Wennekes Manuela Dominique, Almási Tímea, Eilers Renske, Mezei Fruzsina, Petykó Zsuzsanna Ida, Timen Aura, Vokó Zoltán
Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands.
Arch Public Health. 2024 Mar 12;82(1):34. doi: 10.1186/s13690-024-01260-1.
Healthcare workers (HCW) significantly influence older adults' vaccine acceptance. This systematic review aimed to identify effective educational interventions for HCWs that could enhance their ability to engage in a dialogue with older adults on vaccination.
Medline, Scopus, Cochrane library and grey literature were searched for comparative studies investigating educational interventions concerning older adult vaccinations. The search encompassed all languages and publication years. Analysis was performed on the outcomes 'vaccines offered or ordered' and 'vaccination rates'. Whenever feasible, a sub-analysis on publication year was conducted. Methodological limitations were assessed using the RoB 2 for RCTs and the GRADE checklist for non-randomized studies. Study outcomes were categorized according to the four-level Kirkpatrick model (1996) for effectiveness: reaction, learning, behaviour, and results.
In total, 48 studies met all inclusion criteria. Most studies included reminder systems signalling HCWs on patients due for vaccination. Other interventions included seminars, academic detailing and peer-comparison feedback. Four articles reporting on the reaction-level indicated that most HCWs had a favourable view of the intervention. Two of the six articles reporting on the learning-level observed positive changes in attitude or knowledge due to the intervention. Seventeen studies reported on the behaviour-level. An analysis on eleven out of seventeen studies focusing on vaccines 'ordered' or 'offered' outcomes suggested that tailored reminders, particularly those implemented before 2000, were the most effective. Out of 34 studies reporting on the result-level, 24 were eligible for analysis on the outcome 'vaccination rate', which showed that compared to usual care, multicomponent interventions were the most effective, followed by tailored reminders, especially those predating 2000. Nonetheless, tailored reminders often fell short compared to other interventions like standing orders or patient reminders. In both the behaviour-level and result-level 'education only' interventions frequently underperformed relative to other interventions. Seventeen out of the 27 RCTs, and seven of the 21 non-randomized studies presented a low-to-medium risk for bias in the studies' findings.
Tailored reminders and multicomponent interventions effectively assist HCWs in addressing vaccines with older adults. However, education-only interventions appear to be less effective compared to other interventions rates, attitude, knowledge.
医护人员对老年人的疫苗接种接受度有重大影响。本系统评价旨在确定针对医护人员的有效教育干预措施，以增强他们与老年人就疫苗接种进行对话的能力。
检索了Medline、Scopus、Cochrane图书馆和灰色文献，以查找关于老年人疫苗接种教育干预措施的比较研究。检索涵盖所有语言和出版年份。对“提供或订购疫苗”和“接种率”这两个结果进行了分析。只要可行，就按出版年份进行了亚组分析。使用随机对照试验的RoB 2和非随机研究的GRADE清单评估方法学局限性。研究结果根据1996年的四级柯克帕特里克模型进行分类，以评估有效性：反应、学习、行为和结果。
共有48项研究符合所有纳入标准。大多数研究包括提醒系统，向医护人员发出患者应接种疫苗的信号。其他干预措施包括研讨会、学术详述和同行比较反馈。四篇报告反应水平的文章表明，大多数医护人员对干预措施持积极态度。六篇报告学习水平的文章中有两篇观察到干预措施使态度或知识发生了积极变化。十七项研究报告了行为水平。对十七项研究中关注“订购”或“提供”疫苗结果的十一项研究进行的分析表明，量身定制的提醒，尤其是2000年之前实施的提醒，最为有效。在34项报告结果水平的研究中，24项符合对“接种率”结果进行分析的条件，结果表明，与常规护理相比，多成分干预最为有效，其次是量身定制的提醒，尤其是2000年之前的提醒。然而，与其他干预措施（如长期医嘱或患者提醒）相比，量身定制的提醒往往效果不佳。在行为水平和结果水平上，“仅教育”干预措施相对于其他干预措施往往表现不佳。27项随机对照试验中的17项以及21项非随机研究中的7项在研究结果方面存在低至中度的偏倚风险。
量身定制的提醒和多成分干预措施有效地帮助医护人员与老年人讨论疫苗接种问题。然而，与其他干预措施相比，仅教育干预措施似乎效果较差。
