Effectiveness and acceptability of parental financial incentives and quasi-mandatory schemes for increasing uptake of vaccinations in preschool children: systematic review, qualitative study and discrete choice experiment

Results:
Systematic review
–
there was insufficient evidence to conclude that the interventions considered
are effective. There was some evidence that the quasi-mandatory interventions were acceptable. There was
insufficient evidence to draw conclusions on economic costs and consequences. Qualitative study
–
there
was little appetite for parental financial incentives. Quasi-mandatory schemes were more acceptable.
Optimising current services was consistently preferred to the interventions proposed. DCE and
questionnaire
–
universal parental financial incentives were preferred to quasi-mandatory interventions,
which were preferred to targeted incentives. Those reporting that they would need an incentive to
vaccinate their children completely required around £110. Those who did not felt that the maximum
acceptable incentive was around £70.
Limitations:
Systematic review
–
a number of relevant studies were excluded as they did not meet the
study design inclusion criteria. Qualitative study
–
few partially and non-vaccinating parents were recruited.
DCE and questionnaire
–
data were from a convenience sample.
Conclusions:
There is little current evidence on the effectiveness or economic costs and consequences of
parental financial incentives and quasi-mandatory interventions for preschool vaccinations. Universal
incentives are likely to be more acceptable than targeted ones. Preferences concerning incentives versus
quasi-mandatory interventions may depend on the context in which these are elicited.
Future work:
Further evidence is required on (i) the effectiveness and optimal configuration of parental
financial incentive and quasi-mandatory interventions for preschool vaccinations
–
if effectiveness is
confirmed, further evidence is required on how to communicate this to stakeholders and the impact on
acceptability; and (ii) the acceptability of parental financial incentive and quasi-mandatory interventions for
preschool vaccinations to members of the population who are not parents of preschool children or relevant
health professionals. Further consideration should be given to (i) incorporating reasons for non-vaccination
into new interventions for promoting vaccination uptake; and (ii) how existing services can be optimised.
Study registration:
This study is registered as PROSPERO CRD42012003192.
Funding:
The National Institute for Health Research Health Technology Assessment programme.