Phillips David E, Dieleman Joseph L, Lim Stephen S, Shearer Jessica
Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA.
PATH, Seattle, USA.
BMC Health Serv Res. 2017 Sep 26;17(1):681. doi: 10.1186/s12913-017-2626-0.
Many children in low and middle-income countries remain unvaccinated, and vaccines do not always produce immunity. Extensive research has sought to understand why, but most studies have been limited in breadth and depth. This study documents existing evidence on determinants of vaccination and immunization and presents a conceptual framework of determinants.
We used systematic review, content analysis, thematic analysis and interpretive synthesis to document and analyze the existing evidence on determinants of childhood vaccination and immunization.
We documented 1609 articles, including content analysis of 78 articles. Three major thematic models were described in the context of one another. Interpretive synthesis identified similarities and differences between studies, resulting in a conceptual framework with three principal vaccine utilization determinants: 1) Intent to Vaccinate, 2) Community Access and 3) Health Facility Readiness.
This study presents the most comprehensive systematic review of vaccine determinants to date. The conceptual framework represents a synthesis of multiple existing frameworks, is applicable in low and middle-income countries, and is quantitatively testable. Future researchers can use these results to develop competing conceptual frameworks, or to analyze data in a theoretically-grounded way. This review enables better research in the future, further understanding of immunization determinants, and greater progress against vaccine preventable diseases around the world.
许多低收入和中等收入国家的儿童仍未接种疫苗，而且疫苗并不总是能产生免疫力。广泛的研究试图弄清楚原因，但大多数研究在广度和深度上都受到限制。本研究记录了关于疫苗接种和免疫决定因素的现有证据，并提出了一个决定因素的概念框架。
我们使用系统综述、内容分析、主题分析和解释性综合来记录和分析关于儿童疫苗接种和免疫决定因素的现有证据。
我们记录了1609篇文章，包括对78篇文章的内容分析。在相互关联的背景下描述了三个主要的主题模型。解释性综合确定了研究之间的异同，从而形成了一个包含三个主要疫苗使用决定因素的概念框架：1）接种意愿，2）社区可及性，3）卫生机构准备情况。
本研究提供了迄今为止对疫苗决定因素最全面的系统综述。该概念框架是多个现有框架的综合，适用于低收入和中等收入国家，并且可以进行定量检验。未来的研究人员可以利用这些结果来开发相互竞争的概念框架，或以理论为基础分析数据。这篇综述有助于未来开展更好的研究，进一步理解免疫决定因素，并在全球范围内在预防疫苗可预防疾病方面取得更大进展。
