Centre for Health Communication and Participation, Health Sciences 2, School of Psychology and Public Health, La Trobe University, Bundoora, Melbourne, VIC 3086, Australia.
Norwegian Institute of Public Health, Boks 7004, St Olavs plass, 0130 Oslo, Norway; Health Systems Research Unit, South African Medical Research Council, P.O. Box 19070, 7505 Tygerberg, Cape Town, South Africa.
Vaccine. 2018 Oct 22;36(44):6520-6528. doi: 10.1016/j.vaccine.2017.08.027. Epub 2017 Aug 20.
Communication interventions for childhood vaccination are promising strategies to address vaccine hesitancy, but current research is limited by the outcomes measured. Most studies measure only vaccination-related outcomes, with minimal consideration of vaccine hesitancy-relevant intermediate outcomes. This impedes understanding of which interventions or elements are effective. It is also unknown which outcomes are important to the range of stakeholders affected by vaccine hesitancy. Outcome selection shapes the evidence base, informing future interventions and trials, and should reflect stakeholder priorities. Therefore, our aim was to identify which outcome domains (i.e. broad outcome categories) are most important to different stakeholders, identifying preliminary core outcome domains to inform evaluation of three common vaccination communication types: (i) communication to inform or educate, (ii) remind or recall, and (iii) enhance community ownership.
We conducted a two-stage online Delphi survey, involving four stakeholder groups: parents or community members, healthcare providers, researchers, and government or non-governmental organisation representatives. Participants rated the importance of eight outcome domains for each of the three communication types. They also rated specific outcomes within one domain ("attitudes or beliefs") and provided feedback about the survey.
Collectively, stakeholder groups prioritised outcome domains differently when considering the effects of different communication types. For communication that aims to (i) inform or educate, the most important outcome domain is "knowledge or understanding"; for (ii) reminder communication, "vaccination status and behaviours"; and for (iii) community engagement communication, "community participation". All stakeholder groups rated most outcome domains as very important or critical. The highest rated specific outcome within the "attitudes or beliefs" domain was "trust".
This Delphi survey expands the field of core outcomes research and identifies preliminary core outcome domains for measuring the effects of communication about childhood vaccination. The findings support the argument that vaccination communication is not a single homogenous intervention - it has a range of purposes, and vaccination communication evaluators should select outcomes accordingly.
儿童疫苗接种的沟通干预措施是解决疫苗犹豫的有前途的策略，但目前的研究受到所测量结果的限制。大多数研究仅测量与疫苗接种相关的结果，很少考虑与疫苗犹豫相关的中间结果。这阻碍了对哪些干预措施或元素有效的理解。也不知道哪些结果对受疫苗犹豫影响的各种利益相关者重要。结果选择塑造了证据基础，为未来的干预措施和试验提供信息，并且应该反映利益相关者的优先事项。因此，我们的目的是确定不同利益相关者最重要的结果领域（即广泛的结果类别），确定初步的核心结果领域，以告知三种常见疫苗接种沟通类型的评估：（i）沟通以告知或教育，（ii）提醒或召回，和（iii）增强社区所有权。
我们进行了两阶段的在线德尔菲调查，涉及四个利益相关者群体：父母或社区成员、医疗保健提供者、研究人员和政府或非政府组织代表。参与者为三种沟通类型的每种沟通类型的八个结果领域的重要性进行了评分。他们还在一个领域（“态度或信念”）内对特定结果进行了评分，并对调查提供了反馈。
当考虑不同沟通类型的效果时，利益相关者群体对结果领域的重视程度不同。对于旨在（i）告知或教育的沟通，最重要的结果领域是“知识或理解”；对于（ii）提醒沟通，“疫苗接种状况和行为”；对于（iii）社区参与沟通，“社区参与”。所有利益相关者群体都将大多数结果领域评为非常重要或关键。在“态度或信念”领域中评分最高的特定结果是“信任”。
这项德尔菲调查扩展了核心结果研究领域，并确定了衡量儿童疫苗接种沟通效果的初步核心结果领域。研究结果支持这样一种观点，即疫苗接种沟通不是单一的同质干预措施 - 它有多种目的，疫苗接种沟通评估人员应相应地选择结果。
