***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: We evaluate the results of a field experiment design ed to measure the effect of prompts to form implementation intentions on realized behavioral outcomes . The outcome of interest is influenza vaccination receipt at free on-site clinics offered by a large firm to its employees . All employees eligible for study participation received reminder mailings that listed the times and locations of the relevant vaccination clinics . Mailings to employees r and omly assigned to the treatment conditions additionally included a prompt to write down either ( 1 ) the date the employee planned to be vaccinated or ( 2 ) the date and time the employee planned to be vaccinated .  Vaccination rates increased when these implementation intentions prompts were included in the mailing . The vaccination rate among control condition employees was 33.1 % . Employees who received the prompt to write down just a date had a vaccination rate 1.5 percentage points higher than the control group , a difference that is not statistically significant . Employees who received the more specific prompt to write down both a date and a time had a 4.2 percentage point higher vaccination rate , a difference that is both statistically significant and of meaningful magnitude Nosocomial influenza is a large burden in hospitals . Despite recommendations from the World Health Organization to vaccinate healthcare workers against influenza , vaccine uptake remains low in most European countries . We performed a pragmatic cluster r and omised controlled trial in order to assess the effects of implementing a multi-faceted influenza immunisation programme on vaccine coverage in hospital healthcare workers ( HCWs ) and on  in-patient morbidity . We included hospital HCWs of three intervention and three control University Medical Centers ( UMCs ) , and 3,367 patients . An implementation programme was offered to the intervention UMCs to assess the effects on both vaccine uptake among hospital staff and patient morbidity . In 2009/10 , the coverage of seasonal , the first and second dose of p and emic influenza vaccine  as well as seasonal vaccine in 2010/11 was higher in intervention UMCs than control UMCs ( all p<0.05 ) . At the internal medicine departments of the intervention group with higher vaccine coverage compared to the control group , nosocomial influenza and /or pneumonia was recorded in 3.9 % and 9.7 % of patients of intervention and control UMCs , respectively ( p=0.015 ) . Though potential bias could not be completely ruled out , an increase in vaccine coverage was associated with decreased patient in-hospital morbidity from influenza and /or pneumonia Background In the UK public concern about the safety of the combined measles , mumps and rubella [ MMR ] vaccine continues to impact on MMR coverage . Whilst the sharp decline in uptake has begun to level out , first and second dose uptake rates remain short of that required for population immunity . Furthermore , international research consistently shows that some parents lack confidence in making a decision about MMR vaccination for their children . Together , this work suggests that effective interventions are required to support parents to make informed decisions about MMR.This trial assessed the impact of a parent-centred , multi-component intervention ( balanced information , group discussion , coaching exercise ) on informed parental decision-making for MMR . Methods This was a two arm , cluster r and omised trial . One hundred and forty two UK parents of children eligible for MMR vaccination were recruited from six primary healthcare centres and six childcare organisations . The intervention arm received an MMR information leaflet and participated in the intervention ( parent meeting ) . The control arm received the leaflet only . The primary outcome was decisional conflict . Secondary outcomes were actual and intended MMR choice , knowledge , attitude , concern and necessity beliefs about MMR and anxiety . Results Decisional conflict decreased for both arms to a level where an ' effective ' MMR decision could be made one-week ( effect estimate = -0.54 , p < 0.001 ) and three-months ( effect estimate = -0.60 , p < 0.001 ) post-intervention . There was no significant difference between arms ( effect estimate = 0.07 , p = 0.215 ) . Heightened decisional conflict was evident for parents making the MMR decision for their first child ( effect estimate = -0.25 , p = 0.003 ) , who were concerned ( effect estimate = 0.07 , p < 0.001 ) , had less positive attitudes ( effect estimate = -0.20 , p < 0.001 ) yet stronger intentions ( effect estimate = 0.09 , p = 0.006 ) . Significantly more parents in the intervention arm reported vaccinating their child ( 93 % versus 73 % , p = 0.04 ) . Conclusions