Summary of findings for the main comparison. LHWs to promote immunisation uptake in children compared to usual care.
| LHWs to promote immunisation uptake in children compared to usual care | ||||||
| Patient or population: patients with improving immunisation uptake among children < 2 years whose vaccination is not up to date Settings: USA(3), Ireland(1) Intervention: LHWs Comparison: usual care | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| usual care | LHWs | |||||
| Immunisation schedule up to date Interviews with mothers, record reviews Follow‐up: 6.5‐24 months | Low risk population1 | RR 1.22 (1.1 to 1.37) | 3568 (4 studies5) | ⊕⊕⊕⊝ moderate2,3,4 | ||
| 340 per 1000 | 415 per 1000 (374 to 466) | |||||
| High risk population1 | ||||||
| 560 per 1000 | 683 per 1000 (616 to 767) | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 Selected the next to lowest and next to highest figures to represent the control risk. 2 In Barnes 1999, only 37.5% of eligible families consented to participate, 21.2% refused to particpate, 14.3% were living out of the country or in another state. A significantly greater percentage of non‐enrolled children were covered by Medicaid insurance than enrolled children (p=0.02). The quality of evidence was downgraded by 0.5 because of these design limitations (also see footnote 3). 3 In Johnson 1993 the outcomes were recorded by a family development nurse who knew the group assignment of the mother‐child pair. 4 There is wide variation in the estimates of the included studies from no effect to a 36% relative increase. The quality of evidence was downgraded by 0.5 because of these inconsistencies. 5 Barnes 1999, Johnson 1993, LeBaron 2004, Rodewald 1999