Background

Vaccination is a cost-effective strategy for reducing childhood mortality and morbidity, but more than 24 million children still do not have access to basic immunization services. 'Hard to reach' groups also remain an issue.

Strategies to increase vaccination uptake involve:

• Supply-side interventions: these include improving the availability of effective vaccines, technologies to support their application and health personnel to deliver services
• Demand-side or consumer level components: these include reminders to parents to get their children vaccinated

In research and policy, more attention has focussed on the former to the neglect of the latter. However, demand-side strategies, such as interventions to improve communication between parents and health care providers, have the potential to address barriers to vaccination associated with parental knowledge and understanding, attitudes, beliefs and behaviour. Such strategies may improve childhood vaccination uptake in low- and middle-income countries (LMICs) as well as the cost effectiveness of immunization programmes.

What is a communication intervention?
A communication intervention is a purposeful, structured, repeatable and adaptable strategy to inform and influence individual and community decisions in relation to personal and public health participation, disease prevention and promotion, policy making, service improvement and research.

Communication interventions may operate at individual, community or societal levels, and target people in their role as parents or community members. For example:

• Letting people know why vaccination is important, thereby increasing demand e.g., public information campaigns
• Getting parents into a health centre for vaccination in a timely way
• Providing parents with information in ways that are culturally and locally meaningful and helpful
• Involving community members in planning and evaluating programmes

These interventions can complement or be integrated into targeted vaccination programmes or comprehensive primary care services.

What evidence exists to inform the development of communication strategies to increase vaccination uptake?
There are few high quality systematic reviews of interventions to improve vaccination uptake. However, there is a substantial body of evidence from randomized controlled trials (RCTs) assessing relevant communication interventions. To date, the findings of many of these RCTs have not been synthesized in reviews. LMIC policy makers and vaccination programme managers looking for research evidence to inform the development of new approaches to addressing demand-side barriers to vaccination uptake would therefore face considerable difficulties in finding and using the available evidence.