BACKGROUND: Vaccination programs are instrumental in prolonging and improving people's lives by preventing diseases such as measles, diphtheria, tetanus, pertussis, and influenza from escalating into fatal epidemics. Despite the significant impact of these programs, a substantial number of individuals, including 20 million infants annually, lack sufficient access to vaccines. Therefore, it is imperative to raise awareness about vaccination programs. OBJECTIVE: This study aims to investigate the potential utilization of social media, assessing its scalability and robustness in delivering accurate and reliable information to individuals who are contemplating vaccination decisions for themselves or on behalf of their children. METHODS: The protocol for this review is registered in PROSPERO (identifier CRD42022304229) and is being carried out in compliance with the Cochrane Handbook for Systematic Reviews of Interventions. Comprehensive searches have been conducted in databases including MEDLINE, Embase, PsycINFO, CINAHL (Cumulative Index to Nursing and Allied Health), CENTRAL (Cochrane Central Register of Controlled Trials), and Google Scholar. Only randomized controlled trials (RCTs) were deemed eligible for inclusion in this study. The target population encompasses the general public, including adults, children, and adolescents. The defined interventions comprise platforms facilitating 2-way communication for sharing information. These interventions were compared against traditional interventions and teaching methods, referred to as the control group. The outcomes assessed in the included studies encompassed days unvaccinated, vaccine acceptance, and the uptake of vaccines compared with baseline. The studies underwent a risk-of-bias assessment utilizing the Cochrane Risk-of-Bias tool for RCTs, and the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessment. RESULTS: This review included 10 studies, detailed in 12 articles published between 2012 and 2022, conducted in the United States, China, Jordan, Australia, and Israel. The studies involved platforms such as Facebook, Twitter, WhatsApp, and non-general-purpose social media. The outcomes examined in these studies focused on the uptake of vaccines compared with baseline, vaccine acceptance, and the number of days individuals remained unvaccinated. The overall sample size for this review was 26,286, with individual studies ranging from 58 to 21,592 participants. The effect direction plot derived from articles of good and fair quality indicated a nonsignificant outcome (<i>P</i>=.12). CONCLUSIONS: The findings suggest that, in a real-world scenario, an equal number of positive and negative results may be expected due to the interventions' impact on the acceptance and uptake of vaccines. Nevertheless, there is a rationale for accumulating experience to optimize the use of social media with the aim of enhancing vaccination rates. Social media can serve as a tool with the potential to disseminate information and boost vaccination rates within a population. However, relying solely on social media is not sufficient, given the complex structures at play in vaccine acceptance. Effectiveness hinges on various factors working in tandem. It is crucial that authorized personnel closely monitor and moderate discussions on social media to ensure responsible and accurate information dissemination. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
Communicating research findings to the public in a clear but engaging manner is challenging, yet central for maximizing their societal impact. This systematic review aimed to derive evidence-based strategies for science communication from experimental studies. Three databases were searched in December 2022. Experimental studies published in English or German were included if they tested the effect of providing written information about science to adults aged 16+ years by assessing the impact on at least one of four domains of science communication aims (understanding and knowledge, attitudes and trust, intention and behavior, engagement). A total of 171 publications were included. Derived strategies include avoiding jargon, carefully structuring texts, including citations and expert sources, being mindful about how and when to indicate conflict or uncertainty in science, using neutral language, and highlighting Open Science principles and replicability. They can be used to communicate science effectively to lay audiences, benefitting society.
BACKGROUND: Unconditional cash transfers (UCTs; provided without obligation) for reducing poverty and vulnerabilities (e.g. orphanhood, old age, or HIV infection) are a social protection intervention addressing a key social determinant of health (income) in low- and middle-income countries (LMICs). The relative effectiveness of UCTs compared with conditional cash transfers (CCTs; provided only if recipients follow prescribed behaviours, e.g. use a health service or attend school) is unknown.
OBJECTIVES: To assess the effects of UCTs on health services use and health outcomes in children and adults in LMICs. Secondary objectives are to assess the effects of UCTs on social determinants of health and healthcare expenditure, and to compare the effects of UCTs versus CCTs.
