title: Acceptability of Parental Financial Incentives and Quasi-Mandatory Interventions for Preschool Vaccinations: Triangulation of Findings from Three Linked Studies.
abstract: BACKGROUND
  Childhood vaccinations are a core component of public health programmes globally. Recent measles outbreaks in the UK and USA have prompted debates about new ways to increase uptake of childhood vaccinations. Parental financial incentives and quasi-mandatory interventions (e.g. restricting entry to educational settings to fully vaccinated children) have been successfully used to increase uptake of childhood vaccinations in developing countries, but there is limited evidence of effectiveness in developed countries. Even if confirmed to be effective, widespread implementation of these interventions is dependent on acceptability to parents, professionals and other stakeholders.
  
  
  METHODS
  We conducted a systematic review (n = 11 studies included), a qualitative study with parents (n = 91) and relevant professionals (n = 24), and an on-line survey with embedded discrete choice experiment with parents (n = 521) exploring acceptability of parental financial incentives and quasi-mandatory interventions for preschool vaccinations. Here we use Triangulation Protocol to synthesise findings from the three studies.
  
  
  RESULTS
  There was a consistent recognition that incentives and quasi-mandatory interventions could be effective, particularly in more disadvantaged groups. Universal incentives were consistently preferred to targeted ones, but relative preferences for quasi-mandatory interventions and universal incentives varied between studies. The qualitative work revealed a consistent belief that financial incentives were not considered an appropriate motivation for vaccinating children. The costs of financial incentive interventions appeared particularly salient and there were consistent concerns in the qualitative work that incentives did not represent the best use of resources for promoting preschool vaccinations. Various suggestions for improving delivery of the current UK vaccination programme as an alternative to incentives and quasi-mandates were made.
  
  
  CONCLUSIONS
  Parental financial incentives and quasi-mandatory interventions for increasing uptake of preschool vaccinations do not currently attract widespread enthusiastic support in the UK; but some potential benefits of these approaches are recognised.
authors.affiliation: MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Jean
authors.identifier: http://orcid.org/0000-0002-5733-7830
authors.initials: J
authors.lastname: Adams
authors.affiliation: School of Health & Social Care, Teesside University, Middlesbrough, United Kingdom.
authors.forename: Rebekah J
authors.initials: RJ
authors.lastname: McNaughton
authors.affiliation: Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Wigham
authors.affiliation: Institute of Health & Society, Newcastle University, Newcastle upon Tyne, United Kingdom.
authors.forename: Darren
authors.initials: D
authors.lastname: Flynn
authors.affiliation: Institute of Health & Society, Newcastle University, Newcastle upon Tyne, United Kingdom.
authors.forename: Laura
authors.initials: L
authors.lastname: Ternent
authors.affiliation: School of Health & Social Care, Teesside University, Middlesbrough, United Kingdom.
authors.forename: Janet
authors.initials: J
authors.lastname: Shucksmith
mesh_terms: D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D006801:Humans; D009042:Motivation; D010290:Parents; D012107:Research Design; D018401:Sample Size; D014611:Vaccination / Q000191:economics*