title: 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.
abstract: BACKGROUND
  Uptake of preschool vaccinations is less than optimal. Financial incentives and quasi-mandatory policies (restricting access to child care or educational settings to fully vaccinated children) have been used to increase uptake internationally, but not in the UK.
  
  
  OBJECTIVE
  To provide evidence on the effectiveness, acceptability and economic costs and consequences of parental financial incentives and quasi-mandatory schemes for increasing the uptake of preschool vaccinations.
  
  
  METHODS
  Systematic review, qualitative study and discrete choice experiment (DCE) with questionnaire.
  
  
  METHODS
  Community, health and education settings in England.
  
  
  METHODS
  Qualitative study - parents and carers of preschool children, health and educational professionals. DCE - parents and carers of preschool children identified as 'at high risk' and 'not at high risk' of incompletely vaccinating their children.
  
  
  METHODS
  Qualitative study - focus groups and individual interviews. DCE - online questionnaire.
  
  
  METHODS
  The review included studies exploring the effectiveness, acceptability or economic costs and consequences of interventions that offered contingent rewards or penalties with real material value for preschool vaccinations, or quasi-mandatory schemes that restricted access to 'universal' services, compared with usual care or no intervention. Electronic database, reference and citation searches were conducted.
  
  
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  This study is registered as PROSPERO CRD42012003192.
  
  
  BACKGROUND
  The National Institute for Health Research Health Technology Assessment programme.
authors.affiliation: Centre for Diet and Activity Research, Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK.
authors.forename: Jean
authors.initials: J
authors.lastname: Adams
authors.affiliation: Department of Child Health, Northumbria Healthcare NHS Foundation Trust, North Shields, UK.
authors.forename: Belinda
authors.initials: B
authors.lastname: Bateman
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Frauke
authors.initials: F
authors.lastname: Becker
authors.affiliation: Health Protection, North East Public Health England Centre, Newcastle upon Tyne, UK.
authors.forename: Tricia
authors.initials: T
authors.lastname: Cresswell
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Darren
authors.initials: D
authors.lastname: Flynn
authors.affiliation: School of Health and Social Care, Teesside University, Middlesbrough, UK.|Fuse (The Centre for Translational Research in Public Health), Newcastle upon Tyne, UK.
authors.forename: Rebekah
authors.initials: R
authors.lastname: McNaughton
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Yemi
authors.initials: Y
authors.lastname: Oluboyede
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Shannon
authors.initials: S
authors.lastname: Robalino
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Ternent
authors.affiliation: Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: Benjamin Gardner
authors.initials: BG
authors.lastname: Sood
authors.affiliation: Centre for Behaviour Change, University College London, London, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Michie
authors.affiliation: School of Health and Social Care, Teesside University, Middlesbrough, UK.|Fuse (The Centre for Translational Research in Public Health), Newcastle upon Tyne, UK.
authors.forename: Janet
authors.initials: J
authors.lastname: Shucksmith
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.|Fuse (The Centre for Translational Research in Public Health), Newcastle upon Tyne, UK.
authors.forename: Falko F
authors.initials: FF
authors.lastname: Sniehotta
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Wigham
mesh_terms: D000328:Adult; D002675:Child, Preschool; D006801:Humans; D009042:Motivation; D010290:Parents; D010342:Patient Acceptance of Health Care; D036301:Qualitative Research; D012201:Reward; D011795:Surveys and Questionnaires; D006113:United Kingdom; D014611:Vaccination / Q000191:economics* / Q000706:statistics & numerical data