SEARCH METHODS: For this update, we searched 15 electronic academic databases, including CENTRAL, MEDLINE and EconLit, in September 2021. We also searched four electronic grey literature databases, websites of key organisations and reference lists of previous systematic reviews, key journals and included study records.
SELECTION CRITERIA: We included both parallel-group and cluster-randomised controlled trials (C-RCTs), quasi-RCTs, cohort studies, controlled before-and-after studies (CBAs), and interrupted time series studies of UCT interventions in children (0 to 17 years) and adults (≥ 18 years) in LMICs. Comparison groups received either no UCT, a smaller UCT or a CCT. Our primary outcomes were any health services use or health outcome.
DATA COLLECTION AND ANALYSIS: Two review authors independently screened potentially relevant records for inclusion, extracted data and assessed the risk of bias. We obtained missing data from study authors if feasible. For C-RCTs, we generally calculated risk ratios for dichotomous outcomes from crude frequency measures in approximately correct analyses. Meta-analyses applied the inverse variance or Mantel-Haenszel method using a random-effects model. Where meta-analysis was impossible, we synthesised results using vote counting based on effect direction. We assessed the certainty of the evidence using GRADE.
MAIN RESULTS: We included 34 studies (25 studies of 20 C-RCTs, six CBAs, and three cohort studies) involving 1,140,385 participants (45,538 children, 1,094,847 adults) and 50,095 households in Africa, the Americas and South-East Asia in our meta-analyses and narrative syntheses. These analysed 29 independent data sets. The 24 UCTs identified, including one basic universal income intervention, were pilot or established government programmes or research experiments. The cash value was equivalent to 1.3% to 81.9% of the annualised gross domestic product per capita. All studies compared a UCT with no UCT; three studies also compared a UCT with a CCT. Most studies carried an overall high risk of bias (i.e. often selection or performance bias, or both). Most studies were funded by national governments or international organisations, or both. Throughout the review, we use the words 'probably' to indicate moderate-certainty evidence, 'may/maybe' for low-certainty evidence, and 'uncertain' for very low-certainty evidence. Health services use We assumed greater use of any health services to be beneficial. UCTs may not have impacted the likelihood of having used any health service in the previous 1 to 12 months, when participants were followed up between 12 and 24 months into the intervention (risk ratio (RR) 1.04, 95% confidence interval (CI) 1.00 to 1.09; I2 = 2%; 5 C-RCTs, 4972 participants; low-certainty evidence). Health outcomes At one to two years, UCTs probably led to a clinically meaningful, very large reduction in the likelihood of having had any illness in the previous two weeks to three months (RR 0.79, 95% CI 0.67 to 0.92; I2 = 53%; 6 C-RCTs, 9367 participants; moderate-certainty evidence). UCTs may have increased the likelihood of having been food secure over the previous month, at 13 to 36 months into the intervention (RR 1.25, 95% CI 1.09 to 1.45; I2 = 85%; 5 C-RCTs, 2687 participants; low-certainty evidence). UCTs may have increased participants' level of dietary diversity over the previous week, when assessed with the Household Dietary Diversity Score and followed up 24 months into the intervention (mean difference (MD) 0.59 food categories, 95% CI 0.18 to 1.01; I2 = 79%; 4 C-RCTs, 9347 participants; low-certainty evidence). Despite several studies providing relevant evidence, the effects of UCTs on the likelihood of being moderately stunted and on the level of depression remain uncertain. We found no study on the effect of UCTs on mortality risk. Social determinants of health UCTs probably led to a clinically meaningful, moderate increase in the likelihood of currently attending school, when assessed at 12 to 24 months into the intervention (RR 1.06, 95% CI 1.04 to 1.09; I2 = 0%; 8 C-RCTs, 7136 participants; moderate-certainty evidence). UCTs may have reduced the likelihood of households being extremely poor, at 12 to 36 months into the intervention (RR 0.92, 95% CI 0.87 to 0.97; I2 = 63%; 6 C-RCTs, 3805 participants; low-certainty evidence). The evidence was uncertain for whether UCTs impacted livestock ownership, participation in labour, and parenting quality. Healthcare expenditure Evidence from eight cluster-RCTs on healthcare expenditure was too inconsistent to be combined in a meta-analysis, but it suggested that UCTs may have increased the amount of money spent on health care at 7 to 36 months into the intervention (low-certainty evidence). Equity, harms and comparison with CCTs The effects of UCTs on health equity (or unfair and remedial health inequalities) were very uncertain. We did not identify any harms from UCTs. Three cluster-RCTs compared UCTs versus CCTs with regard to the likelihood of having used any health services or had any illness, or the level of dietary diversity, but evidence was limited to one study per outcome and was very uncertain for all three.
