title: Improving immunisation timeliness in Aboriginal children through personalised calendars.
abstract: BACKGROUND
  Delayed immunisation and vaccine preventable communicable disease remains a significant health issue in Aboriginal children. Strategies to increase immunisation coverage and timeliness can be resource intensive. In a low cost initiative at the Aboriginal Medical Service Western Sydney (AMSWS) in 2008-2009, a trial of personalised calendars to prompt timely childhood immunisation was undertaken.
  
  
  METHODS
  Calendars were generated during attendances for early childhood immunisations. They were designed for display in the home and included the due date of the next immunisation, a photo of the child and Aboriginal artwork. In a retrospective cohort design, Australian Childhood Immunisation Register data from AMSWS and non-AMSWS providers were used to determine the delay in immunisation and percentage of immunisations on time in those who received a calendar compared to those who did not. Interviews were undertaken with carers and staff.
  
  
  RESULTS
  Data on 2142 immunisation doses given to 505 children were analysed, utilising pre-intervention (2005-2007) and intervention (2008-2009) periods and a 2 year post-intervention observation period. 113 calendars were distributed (30% of eligible immunisation attendances). Improvements in timeliness were seen at each schedule point for those children who received a calendar. The average delay in those who received a calendar at their previous visit was 0.6 months (95% CI -0.8 to 2.6) after the due date, compared to 3.3 months (95% CI -0.6 to 7.5) in those who did not. 80% of doses were on time in the group who received a calendar at the preceding immunisation, 66% were on time for those who received a calendar at an earlier point and 57% of doses were on time for those who did not receive a calendar (P<0.0001, Cochran-Armitage trend test). Interview data further supported the value and effectiveness of the calendars as both a prompt to timely immunisations and a community health education project without undue resource implications.
  
  
  CONCLUSIONS
  Personalised calendars can increase the timeliness of immunisations in Aboriginal children. This simple, low cost tool appears practicable and effective in an Aboriginal community setting in improving early childhood vaccination timeliness and has high potential for local adaptation to suit the needs of diverse communities.
authors.affiliation: Aboriginal Medical Service Western Sydney, Sydney, Australia. p.abbott@uws.edu.au
authors.forename: Penelope
authors.initials: P
authors.lastname: Abbott
authors.forename: Robert
authors.initials: R
authors.lastname: Menzies
authors.forename: Joyce
authors.initials: J
authors.lastname: Davison
authors.forename: Louise
authors.initials: L
authors.lastname: Moore
authors.forename: Han
authors.initials: H
authors.lastname: Wang
mesh_terms: D001315:Australia; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D017589:Immunization Programs / Q000458:organization & administration*; D007115:Immunization Schedule; D007223:Infant; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors