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. 2014 Nov 19;2014(11):CD010232. doi: 10.1002/14651858.CD010232.pub2

for the main comparison.

Interventions aimed at communities to inform and/or educate about early childhood vaccination versus routine immunisation practices in primary and community care
People: community members
Settings: primary and community care
Intervention: interventions to inform and/or educate members of the community about early childhood vaccination
Comparison: routine immunisation practices
Outcomes Impact Number of participants
 (studies) Certainty of the evidence
 (GRADE)†
Absolute effect* Estimated effects Results in words
Without
interventions aimed at communities 		With
interventions aimed at communities
Knowledge among participants of vaccine or vaccine‐preventable disease (number of people whose vaccine knowledge had increased; follow‐up: mean = 2 years; assessed through household survey using a questionnaire) 59 per 100 people 71 per 100 people (from 65 to 78) Adjusted mean difference 0.121 (95% CI 0.06 to 0.19) The intervention may improve knowledge of vaccine‐preventable diseases among intervention participants 55821 ⊕⊕⊖⊖
 Low2
Knowledge among participants of vaccine service delivery The included studies did not assess this outcome
Immunisation status of child (follow‐up: mean = 2 years; assessed through household survey using a questionnaire) Pooling of the data from these studies was not possible

  • Study 1 (any vaccine): RR 1.67 (95% CI 1.21 to 2.31)

  • Study 2 (measles): RR 1.63 (95% CI 1.03 to 2.58)

  • Study 2 (DPT): RR 2.17 (95% CI 1.43 to 3.29)

  • Study 2 (polio): RR 1.01 (95% CI 0.97 to 1.05)

 One study showed that the intervention probably increases the number of children who received one or more vaccinations. A second study showed that the intervention probably increases the uptake of both measles and DPT vaccines but makes little or no difference to the number of children who received polio vaccine

  • Study 1 (any vaccine): 228

  • Study 2 (measles): 956

  • Study 2 (DPT): 957

  • Study 2 (polio): 952


3 		⊕⊕⊕⊖
 Moderate4
Participants' attitudes towards vaccination (number of parents who think it is worthwhile to vaccinate children; follow‐up: mean = 2 years; assessed through household survey using a questionnaire) 86 per 100 parents 91 per 100 parents (from 87 to 96) Adjusted mean difference 0.054 (95% CI 0.01 to 0.11) The intervention may improve attitudes towards vaccination among intervention participants 56361 ⊕⊕⊖⊖
 Low5
Participants' involvement in decision‐making regarding vaccination (number of mothers included in decisions about vaccination; follow‐up: mean = 2 years; assessed through household survey using a questionnaire) 55 per 100 mothers 60 per 100 mothers (from 54 to 65) Adjusted mean difference 0.043 (95% CI ‐0.01 to 0.1) The intervention may make little or no difference to the involvement of mothers in decision‐making regarding vaccination 55651 ⊕⊕⊖⊖
 Low6
Participant confidence in the decision made regarding vaccination The included studies did not assess this outcome
Unintended or adverse effects The included studies did not assess this outcome
Resource use or cost of the intervention The included studies did not assess this outcome
*The absolute effect WITHOUT the intervention is based on data from the trial control group. The corresponding absolute effect WITH the intervention is based on the estimated effect of the intervention relative to the control group.
 CI: confidence interval; RR: risk ratio; DPT: diphtheria, pertussis and tetanus vaccine
†GRADE Working Group grades of evidence
High certainty: This research provides a very good indication of the likely effect. The likelihood that the effect will be substantially different^ is low.
Moderate certainty: This research provides a good indication of the likely effect. The likelihood that the effect will be substantially different^ is moderate.
Low certainty: This research provides some indication of the likely effect. However, the likelihood that it will be substantially different^ is high.
Very low certainty: This research does not provide a reliable indication of the likely effect. The likelihood that the effect will be substantially different^ is very high.
^Substantially different = a large enough difference that it might affect a decision

1Andersson 2009.
 2Downgraded due to risk of bias, as the outcome is based on self report; indirectness as the outcome assessed in the trial is not identical to that specified in the review; and sparse data drawn from a single study.
 3Andersson 2009 (study 2), Pandey 2007 (study 1 ‐ unpublished data).
 4Downgraded due to some imprecision (wide confidence intervals that include both little effect and a substantial effect) and some inconsistency across the findings from the two studies.
 5Downgraded due to risk of bias, as the outcome is based on self report; indirectness as the outcome assessed in the trial is not identical to that specified in the review; and sparse data drawn from a single study.
 6Downgraded due to risk of bias, as the outcome is based on self report; indirectness as the outcome assessed in the trial is not identical to that specified in the review; and sparse data drawn from a single study.