AUTHORS' CONCLUSIONS: This body of evidence suggests that unconditional cash transfers (UCTs) may not impact a summary measure of health service use in children and adults in LMICs. However, UCTs probably or may improve some health outcomes (i.e. the likelihood of having had any illness, the likelihood of having been food secure, and the level of dietary diversity), two social determinants of health (i.e. the likelihoods of attending school and being extremely poor), and healthcare expenditure. The evidence on the relative effectiveness of UCTs and CCTs remains very uncertain.
It is widely acknowledged that vaccine hesitancy is a multifaceted problem that cannot be addressed by a single strategy. Behavior change theories and social media tools may together help to guide the design of interventions aimed at improving vaccination uptake. This systematic review aims to identify the breadth and effectiveness of such theories and tools. The systematic review search was performed in PubMed, Scopus, ACM, Cochrane Library, ProQuest, and Web of Science databases for studies between January 2011 and January 2021 that applied social media tools to increase vaccine confidence or improve vaccination uptake. The literature search yielded a total of 3,065 publications. Twenty articles met the eligibility criteria, 12 of which were theory-based interventions. The result shows that the Health Belief Model was the most frequently deployed theory, and the most common social media tool was educational posts, followed by dialogue-based groups, interactive websites, and personal reminders. Theory-based interventions were generally more measurable and comparable and had more evidence to trigger the positive behavior change. Fifteen studies reported the effectiveness in knowledge gain, intention increase, or behavior change. Educational messages were proved to be effective in increasing knowledge but less helpful in triggering behavior change. Dialogue-based social media intervention performed well in improving people's intention to vaccinate. Interventions informed by behavior change theory and delivered via social media platforms offer an important opportunity for addressing vaccine hesitancy. This review highlights the need to use a multitheory framework and tailoring social media interventions to the specific circumstances and needs of the target audience in future interventions. The results and insights gained from this review will be of assistance to future studies.
BACKGROUND: Vaccine hesitancy (VH) and the global decline of vaccine coverage are a major global health threat, and novel approaches for increasing vaccine confidence and uptake are urgently needed. 'Nudging', defined as altering the environmental context in which a decision is made or a certain behaviour is enacted, has shown promising results in several health promotion strategies. We present a comprehensive synthesis of evidence regarding the value and impact of nudges to address VH.
METHODS: We conducted a systematic review to determine if nudging can mitigate VH and improve vaccine uptake. Our search strategy used Medical Subject Headings (MeSH) and non-MeSH terms to identify articles related to nudging and vaccination in nine research databases. 15 177 titles were extracted and assessed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The final list of included articles was evaluated using the Mixed Methods Appraisal Tool and the Grading of Recommendations, Assessment, Development and Evaluations framework.
FINDINGS: Identified interventions are presented according to a framework for behaviour change, MINDSPACE. Articles (n=48) from 10 primarily high-income countries were included in the review. Nudging-based interventions identified include using reminders and recall, changing the way information is framed and delivered to an intended audience, changing the messenger delivering information, invoking social norms and emotional affect (eg, through storytelling, dramatic narratives and graphical presentations), and offering incentives or changing defaults. The most promising evidence exists for nudges that offer incentives to parents and healthcare workers, that make information more salient or that use trusted messengers to deliver information. The effectiveness of nudging interventions and the direction of the effect varies substantially by context. Evidence for some approaches is mixed, highlighting a need for further research, including how successful interventions can be adapted across settings.
CONCLUSION: Nudging-based interventions show potential to increase vaccine confidence and uptake, but further evidence is needed for the development of clear recommendations. The ongoing COVID-19 pandemic increases the urgency of undertaking nudging-focused research.
PROSPERO REGISTRATION NUMBER: CRD42020185817.
