Addressing vaccine hesitancy: A systematic review comparing the efficacy of motivational versus educational interventions on vaccination uptake

Traditional approaches to increase vaccination rely upon educating patients about vaccines. However, research shows that "knowing" vaccines are important is often insufficient: patients need to believe that getting vaccinated is important. Evidence-based motivational approaches, such as motivational interviewing/communication (MI/MC), have become increasingly popular for promoting good health behaviors, including vaccination. The objective of this review was to compare the efficacy of educational and MI/MC interventions on vaccination rates relative to each other and to usual/standard care. Pubmed, PsycINFO, and Cochrane trials databases were searched to identify articles that assessed vaccination rates post-patient education or MI/MC vaccine counseling in the context of adult or child vaccination (PROSPERO: CRD42019140255). Following the screening, 118 studies were included (108 educational and 10 MI/MC). The pooled effect sizes for vaccination rates corresponded to 52% for educational interventions (95% CI: 0.48-0.56) and 45% for MI/MC interventions (95% CI: 0.29-0.62) (P = .417). Fifty-nine randomized controlled studies (55 educational and 4 MI/MC) showed that, compared with usual/standard of care, exposure to education and MI/MC was associated with a 10% (RR =1.10; 95% CI =1.03-1.16, P = .002) and 7% (RR =1.07; 95% CI =0.78-1.45, P = .691) increased likelihood of getting vaccinated, respectively. Results suggest comparable efficacy of educational and MI/MC interventions on vaccination uptake and a small superiority of educational interventions compared with usual/standard of care. The overall poor quality of the studies, including lack of fidelity assessments of MI/MC studies, contributes to low confidence in the results and highlights the need for better quality intervention trials examining the efficacy of MI/MC for vaccine uptake.