Improving vaccination uptake among adolescents

This Cochrane Review aimed to assess the effects of approaches to increase the number of adolescents who get vaccinated. Cochrane researchers collected and analysed all relevant studies to answer this question and found 16 studies.

Key messages

This review showed that several different approaches may increase the number of adolescents who get their recommended vaccines. These include giving health education, offering gifts, and passing laws. However, more research is needed to understand what approaches work best, especially in low‐ and middle‐income countries.

What was studied in the review?

The World Health Organization recommends several vaccines for children aged between 10 and 19 years (adolescents). Some of these vaccines are mainly offered to this age group, such as the human papillomavirus (HPV; a viral infection that is passed between people through skin‐to‐skin contact and can cause genital warts and cancer) vaccine. Others are booster vaccines and are also given to younger children, such as hepatitis B vaccines, diphtheria, tetanus, and pertussis (whooping cough) vaccines.

Many adolescents do not get their recommended vaccines. Governments and organisations have tried different approaches to change this. One approach is to target adolescents and their parents and communities. This can be done, for instance, by giving them information about vaccines; reminding them when the vaccines are due; or giving them gifts. Another approach is to target healthcare providers, for instance through information, reminders, or feedback about their practice. A third approach is to make vaccines more accessible to people. This can be done, for instance, by making vaccines free or cheap, or by offering vaccines closer to home, including at schools. A fourth approach is to pass laws about vaccination. For instance, in some countries, students have to prove that they have been vaccinated before they can attend school.

What were the main results of the review?

The review authors found 16 relevant studies. Twelve of the studies were from the USA. The other studies were one each from Australia, Sweden, Tanzania, and the UK. These studies showed the following.

When adolescents (girl or boys, or both) and their parents were given vaccination information and education, more adolescents got HPV vaccines (high‐certainty evidence).

When adolescents were given gift vouchers, more adolescents may have got HPV vaccines (low‐quality evidence). However, we were uncertain whether giving adolescents and their parents health education, cash, and gift packages led to more adolescents getting hepatitis B vaccines (very low certainty evidence).

When laws were passed stating that adolescents must be vaccinated to go to school, substantially more adolescents probably got hepatitis B vaccines (moderate‐certainty evidence).

When healthcare providers were reminded to vaccinate adolescents when they opened their electronic medical charts, this probably had little or no effect on the number of adolescents who got tetanus–diphtheria–pertussis, meningococcal, HPV, or influenza vaccines (moderate‐certainty evidence).

When healthcare providers were given education with performance feedback, more adolescents may have got HPV vaccines (low‐certainty evidence).

When healthcare providers were given education, individualised feedback, frequent visits, and incentives, more adolescents probably got HPV vaccines (moderate‐certainty evidence).

When healthcare providers and parents were targeted in several ways, including through education, telephone calls, and radio messages, more adolescents may have got HPV vaccines (low‐certainty evidence).

These studies compared the use of these approaches (health education, gifts and rewards, laws, or reminders) to using no approaches.

In addition, one study from Tanzania gave vaccination information to all girls that were in school class six but were not necessarily of the same age. They were compared to girls who were given vaccination information because they were all born in the same year, but were not necessarily in the same class. This study showed that the class‐based approach probably led to slightly more girls getting HPV vaccines (moderate‐certainty evidence).

How up‐to‐date is this review?

The review authors searched for studies that had been published up to 31 October 2018.