Effectiveness of Interventions that Apply New Media to Improve Vaccine Uptake and Vaccine Coverage

This study systematically collects and summarises evidence on the effectiveness of interventions around the world that apply new media to promote vaccination uptake and increase vaccination coverage. New media are means of mass communication, developed at the time of the web era, that feature on-demand access to content through digital devices that provide the opportunity to participate and be actively involved, reply to other users, and give feedback; in contrast, media such as television, film, and printed magazines are static representations of text and graphics without interactivity. This study explores research on the question of whether new media might offer potential to further improve immunisation coverage.

Studies were included in the review if they focused on interventions that targeted recommended vaccinations for children, adolescents, and adults and: (1) aimed at increasing community demand for immunisations, or (2) were provider-based interventions. They had to meet the following criteria: were conducted in countries that were members of the Organisation for Economic Co-operation and Development (OECD); were original studies using an observational or experimental study design (guidelines, review, letters, or editorials were excluded); were published in books or journals from January 1 1999 to September 10 2013; were written in English.

The primary outcome was a measure of vaccination (vaccine uptake or vaccine coverage). Considered secondary outcomes included willingness to receive immunisation, attitudes and perceptions toward vaccination, and perceived helpfulness of the intervention.

Nineteen studies were included in the systematic review. Eleven of the studies were experimental, the rest having an observational study design. Retrieved studies explored the role of: text messaging (37%), smartphone applications (5%), YouTube videos (5%), Facebook (5%), targeted websites and portals (21%), software for physicians and health professionals (21%), and email communication (5%). In brief, there is some evidence that text messaging, accessing immunisation campaign websites, using patient-held web-based portals, and computerised reminders increase immunisation coverage rates. Insufficient evidence is available on the use of social networks, email communication, and smartphone applications.

To cite only one example: A randomised controlled trial conducted in Australia explored the efficacy of a personalized web-based portal on influenza vaccination uptake. The portal integrated personal health records with consumer care pathways called "journeys", social forums and messaging tools that allowed consumers to interact with each other as well as with healthcare professionals. In particular, authors assessed the association between a specific influenza vaccine journey and vaccination rates during the study period. The influenza vaccine journey combined two elements: (1) an educational component that offered information on the influenza vaccine and how to get it; and (2) access to an online appointment booking system. Authors reported that subjects randomised to have access to the portal were 6.7% (95% confidence interval (CI): 1.46-12.30) more likely than people with no access to receive an influenza vaccine. In addition, they were also 11.6% (95% CI: 3.6-19.5) more likely to visit health service providers.

On the other hand, as the internet plays an increasingly central role in connecting people to information, the negative impact associated with the dissemination of negative or wrong messages regarding immunisation has also increased. As emerged from the literature review anecdotally, "against-vaccination" blogs and websites are effective in discouraging people to get vaccinated or not to conform to recommended immunisation schedules - underlining how the potential harm of bad communication in the new media era is a public health concern.

The researchers conclude that, although there is great potential for improving vaccine uptake and vaccine coverage by implementing programmes and interventions that apply new media, further rigorous research is needed.