TY - JOUR
T1 - Community health worker intervention improves early childhood vaccination rates
T2 - results from a propensity-score matching evaluation
AU - Wightman, Patrick
AU - McCue, Kelly
AU - Sabo, Samantha
AU - Annorbah, Rebecca
AU - Jiménez, Dulce
AU - Pilling, Vern
AU - Butler, Matthew
AU - Celaya, Martín F.
AU - Rumann, Sara
N1 - Funding Information:
Initially created in 1984, the HSP has been overseen by the Arizona Department of Health Services’ Bureau of Women’s and Children’s Health since 1992. The program was formalized through state statute in 1994 and has been funded by the Healthy Arizona Initiative lottery funds since 2004. HSP serves 14 communities across the state, “to educate, support and advocate for families at risk by promoting optimal use of community-based family health care services and education services through the use of CHWs who live in and reflect the ethnic, cultural and socioeconomic characteristics of the community they serve.” [].
Funding Information:
We would like to acknowledge Arizona Department of Health Services and the numerous departments and staff who supported this partnership, including the Bureau of Women’s and Children’s Health, the Health Start Program, Vital Statistics, and ASIIS. Special thanks to Valentin Šoštarić, ASIIS Program Manager; Dr. Kimberly McCombs-Thornton, Senior Research Associate at James Bell Associates; and Dr. Lorraine McKelvey, Associate Professor at the Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences. And to the hundreds of Health Start Program CHWs who work tirelessly to improve maternal and child health equity among thousands of families in Arizona, thank you.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - Background: Arizona’s Health Start Program is a statewide community health worker (CHW) maternal and child health home visiting intervention. The objective of this study was to test if participation in Health Start during 2006–2016 improved early childhood vaccination completion rates. Methods: This retrospective study used 11 years of administrative, birth certificate, and immunization records. Propensity score matching was used to identify control groups, based on demographic, socioeconomic, and geographic characteristics. Results are reported by historically disadvantaged subgroups and/or with a history of low vaccine uptake, including Hispanic/Latinx and American Indian children, and children of low socioeconomic status and from rural areas, children with teen mothers and first-born children. The average treatment-on-the-treated (ATT) effect estimated the impact of Health Start on timely completion of seven early childhood vaccine series: diphtheria/tetanus toxoids and acellular/whole-cell pertussis (DTaP/DTP), Haemophilus influenzae type b (Hib), hepatitis B (Hep. B), measles-mumps-rubella (MMR), pneumococcal conjugate vaccine (PCV13), poliovirus, and varicella. Results: Vaccination completion rates (by age five) were 5.0% points higher for Health Start children as a group, and on average 5.0% points higher for several subgroups of mothers: women from rural border counties (ATT 5.8), Hispanic/Latinx women (ATT 4.8), American Indian women (ATT 4.8), women with less than high school education (ATT 5.0), teen mothers (ATT 6.1), and primipara women (ATT 4.5), compared to matched control groups (p-value ≤ 0.05). Time-to-event analyses show Health Start children complete vaccination sooner, with a hazard rate for full vaccination 13% higher than their matches. Conclusion: A state-operated home visiting intervention with CHWs as the primary interventionist can effectively promote early childhood vaccine completion, which may reduce the incidence of preventable diseases and subsequently improve children’s health. Effects of CHW interventions on vaccination uptake is particularly relevant given the rise in vaccine-preventable diseases in the US and globally. Trial registration: Approved by the University of Arizona Research Institutional Review Board (Protocol 1701128802), 25 January 2017.
AB - Background: Arizona’s Health Start Program is a statewide community health worker (CHW) maternal and child health home visiting intervention. The objective of this study was to test if participation in Health Start during 2006–2016 improved early childhood vaccination completion rates. Methods: This retrospective study used 11 years of administrative, birth certificate, and immunization records. Propensity score matching was used to identify control groups, based on demographic, socioeconomic, and geographic characteristics. Results are reported by historically disadvantaged subgroups and/or with a history of low vaccine uptake, including Hispanic/Latinx and American Indian children, and children of low socioeconomic status and from rural areas, children with teen mothers and first-born children. The average treatment-on-the-treated (ATT) effect estimated the impact of Health Start on timely completion of seven early childhood vaccine series: diphtheria/tetanus toxoids and acellular/whole-cell pertussis (DTaP/DTP), Haemophilus influenzae type b (Hib), hepatitis B (Hep. B), measles-mumps-rubella (MMR), pneumococcal conjugate vaccine (PCV13), poliovirus, and varicella. Results: Vaccination completion rates (by age five) were 5.0% points higher for Health Start children as a group, and on average 5.0% points higher for several subgroups of mothers: women from rural border counties (ATT 5.8), Hispanic/Latinx women (ATT 4.8), American Indian women (ATT 4.8), women with less than high school education (ATT 5.0), teen mothers (ATT 6.1), and primipara women (ATT 4.5), compared to matched control groups (p-value ≤ 0.05). Time-to-event analyses show Health Start children complete vaccination sooner, with a hazard rate for full vaccination 13% higher than their matches. Conclusion: A state-operated home visiting intervention with CHWs as the primary interventionist can effectively promote early childhood vaccine completion, which may reduce the incidence of preventable diseases and subsequently improve children’s health. Effects of CHW interventions on vaccination uptake is particularly relevant given the rise in vaccine-preventable diseases in the US and globally. Trial registration: Approved by the University of Arizona Research Institutional Review Board (Protocol 1701128802), 25 January 2017.
KW - Community health worker
KW - Early childhood
KW - Propensity score matching
KW - Vaccines
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U2 - 10.1186/s12889-022-14239-w
DO - 10.1186/s12889-022-14239-w
M3 - Article
C2 - 36195944
AN - SCOPUS:85139497118
SN - 1471-2458
VL - 22
JO - BMC public health
JF - BMC public health
IS - 1
M1 - 1854
ER -