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Can opportunities be enhanced for vaccinating children in home visiting programs? A population-based cohort study.

Isaac MR, Chartier M, Brownell M, Chateau D, Nickel NC, Martens P, Katz A, Sarkar J, Hu M, Burland E, Goh C, Taylor C, PATHS Equity Team Membe - BMC Public Health (2015)

Bottom Line: Home visiting programs focused on improving early childhood environments are commonplace in North America.The interaction between program and income quintiles was not statistically significant suggesting that the program effect did not differ by income quintile.Evidence-based program enhancements have the potential to increase these rates further, however more research is needed to inform policy makers of optimal approaches in this regard, especially with respect to cost-effectiveness.

View Article: PubMed Central - PubMed

Affiliation: Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. Michael.Isaac@gov.mb.ca.

ABSTRACT

Background: Home visiting programs focused on improving early childhood environments are commonplace in North America. A goal of many of these programs is to improve the overall health of children, including promotion of age appropriate vaccination. In this study, population-based data are used to examine the effect of a home visiting program on vaccination rates in children.

Methods: Home visiting program data from Manitoba, Canada were linked to several databases, including a provincial vaccination registry to examine vaccination rates in a cohort of children born between 2003 and 2009. Propensity score weights were used to balance potential confounders between a group of children enrolled in the program (n = 4,562) and those who were eligible but not enrolled (n = 5,184). Complete and partial vaccination rates for one and two year old children were compared between groups, including stratification into area-level income quintiles.

Results: Complete vaccination rates from birth to age 1 and 2 were higher for those enrolled in the Families First program [Average Treatment Effect Risk Ratio (ATE RR) 1.06 (95 % CI 1.03-1.08) and 1.10 (95 % CI 1.05-1.15) respectively]. No significant differences were found between groups having at least one vaccination at age 1 or 2 [ATE RR 1.01 (95 % CI 1.00-1.02) and 1.00 (95 % CI 1.00-1.01) respectively). The interaction between program and income quintiles was not statistically significant suggesting that the program effect did not differ by income quintile.

Conclusions: Home visiting programs have the potential to increase vaccination rates for children enrolled, despite limited program content directed towards this end. Evidence-based program enhancements have the potential to increase these rates further, however more research is needed to inform policy makers of optimal approaches in this regard, especially with respect to cost-effectiveness.

No MeSH data available.


Related in: MedlinePlus

Flow diagram showing study participant selection
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Related In: Results  -  Collection

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Fig1: Flow diagram showing study participant selection

Mentions: Figure 1 outlines the process of selecting study participants. The original Families First database had information on 16,153 families. There was no parent survey score for 5,369 families. These families’ parent survey scores were estimated using multiple imputation (explained below) because excluding them could bias the results of our study. In practice, the parent survey may not have been done due to public health nurse challenges (e.g., large workloads, lack of experience with at-risk families) or family characteristics such as lack of trust of service providers, no address, no telephone, or addictions issues (personal communication-Marion Ross). Imputing the missing parent survey scores added 2,736 families to the comparison group, 104 to the program group, and 2,253 were excluded because the imputed scores were lower than 25. An additional 904 families were excluded because the program assignment variable and other key variables confirming program entry were missing. The final sample included 4,562 children from families in the program (the intervention group) and 5,184 children from families who were eligible for the program, but did not receive it (the comparison group). Based on statistics kept by Healthy Child Manitoba, we estimate that of the 5,186 eligible families (imputed or documented parent survey score ≥25) that did not participate in the program, 37 % of families refused the program, 11 % did not enter because the program was full and another 52 % were never offered the program because the parent survey questionnaire was unable to be completed for reasons discussed above.Fig. 1


Can opportunities be enhanced for vaccinating children in home visiting programs? A population-based cohort study.

Isaac MR, Chartier M, Brownell M, Chateau D, Nickel NC, Martens P, Katz A, Sarkar J, Hu M, Burland E, Goh C, Taylor C, PATHS Equity Team Membe - BMC Public Health (2015)

Flow diagram showing study participant selection
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4494701&req=5

Fig1: Flow diagram showing study participant selection
Mentions: Figure 1 outlines the process of selecting study participants. The original Families First database had information on 16,153 families. There was no parent survey score for 5,369 families. These families’ parent survey scores were estimated using multiple imputation (explained below) because excluding them could bias the results of our study. In practice, the parent survey may not have been done due to public health nurse challenges (e.g., large workloads, lack of experience with at-risk families) or family characteristics such as lack of trust of service providers, no address, no telephone, or addictions issues (personal communication-Marion Ross). Imputing the missing parent survey scores added 2,736 families to the comparison group, 104 to the program group, and 2,253 were excluded because the imputed scores were lower than 25. An additional 904 families were excluded because the program assignment variable and other key variables confirming program entry were missing. The final sample included 4,562 children from families in the program (the intervention group) and 5,184 children from families who were eligible for the program, but did not receive it (the comparison group). Based on statistics kept by Healthy Child Manitoba, we estimate that of the 5,186 eligible families (imputed or documented parent survey score ≥25) that did not participate in the program, 37 % of families refused the program, 11 % did not enter because the program was full and another 52 % were never offered the program because the parent survey questionnaire was unable to be completed for reasons discussed above.Fig. 1

Bottom Line: Home visiting programs focused on improving early childhood environments are commonplace in North America.The interaction between program and income quintiles was not statistically significant suggesting that the program effect did not differ by income quintile.Evidence-based program enhancements have the potential to increase these rates further, however more research is needed to inform policy makers of optimal approaches in this regard, especially with respect to cost-effectiveness.

View Article: PubMed Central - PubMed

Affiliation: Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. Michael.Isaac@gov.mb.ca.

ABSTRACT

Background: Home visiting programs focused on improving early childhood environments are commonplace in North America. A goal of many of these programs is to improve the overall health of children, including promotion of age appropriate vaccination. In this study, population-based data are used to examine the effect of a home visiting program on vaccination rates in children.

Methods: Home visiting program data from Manitoba, Canada were linked to several databases, including a provincial vaccination registry to examine vaccination rates in a cohort of children born between 2003 and 2009. Propensity score weights were used to balance potential confounders between a group of children enrolled in the program (n = 4,562) and those who were eligible but not enrolled (n = 5,184). Complete and partial vaccination rates for one and two year old children were compared between groups, including stratification into area-level income quintiles.

Results: Complete vaccination rates from birth to age 1 and 2 were higher for those enrolled in the Families First program [Average Treatment Effect Risk Ratio (ATE RR) 1.06 (95 % CI 1.03-1.08) and 1.10 (95 % CI 1.05-1.15) respectively]. No significant differences were found between groups having at least one vaccination at age 1 or 2 [ATE RR 1.01 (95 % CI 1.00-1.02) and 1.00 (95 % CI 1.00-1.01) respectively). The interaction between program and income quintiles was not statistically significant suggesting that the program effect did not differ by income quintile.

Conclusions: Home visiting programs have the potential to increase vaccination rates for children enrolled, despite limited program content directed towards this end. Evidence-based program enhancements have the potential to increase these rates further, however more research is needed to inform policy makers of optimal approaches in this regard, especially with respect to cost-effectiveness.

No MeSH data available.


Related in: MedlinePlus