McPhee 2003.
Methods |
Study design: controlled before‐after study (independent samples) Sampling frame: Vietnamese or Chinese‐Vietnamese adults age 18+ and parent of at least 1 child age 3 to 18 living in the same household Sampling method: telephone numbers of individuals with Vietnamese surnames randomly selected from area telephone books Collection method: physician or county health department contact via mail or telephone, or in person, to obtain verification of immunization status (n = 784) Description of the community coalition: Community mobilization campaign was sponsored by the Vietnamese Community Health Promotion Project, which subcontracted with the East Dallas Counseling Center to form a coalition of Vietnamese groups in Dallas. The 19 coalition members consisted of physicians, dentists, pharmacists, city and county department of public health and education officials, business leaders, veterans, seniors, teachers, researchers, parents, grandparents, homemakers, newspaper editors, and community‐based organization representatives. The coalition employed a program co‐ordinator and worked through 3 committees: advisory, planning, and outreach |
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Participants |
Communities: metropolitan areas Country: USA Ages included in assessment: 3 to 16 at pre‐intervention, 5 to 18 at post intervention Reasons provided for selection of intervention community: large Vietnamese‐American population that had not received interventions for hepatitis B vaccination Intervention community (population size): Dallas/Fort Worth metropolitan area (41,591 Vietnamese‐Americans) Comparison community (population size): Washington, DC, metropolitan area (38,796 Vietnamese‐Americans) |
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Interventions |
Name of intervention: not reported Theory: not reported Aim: to promote awareness of and responsibility for hepatitis B vaccinations of Vietnamese‐American children through families, healthcare providers, and community organizations Description of costs and resources: Costs included direct intervention costs (personnel, volunteers’ time, other operating expenses) plus vaccination costs. Prizes for children receiving vaccines and media publicity were donated Components of the intervention: The coalition promoted physicians’ registration as Vaccines for Children providers, distributed referral lists of vaccine providers and educational materials, conducted health fairs, sent targeted mailings, gave educational presentations, conducted home visits for new immigrants, worked at 2 weekly community clinics to translate and help children receive vaccines, and utilized free local media publicity. Estimated cost‐benefit ratio was 4.47:1 Start date: April 1998 Duration: 2 years |
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Outcomes |
Outcomes and measures: proportion of Vietnamese‐American children who had received 3 doses of HepB (%) Time points: pre‐intervention (1998) and post‐intervention (2000) |
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Notes | This study also included a media intervention arm in the Houston metropolitan area that was not coalition‐driven, and was not included in this review Funding source: government |
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Risk of bias | ||
Bias | Authors' judgement | Support for judgement |
Random sequence generation (selection bias) | High risk | Intervention not randomly assigned |
Allocation concealment (selection bias) | High risk | No allocation concealment |
Baseline outcome measurement similar | High risk | At pre‐intervention, children in the control population reported significantly higher levels of HepB immunization than children in the intervention group; baseline levels were not taken into account in the main results |
Baseline characteristics similar | High risk | Parents of children in the control group were more likely to speak English, have more education, higher income level, health insurance, and a Vietnamese healthcare provider than parents of children in the intervention group |
Blinding of outcome assessment (detection bias) All outcomes | High risk | No blinding |
Incomplete outcome data (attrition bias) All outcomes | Unclear risk | Independent samples were measured pre‐intervention and post intervention, and response rates were similar (93% and 92.5%. respectively). However, HepB status was reported in only 44% to 61% of each sample. The main study analysis excludes respondents with missing outcome data, and a secondary analysis codes these individuals as unvaccinated |
Blinding of participants and personnel (performance bias) All outcomes | High risk | No blinding |
Protection against contamination | Low risk | No protection against contamination is noted, but study sites were separated by a large distance |
Selective reporting (reporting bias) | Low risk | All intended outcomes appear to have been reported |
Other bias | High risk | Characteristics of participants sampled within each group appear to vary considerably between pre‐intervention and post intervention with regard to income, insurance status, and provider ethnicity for the intervention group, and with regard to education, employment status, and provider ethnicity for the control group |