Effectiveness and acceptability of parental financial incentives and quasi-mandatory schemes for increasing uptake of vaccinations in preschool children: Systematic review, qualitative study and discrete choice experiment

Background: Uptake of preschool vaccinations is less than optimal. Financial incentives and quasi-mandatory policies (restricting access to child care or educational settings to fully vaccinated children) have been used to increase uptake internationally, but not in the UK. Objective: To provide evidence on the effectiveness, acceptability and economic costs and consequences of parental financial incentives and quasi-mandatory schemes for increasing the uptake of preschool vaccinations. Design: Systematic review, qualitative study and discrete choice experiment (DCE) with questionnaire. Setting: Community, health and education settings in England. Participants: Qualitative study – parents and carers of preschool children, health and educational professionals. DCE – parents and carers of preschool children identified as ‘at high risk’ and ‘not at high risk’ of incompletely vaccinating their children. Data sources: Qualitative study – focus groups and individual interviews. DCE – online questionnaire. Review methods: The review included studies exploring the effectiveness, acceptability or economic costs and consequences of interventions that offered contingent rewards or penalties with real material value for preschool vaccinations, or quasi-mandatory schemes that restricted access to ‘universal’ services, compared with usual care or no intervention. Electronic database, reference and citation searches were conducted. Results: Systematic review – there was insufficient evidence to conclude that the interventions considered are effective. There was some evidence that the quasi-mandatory interventions were acceptable. There was insufficient evidence to draw conclusions on economic costs and consequences. Qualitative study – there was little appetite for parental financial incentives. Quasi-mandatory schemes were more acceptable. Optimising current services was consistently preferred to the interventions proposed. DCE and questionnaire – universal parental financial incentives were preferred to quasi-mandatory interventions, which were preferred to targeted incentives. Those reporting that they would need an incentive to vaccinate their children completely required around £110. Those who did not felt that the maximum acceptable incentive was around £70. Limitations: Systematic review – a number of relevant studies were excluded as they did not meet the study design inclusion criteria. Qualitative study – few partially and non-vaccinating parents were recruited. DCE and questionnaire – data were from a convenience sample. Conclusions: There is little current evidence on the effectiveness or economic costs and consequences of parental financial incentives and quasi-mandatory interventions for preschool vaccinations. Universal incentives are likely to be more acceptable than targeted ones. Preferences concerning incentives versus quasi-mandatory interventions may depend on the context in which these are elicited.