A systematic review and meta-analysis of effectiveness of decision aids for vaccination decision-making

Cassandra Vujovich-Dunn; Jessica Kaufman; Catherine King; S Rachel Skinner; Handan Wand; Rebecca Guy; Julie Leask

doi:10.1016/j.vaccine.2021.05.021

A systematic review and meta-analysis of effectiveness of decision aids for vaccination decision-making

Vaccine. 2021 Jun 23;39(28):3655-3665. doi: 10.1016/j.vaccine.2021.05.021. Epub 2021 May 26.

Authors

Cassandra Vujovich-Dunn¹, Jessica Kaufman², Catherine King³, S Rachel Skinner⁴, Handan Wand⁵, Rebecca Guy⁶, Julie Leask⁷

Affiliations

¹ The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, NSW 2052, Australia. Electronic address: cvujovich-dunn@kirby.unsw.edu.au.
² Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria 3052, Australia; Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Victoria 3086 Australia. Electronic address: Jess.kaufman@mcri.edu.au.
³ National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Locked Bag 4001, 2145 Westmead, NSW, Australia; The Children's Hospital at Westmead Clinical School, the Faculty of Medicine and Health, The University of Sydney, Locked Bag 4001, 2145 Westmead, NSW, Australia. Electronic address: Catherine.king@sydney.edu.au.
⁴ The Children's Hospital at Westmead Clinical School, the Faculty of Medicine and Health, The University of Sydney, Locked Bag 4001, 2145 Westmead, NSW, Australia; University of Sydney, Specialty of Child and Adolescent Health, Faculty of Medicine and Health, Camperdown, NSW 2006, Australia. Electronic address: rachel.skinner@sydney.edu.au.
⁵ The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, NSW 2052, Australia. Electronic address: hwand@kirby.unsw.edu.au.
⁶ The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, NSW 2052, Australia. Electronic address: rguy@kirby.unsw.edu.au.
⁷ National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Locked Bag 4001, 2145 Westmead, NSW, Australia; University of Sydney, Susan Wakil School of Nursing and Midwifery, Camperdown, NSW 2006, Australia. Electronic address: julie.leask@sydney.edu.au.

PMID: 34052064
DOI: 10.1016/j.vaccine.2021.05.021

Abstract

Background: This systematic review and meta-analysis aimed to assess the effectiveness of vaccination decision aids compared with usual care on vaccine uptake, vaccine attitudes, decisional conflict, intent to vaccinate and timeliness.

Methods: Searches were conducted in OVID Medline, OVID Embase, CINAHL, PsycINFO, the Cochrane Library and SCOPUS. Randomised controlled trials were included if they evaluated the impact of decision aids as defined by the International Patient Decision Aids Standards Collaboration. Where possible, meta-analysis was undertaken. Where meta-analysis was not possible, we conducted a narrative synthesis. Risk of bias in included trials was assessed using the Cochrane Collaboration's risk of bias tool. Data were analysed using STATA.

Results: Five RCTs were identified that evaluated the effectiveness of decision aids in the context of vaccination decision making. Meta-analysis of four studies showed that decision aids may have slightly increased vaccination uptake, but this was reduced to no effect once studies with higher risk of bias were excluded. Meta-analysis of three studies showed that decision aids moderately increased intention to vaccinate. Narrative synthesis of two studies suggested that decision aids reduced decisional conflict. One study reported that decision aids decreased perceived risk of vaccination. Content, format and delivery method of the decision aids varied across the studies. It was not clear from the information reported whether these variations affected the effectiveness of the decision aids.

Conclusion: Decision aids can assist in vaccine decision making. Future studies of decision aids could provide greater detail of the decision aids themselves, which would enable comparison of the effectiveness of different elements and formats. Standardising decision aids would also allow for easier comparison between decision aids.

Keywords: Decision aids; Decisional conflict; Vaccination; Vaccine hesitancy; Vaccine uptake.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Decision Making
Decision Support Techniques*
Humans
Reference Standards
Vaccination*