INTRODUCTION: Influenza vaccination during pregnancy can offer many benefits to both mother and infant. Despite recommendations from the Advisory Committee on Immunization Practices, vaccine coverage rates among pregnant women during pregnancy are below 40% in the United States. There is a need for a greater understanding of what interventions can improve vaccine uptake among pregnant women.
AREAS COVERED: This review synthesizes the existing evidence on the effectiveness of interventions to improve maternal influenza vaccine uptake. These interventions are examined within the framework of the three psychological propositions: thoughts and feelings, social processes and changing behavior directly.
EXPERT COMMENTARY: A number of promising and effective interventions were identified in this review. Nudge-based interventions that build on favorable intentions to vaccinate such as provider prompts and standing orders have demonstrated significant success in improving influenza vaccine uptake. However, substantial gaps in the literature still exist. Provider recommendations are the most important predictor of vaccine receipt among pregnant women, yet few studies evaluated intervening to improve the dialogue between patient and provider. With the potential for even more vaccines to be added to the maternal immunization schedule, it is vitally important to understand how to improve uptake.
Suboptimal vaccination rates are a significant problem in many countries today, in spite of improved access to vaccine services. As a result, there has been a recent expansion of research on how best to communicate about vaccines. The purpose of the present article is to provide an updated review of published, peer-reviewed empirical studies that examined the effectiveness of gain versus loss framing (i.e., goal framing) in the context of vaccine communication. To locate studies, we examined the reference list from the previous meta-analytic review (O'Keefe & Nan, 2012), and we conducted systematic searches across multiple databases. We included 34 studies in the qualitative synthesis. The relative effectiveness of goal-framed vaccine messages was often shown to depend on characteristics of the message recipient, perceived risk, or situational factors, yet most effects were inconsistent across studies, or simply limited by an insufficient number of studies. Methodological characteristics and variations are noted and discussed. The review points to several directions concerning moderators and mediators of framing effects where additional rigorous studies would be needed.
BACKGROUND: The effectiveness of interventions to increase influenza vaccination uptake in people aged 60 years and older varies by country and participant characteristics. This review updates versions published in 2010 and 2014.
OBJECTIVES: 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.
SEARCH METHODS: We searched CENTRAL, which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE, Embase, CINAHL, and ERIC for this update, as well as WHO ICTRP and ClinicalTrials.gov for ongoing studies to 7 December 2017. We also searched the reference lists of included studies.
SELECTION CRITERIA: Randomised controlled trials (RCTs) and cluster-randomised trials of interventions to increase influenza vaccination in people aged 60 years or older in the community.
DATA COLLECTION AND ANALYSIS: We used standard methodological procedures as specified by Cochrane.
MAIN RESULTS: We included three 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. We 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. We identified three levels of intervention intensity: low (e.g. postcards), medium (e.g. personalised phone calls), and high (e.g. home visits, facilitators).Increasing 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 (odds ratio (OR) 1.11, 95% confidence interval (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).Some interventions could not be meta-analysed due to significant heterogeneity: 17 studies tested simple reminders (11 with 95% CI entirely above unity); 16 tested personalised reminders (12 with 95% CI entirely above unity); two investigated customised compared to form letters (both 95% CI above unity); and four studies examined the impact of health risk appraisals (all had 95% CI above unity). One study of a lottery for free groceries was not effective.Enhancing vaccination access (6 strategies, 8 trials, 10 arms, 9353 participants)We meta-analysed results from two studies of home visits (OR 1.30, 95% CI 1.05 to 1.61) and two studies that tested free vaccine compared to patient payment for vaccine (OR 2.36, 95% CI 1.98 to 2.82). We were unable to conduct meta-analyses of two studies of home visits by nurses plus a physician care plan (both with 95% CI above unity) and two studies of free vaccine compared to no intervention (both with 95% CI above unity). One study of group visits (OR 27.2, 95% CI 1.60 to 463.3) was effective, and one study of home visits compared to safety interventions was not.Provider- 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).We were unable to meta-analyse four studies that looked at physician reminders (three studies with 95% CI above unity) and three studies of facilitator encouragement of vaccination (two studies with 95% CI above unity). 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.Interventions at the societal levelNo studies reported on societal-level interventions.Study funding sourcesStudies were funded by government health organisations (n = 33), foundations (n = 9), organisations that provided healthcare services in the studies (n = 3), and a pharmaceutical company offering free vaccines (n = 1). Fifteen studies did not report study funding sources.
