tetano
Editor, Senior Moderator
Vaccine
. 2026 Jul 10:88:128910.
doi: 10.1016/j.vaccine.2026.128910. Online ahead of print.
Characteristics of successful and unsuccessful strategies to increase vaccine intention and improve vaccine uptake for U.S. adult populations in the Affordable Care Act era (2010-2025): a systematic review and meta-regression
Amanda A Hensley[SUP] 1 [/SUP], Kristina A Jiles[SUP] 2 [/SUP], Samantha Edwards[SUP] 3 [/SUP], Claudia Clinchard[SUP] 4 [/SUP], Kathy Hosig[SUP] 5 [/SUP]
Affiliations
Background: Vaccine-preventable diseases continue to burden U.S. population health. Despite the Affordable Care Act (ACA) eliminating cost-sharing for recommended vaccines in 2010, adult vaccination rates persistently fall below Healthy People 2030 targets, signaling that access alone is insufficient.
Objectives: To synthesize peer-reviewed literature (2010-2025) on interventions designed to increase vaccine intention or uptake among U.S. adults; characterize strategies, populations, settings, and study quality; and identify predictors of vaccine uptake rate.
Methods: Following PRISMA 2020 guidelines, a multi-database search was conducted across PubMed, Web of Science, Ovid/MEDLINE, and EBSCOhost, with a final updated search in December 2025. Dual independent reviewers screened studies in two stages. Quality was assessed using the EPHPP tool and certainty evaluated using GRADE. Strategies were categorized per the WHO Behavioral and Social Drivers of Vaccination (BeSD) Model. A meta-regression was conducted on 79 studies, with narrative synthesis across all 92 included studies.
Results: Of 11,219 records, 92 studies were included. Study designs were predominantly RCTs; Influenza and COVID-19 vaccines were most commonly studied. In the meta-regression (adjusted R[SUP]2[/SUP] = 0.229), prioritizing a specific population (b=0.121, p=.027), using service quality improvement strategies (b=0.226, p=.040), and recruiting through community-based partner organizations (b=0.585, p=.005) or healthcare organizations (b=0.230, p=.040) were associated with significantly higher vaccine uptake rates. Onsite vaccination was associated with lower uptake rates (b=-0.185, p=.033), an effect confirmed as specific to the COVID-19 pandemic emergency-response context rather than a generalizable effect of the strategy in sensitivity analysis. Narrative synthesis identified message framing and educational campaigns as the most frequently deployed strategies, with multi-component designs and community partnerships showing the most favorable outcomes.
Conclusions: Effective adult vaccination strategies were multifactorial. Service quality improvement, priority population focus, and community-based recruitment were the strongest predictors of higher uptake. Findings support the WHO BeSD model's Practical Issues domain: reducing friction outperformed persuasion alone. GRADE certainty remained LOW to MODERATE, emphasizing the need for higher-quality, equity-focused research.
Registration: This systematic review was registered at Open Science Framework: 10.17605/OSF.IO/SM7YD.
Keywords: Adult immunization; Affordable Care Act; BeSD model; Health equity; Meta-analysis; Systematic review; Vaccine hesitancy; Vaccine intention; Vaccine uptake.
. 2026 Jul 10:88:128910.
doi: 10.1016/j.vaccine.2026.128910. Online ahead of print.
Characteristics of successful and unsuccessful strategies to increase vaccine intention and improve vaccine uptake for U.S. adult populations in the Affordable Care Act era (2010-2025): a systematic review and meta-regression
Amanda A Hensley[SUP] 1 [/SUP], Kristina A Jiles[SUP] 2 [/SUP], Samantha Edwards[SUP] 3 [/SUP], Claudia Clinchard[SUP] 4 [/SUP], Kathy Hosig[SUP] 5 [/SUP]
Affiliations
- PMID: 42430872
- DOI: 10.1016/j.vaccine.2026.128910
Background: Vaccine-preventable diseases continue to burden U.S. population health. Despite the Affordable Care Act (ACA) eliminating cost-sharing for recommended vaccines in 2010, adult vaccination rates persistently fall below Healthy People 2030 targets, signaling that access alone is insufficient.
Objectives: To synthesize peer-reviewed literature (2010-2025) on interventions designed to increase vaccine intention or uptake among U.S. adults; characterize strategies, populations, settings, and study quality; and identify predictors of vaccine uptake rate.
Methods: Following PRISMA 2020 guidelines, a multi-database search was conducted across PubMed, Web of Science, Ovid/MEDLINE, and EBSCOhost, with a final updated search in December 2025. Dual independent reviewers screened studies in two stages. Quality was assessed using the EPHPP tool and certainty evaluated using GRADE. Strategies were categorized per the WHO Behavioral and Social Drivers of Vaccination (BeSD) Model. A meta-regression was conducted on 79 studies, with narrative synthesis across all 92 included studies.
Results: Of 11,219 records, 92 studies were included. Study designs were predominantly RCTs; Influenza and COVID-19 vaccines were most commonly studied. In the meta-regression (adjusted R[SUP]2[/SUP] = 0.229), prioritizing a specific population (b=0.121, p=.027), using service quality improvement strategies (b=0.226, p=.040), and recruiting through community-based partner organizations (b=0.585, p=.005) or healthcare organizations (b=0.230, p=.040) were associated with significantly higher vaccine uptake rates. Onsite vaccination was associated with lower uptake rates (b=-0.185, p=.033), an effect confirmed as specific to the COVID-19 pandemic emergency-response context rather than a generalizable effect of the strategy in sensitivity analysis. Narrative synthesis identified message framing and educational campaigns as the most frequently deployed strategies, with multi-component designs and community partnerships showing the most favorable outcomes.
Conclusions: Effective adult vaccination strategies were multifactorial. Service quality improvement, priority population focus, and community-based recruitment were the strongest predictors of higher uptake. Findings support the WHO BeSD model's Practical Issues domain: reducing friction outperformed persuasion alone. GRADE certainty remained LOW to MODERATE, emphasizing the need for higher-quality, equity-focused research.
Registration: This systematic review was registered at Open Science Framework: 10.17605/OSF.IO/SM7YD.
Keywords: Adult immunization; Affordable Care Act; BeSD model; Health equity; Meta-analysis; Systematic review; Vaccine hesitancy; Vaccine intention; Vaccine uptake.