Whilst both the leaflet and the parent meeting reduced parents ' decisional conflict , the parent meeting appeared to enable parents to act upon their decision leading to vaccination uptake PURPOSE Although vaccination of health care workers against influenza is widely recommended , vaccination uptake is low . Data on interventions to increase staff immunization in primary care are lacking . We examine the effect of a promotional and educational intervention program , not addressing vaccine availability , to raise the influenza vaccination rate among staff in primary care clinics . METHODS The study included all 344 staff members with direct patient contact ( physicians , nurses , pharmacists , and administrative and ancillary staff ) in 27 primary care community clinics in the Jerusalem area during the 2007–2008 influenza season . Thirteen clinics were r and omly selected for an intervention that consisted of a lecture session given by a family physician , e-mail-distributed literature and reminders , and a key figure from the local staff who personally approached each staff member .  RESULTS Influenza immunization rate was 52.8 % ( 86 of 163 ) in the intervention group compared with 26.5 % ( 48 of 181 ) in the control group ( P<.001 ) . When compared with the rate of immunization for the previous season , the absolute increase in immunization rate was 25.8 % in the intervention clinics and 6.6 % in the control clinics . Multivariate analysis showed a highly significant ( P<.001 ) independent association between intervention and immunization , with an odds ratio of 3.51 ( 95 % confidence interval , 2.03–6.09 ) . CONCLUSION We have developed an effective intervention program to increase previously low vaccination rates among primary health care workers . This simple intervention could be reproduced easily in other clinics and organizations with an expected substantial increase in influenza immunization rates BACKGROUND AND AIMS The multiplicity of vaccine injections during childhood leads to iterative painful and stressful experiences which may lead in turn to anticipated pain and then possibly to a true needle phobia . We aim ed at evaluating a multifactorial strategy of pain management combining pharmacological and non-pharmacological approaches during vaccination , as compared to usual care , in 4- to 12-year-old children . METHODS In all , 239 children were enrolled by 25 family practitioners in an open-label study . After a pseudo-r and omization , usual pain management ( n = 132 ) was compared to a multifactorial strategy ( n = 107 ) associating preliminary application of an anesthesic patch , preferential use of specified vaccines , child education by the parents and the doctor , parental accompaniment and child distraction with soap bubbles during the procedure . The primary outcome ( i.e. child pain ) was assessed with a self-report scale named visual analog scale ( VAS ) of pain . RESULTS A significant decrease in pain was obtained using the multifactorial strategy , as assessed by self-reported VAS ( P < 0.0001 ) . This was confirmed by another self-report scale ( the facial pain scale revised : P = 0.005 ) , as well as with hetero-evaluations by GPs and parents [ Children 's Hospital of Eastern Ontario Pain Scale : P = 0.0007 ; GPs VAS ( P < 0.0001 ) , parents VAS ( P < 0.0001 ) ] , which were secondary outcome criteria . CONCLUSIONS This multifactorial method significantly decreases vaccination pain in 4- to 12-year-old children . This strategy could make vaccines more acceptable to children and may improve child-doctor relationships and contribute to a decrease in child fear about health care Background .We compared vaccine coverage achieved by 2 different delivery strategies for the quadrivalent human papillomavirus ( HPV ) vaccine in Tanzanian schoolgirls . Methods .In a cluster-r and omized trial of HPV vaccination conducted in Tanzania , 134 primary schools were r and omly assigned to  class-based ( girls enrolled in primary school grade [ class ] 6 ) or age-based ( girls born in 1998 ; 67 schools per arm )  vaccine delivery . The primary outcome was coverage by dose . Results .There were 3352 and 2180 eligible girls in schools r and omized to class-based and age-based delivery , respectively .  HPV vaccine coverage was 84.7 % for dose 1 , 81.4 % for dose 2 , and 76.1 % for dose 3 . For each dose , coverage was higher in class-based schools than in age-based schools ( dose 1 : 86.4 % vs 82.0 % [ P = .30 ] ; dose 2 : 83.8 % vs 77.8 % [ P = .05 ] ; and dose 3 : 78.7 % vs 72.1 % [ P = .04 ] ) . Vaccine-related adverse events were rare . Reasons for not vaccinating included absenteeism ( 6.3 % ) and parent refusal ( 6.7 % ) . School absenteeism rates prior to vaccination ranged from 8.1 % to 23.5 % . Conclusions .HPV vaccine can be delivered with high coverage in schools in sub-Saharan Africa . Compared with age-based vaccination , class-based vaccination located more eligible pupils and achieved higher coverage .  