Community engagement in vaccination promotion: A systematic review and meta-analysis.

BACKGROUND:Community engagement takes predominance in global immunization strategies with capacity to eliminate vaccination hesitancy and boost vaccination confidence. Despite strong support for community engagement in promoting health, evidence for community engagement in vaccination promotion emerges in fragments with uncertain qualities. OBJECTIVE:The current review aims to systematic examine the effectiveness of different contents and extents of community engagement for promoting vaccination rates. METHODS:This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A comprehensive and exhaustive literature search was performed in four English databases (PubMed, Embase, Web of Science, and Cochrane Library) and Two Chinese databases (CNKI and Wan Fang) to locate all possible articles. Original research article with an experimental study design examined the effectiveness of community engagement in vaccination promotion was eligible for inclusion. Two reviewers independently performed the literature search, study selection, quality assessment and data extraction. Discrepancies were resolved through discussion, with the arbitration of a third reviewer where necessary. RESULTS:A total of 20 articles out of 11,404 records over the period of 2006 to 2021 were retrieved as the sample set to quantified the effectiveness of community engagement in vaccination promotion. These included studies were performed in various designs, 12 used single group pre-post study designs, 5 used cluster RCTs and 3 used non-randomized controlled trials. These included studies targeted multiple vaccine, 8 studies focused on children immunization, 8 studies focused on HPV vaccine, 3 studies focused on HBV vaccine, and 1 study focused on COVID-19 vaccine. Meta-analysis reported significant increases in vaccination rates in both pre-post comparation ((rate difference) RD:0.34; 95% CI: 0.21-0.47) and between group comparation (RD: 0.18; 95% CI: 0.07-0.29). Meta-analysis about the contents of community engagement found that participant recruitment yielded the largest effect size (RD: 0.51; 95% CI: 0.37-0.67; I2=99.5%), followed by intervention development (RD: 0.36; 95% CI: 0.23-0.50; I2=99.7%), intervention implementation (RD: 0.35; 95% CI: 0.22-0.47; I2=99.8%), and data collection (RD: 0.34; 95% CI: 0.19-0.50; I2=99.8%). Meta-analysis about the extents of community engagement found that high community engagement extent yielded the largest effect size (RD: 0.49; 95% CI: 0.17-0.82; I2 = 99.5%), followed by moderate community engagement extent (RD: 0.45; 95% CI: 0.33-0.58; I2 = 99.4%), and low community engagement extent (RD: 0.15; 95% CI: 0.05-0.25; I2 = 98.6%). Meta-analysis about the types of intervention strategies found that "health service support" endorsed the largest effect sizes (RD: 0.45; 95% CI: 0.25-0.65; I2 = 99.9%), followed by "health education and discussion" (RD: 0.39; 95% CI: 0.20-0.58; I2 = 99.7%), "follow-up and reminder" (RD: 0.33; 95% CI: 0.23-0.42; I2 = 99.3%), and "social marketing campaign (SMC) and community mobilization (CM)" (RD: 0.24; 95% CI: 0.06-0.41; I2 = 99.9%). CONCLUSIONS:The results of this meta-analysis supported the effectiveness of community engagement in vaccination promotion with variations in terms of engagement contents and extents. Community engagement required a "fit for purpose" approach rather than "one size fits all" approach to maximize the effectiveness of vaccine promotion. CLINICALTRIAL:This review protocol was registered in the PROSPERO database (CRD42022339081).