AUTHORS' CONCLUSIONS: We 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.
Problem It has been reported that some adolescents and young women who started taking human papillomavirus (HPV) vaccination are not completing all three doses. The aim of this study was to systematically review intervention studies on HPV vaccination completion. Eligibility Criteria Intervention studies with a comparison group that assessed HPV vaccination completion rate as the primary outcome variable in adolescents and adults younger than 26 years of age, and published in English from 2006 to 2016, were eligible for review. Sample Five studies from a literature search of CINAHL, EMBASE, PsycARTICLES, PubMed, SCOPUS, and Web of Science databases were included in this review. Results The overall quality of the reviewed studies was moderate, and the studies have mainly been conducted in a high-income country. Intervention strategies were DVD-based education on HPV and reminders that were delivered via either electronic or non-electronic methods. Some studies used fixed type of electronic reminders. Others chose preference-based electronic reminders, allowing participants to select one or two delivery options from e-mail, text message, automated telephone message, or Facebook message. Non-electronic reminders were letters sent by standard mail. Conclusions The rates of HPV vaccination completeness increased with the interventions. However, the completeness rate of HPV vaccination remained unsatisfactory and lower than its initiation rate. Implications Educational and reminder interventions for HPV vaccination could contribute to HPV vaccination completion. However, this review highlights the need for more high-quality studies to identify the best way to promote vaccination completion.
Vaccination programs are instrumental in prolonging and improving people's lives by preventing diseases such as measles, diphtheria, tetanus, pertussis, and influenza from escalating into fatal epidemics. Despite the significant impact of these programs, a substantial number of individuals, including 20 million infants annually, lack sufficient access to vaccines. Therefore, it is imperative to raise awareness about vaccination programs.
OBJECTIVE:
This study aims to investigate the potential utilization of social media, assessing its scalability and robustness in delivering accurate and reliable information to individuals who are contemplating vaccination decisions for themselves or on behalf of their children.
METHODS:
The protocol for this review is registered in PROSPERO (identifier CRD42022304229) and is being carried out in compliance with the Cochrane Handbook for Systematic Reviews of Interventions. Comprehensive searches have been conducted in databases including MEDLINE, Embase, PsycINFO, CINAHL (Cumulative Index to Nursing and Allied Health), CENTRAL (Cochrane Central Register of Controlled Trials), and Google Scholar. Only randomized controlled trials (RCTs) were deemed eligible for inclusion in this study. The target population encompasses the general public, including adults, children, and adolescents. The defined interventions comprise platforms facilitating 2-way communication for sharing information. These interventions were compared against traditional interventions and teaching methods, referred to as the control group. The outcomes assessed in the included studies encompassed days unvaccinated, vaccine acceptance, and the uptake of vaccines compared with baseline. The studies underwent a risk-of-bias assessment utilizing the Cochrane Risk-of-Bias tool for RCTs, and the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessment.
RESULTS:
This review included 10 studies, detailed in 12 articles published between 2012 and 2022, conducted in the United States, China, Jordan, Australia, and Israel. The studies involved platforms such as Facebook, Twitter, WhatsApp, and non-general-purpose social media. The outcomes examined in these studies focused on the uptake of vaccines compared with baseline, vaccine acceptance, and the number of days individuals remained unvaccinated. The overall sample size for this review was 26,286, with individual studies ranging from 58 to 21,592 participants. The effect direction plot derived from articles of good and fair quality indicated a nonsignificant outcome (P=.12).
CONCLUSIONS:
The findings suggest that, in a real-world scenario, an equal number of positive and negative results may be expected due to the interventions' impact on the acceptance and uptake of vaccines. Nevertheless, there is a rationale for accumulating experience to optimize the use of social media with the aim of enhancing vaccination rates. Social media can serve as a tool with the potential to disseminate information and boost vaccination rates within a population. However, relying solely on social media is not sufficient, given the complex structures at play in vaccine acceptance. Effectiveness hinges on various factors working in tandem. It is crucial that authorized personnel closely monitor and moderate discussions on social media to ensure responsible and accurate information dissemination. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
