study arms) and across a range of racial and ethnic groups. Most of the included evidence evaluated client populations with low to moderate baseline vaccination rates,\nand findings are most applicable to these situations.\n\nMore evidence is needed on the effectiveness of these interventions in rural settings and when applied to increase vaccinations recommended for adolescents. Future research on quality improvement activities in these settings should incorporate study periods sufficient to evaluate continuous quality improvement efforts."]

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[null,"TALFYRIADAU GYDA'R FFURF LAWN"]
[null,"TALFYRIAD","FFURF LAWN"]
[null,"MNCH","Maternal, neonatal and child health"]
[null,"USA","United States of America"]
[null,"USD ","US Dollars"]
[null,"MD ","Mean difference"]
[null,"RR","Risk ratio"]
[null,"CI","Confidence interval"]
[null,"OR","Odds ratio"]
[null,"HPV ","Human papillomavirus"]
[null,"Tdap","Tetanus–diphtheria–acellular–pertussis"]
[null,"RCT","Randomised controlled trial"]
[null,"IQR","Inter quartile range"]
[null,"IQI","Inter quartile interval"]
[null,"ATCS","Automated telephone communication system"]
[null,"DPT","Diphtheria pertussis tetanus"]
[null,"TB","Tuberculosis"]
[null,"BCG","Bacillus Calmette–Guérin"]
[null,"TCCMD","Targeted client communication via mobile device "]
[null,"LMHIC","Low‐, middle‐ or high‐income countries"]