HPV vaccination did not increase absenteeism rates in selected schools . Innovative strategies will be needed to reach out-of-school girls . Clinical Trials Registration . NCT01173900 Objective To assess whether a model of care with augmented services within an existing medical home could improve immunization rates for Children with Special Health Care Needs ( CSHCN ) and to evaluate the influence of family and practice characteristics on these children ’s immunization rates . Method Participants were six general pediatric practice s , CSHCN , and their families . Enhancements were added to the medical home for CSHCN , including additional nurse practitioner time . A prospect i ve survey and chart review of volunteer families was made in 1998 repeating the chart review in 2000 . Results The immunization rates of CSHCN in the practice s before the intervention was 83.4 % for DTaP , polio and MMR and 80 % if HIB and HepB were added . The intervention did not improve these already high rates . In regression models , children with late onset disorders were more likely NOT to be up-to- date ( UTD ) by 2 years of age ( OR 3.29 ) . CSHCN cared for by non-birth parents and CSHCN whose family incomes were greater than $ 40,000 per year were also more likely NOT to be UTD ( OR 3.81 , 2.75 respectively ) as were patients of providers not satisfied with any aspect of serving patients ( OR 3.29 ) . Conclusions In these practice s already committed to a medical home model of care for CSHCN , immunization rates were at or above state and national averages before any intervention took place . Some groups of patients among these CSHCN were more likely to be delayed with immunizations , including those with late onset disorders and those with high family incomes OBJECTIVE Hepatitis B virus ( HBV ) infection remains a serious public health problem , due in part to low vaccination rates among high-risk adults , many of whom decline vaccination because of barriers such as perceived inconvenience or discomfort . This study evaluates the efficacy of a self-prediction intervention to increase HBV vaccination rates  among high-risk adults . METHOD R and omized controlled trial of 1,175 adults recruited from three sexually transmitted disease clinics in the United States over 28 months . Participants completed an audio-computer-assisted self-interview , which presented information about HBV infection and vaccination , and measured relevant beliefs , behaviors , and demographics . Half of participants were assigned r and omly to a " self-prediction " intervention , asking them to predict their future acceptance of HBV vaccination . The main outcome measure was subsequent vaccination behavior . Other measures included perceived barriers to HBV vaccination , measured prior to the intervention . RESULTS There was a significant interaction between the intervention and vaccination barriers , indicating the effect of the intervention differed depending on perceived vaccination barriers . Among high-barriers patients , the intervention significantly increased vaccination acceptance . Among low-barriers patients , the intervention did not influence vaccination acceptance . CONCLUSIONS The self-prediction intervention significantly increased vaccination acceptance among " high-barriers " patients , who typically have very low vaccination rates . This brief intervention could be a useful tool in increasing vaccine uptake among high-barriers patients Despite significant global efforts to improve vaccination coverage against major childhood diseases , vaccination rates are below 90 % . To eradicate diseases such as measles , however , vaccination rates close to 95 % are needed . We use a r and omized experiment to investigate the effect of a dem and incentive , a conditional cash transfer program , in improving  vaccination coverage in rural Nicaragua . Double-difference estimates show the program led to large increases in vaccination coverage , and these result ed in vaccination levels greater than 95 % for some vaccines . Effects were especially large for children who are typically harder to 
    Output:
    
Across all regions , most interventions were multi-component and the majority of strategies focused on raising knowledge and awareness .
Thirteen relevant studies were used for the GRADE assessment that indicated evidence of moderate quality for the use of social mobilization , mass media , communication tool-based training for health-care workers , non-financial incentives and reminder/recall-based interventions .
Overall , our results showed that multicomponent and dialogue-based interventions were most effective .