Albers Alexandria N, Thaker Juthika, Newcomer Sophia R
University of Montana, School of Public and Community Health Sciences, 32 Campus Drive, Missoula, MT, USA.
University of Montana, Center for Population Health Research, 32 Campus Drive, Missoula, MT, USA.
Prev Med Rep. 2022 Apr 25;27:101804. doi: 10.1016/j.pmedr.2022.101804. eCollection 2022 Jun.
Early childhood vaccination rates are lower in rural areas of the U.S. compared with suburban and urban areas. Our aim was to identify barriers to and facilitators of early childhood immunization in rural U.S. communities. We completed a systematic review of original research conducted in the U.S. between January 1, 2000-July 25, 2021. We searched PubMed, Cumulative Index for Nursing and Allied Health Literature, and Web of Science. We included studies that examined barriers to and facilitators of routine immunizations in children <36 months old in rural areas. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we reported studies' methodologies and targeted populations, definitions of rurality, and common themes across studies that reflected barriers to or facilitators of vaccination. Ultimately, 17 papers met inclusion criteria for review. The majority of studies (10/17) were conducted within one U.S. state, and the same number (10/17) were conducted prior to 2005. Facilitators of vaccine uptake in rural communities identified across studies included reminder/recall systems and parents' relationships with providers. Parental hesitancy, negative clinic experiences, referrals outside of primary care settings, and distance to providers were identified as barriers to vaccination in rural settings. This review revealed a limited scope of evidence on barriers to and facilitators of early childhood immunization in rural communities. More investigations of the causes of low vaccine coverage and the effectiveness of interventions for increasing vaccine uptake are urgently needed in rural pediatric populations to address persistent rural-urban immunization disparities.
与郊区和城市地区相比，美国农村地区的幼儿疫苗接种率较低。我们的目的是确定美国农村社区幼儿免疫接种的障碍和促进因素。我们对2000年1月1日至2021年7月25日在美国进行的原始研究进行了系统综述。我们检索了PubMed、护理及相关健康文献累积索引和科学网。我们纳入了研究农村地区36个月以下儿童常规免疫接种障碍和促进因素的研究。按照系统评价和荟萃分析的首选报告项目指南，我们报告了研究的方法和目标人群、农村地区的定义以及各项研究中反映疫苗接种障碍或促进因素的共同主题。最终，有17篇论文符合纳入综述的标准。大多数研究（10/17）在一个美国州内进行，且同样数量（10/17）的研究在2005年之前进行。各项研究确定的农村社区疫苗接种促进因素包括提醒/召回系统以及家长与医疗服务提供者的关系。家长的犹豫、负面的诊所体验、初级保健机构以外的转诊以及到医疗服务提供者处的距离被确定为农村地区疫苗接种的障碍。本综述显示，关于农村社区幼儿免疫接种障碍和促进因素的证据范围有限。迫切需要对农村儿童人群中疫苗接种覆盖率低的原因以及提高疫苗接种率的干预措施的有效性进行更多调查，以解决持续存在的城乡免疫差距问题。
