Health education as a strategy for encouraging children's vaccination: rapid review

Introduction : Although vaccines have significantly improved the lives of the world's population since their implementation, there has been recent stagnation and, in some cases, even a reversal of previously achieved gains. Aim : To summarize the evidence on how to use health education to encourage the vaccination of children. Outlining : Rapid review, guided by the question "How to use health education to encourage the vaccination of children?" carried out in 2023, using two databases and an electronic library. The searches yielded 2,666 documents, of which 12 articles were selected for data extraction, summarization, and discussion. Results : The community and the home were the main places described for interventions. Fathers, mothers, and guardians/caregivers of children were the audience most mentioned for interventions. Educational instruments, such as booklets, leaflets


INTRODUCTION
In this context, it is noteworthy that efforts to distribute vaccines have been ongoing since the eradication of smallpox, with the launch of the Expanded Immunization Program (PAI) in 1974 by the World Health Organization (WHO) to ensure that all children, in all countries, have access to vaccines. 3veral countries worldwide have national immunization programs, such as Brazil, which has had the National Immunization Program (PNI) since 1973.This program is an efficient public policy that positively impacts the Brazilian population, reducing morbidity and mortality and adapting to changes in the political, epidemiological, and social fields, being guided by the doctrinal principles of the Unified Health System (SUS in Portuguese): universality, comprehensiveness, and equity in health care. 4wever, despite improving the lives of the world's population, vaccines have recently faced stagnation and, in some cases, a reversal of previous gains, serving as a warning sign for programs that aim to provide universal access to immunization now and in the future. Notably, there was a significant reduction in vaccination coverage of vaccine-preventable diseases before and during the COVID-19 pandemic. 8he literature attributes the return of already eradicated diseases and the difficulty in preventing new diseases, such as COVID-19, to several factors. 9ong these factors are the collapse of national immunization programs due to conflicts, wars, and social tensions; the migration of unvaccinated people; inadequate vaccinations in hard-to-reach groups and minority populations; as well as the anti-vaccination debate, often influenced by fake news shared through social networks. 10 is noteworthy that the emergence of the anti-vaccination movement, triggered by Andrew Wakefield around 1998 after the publication of an article that alleged an association between autism and vaccines, is of extreme global relevance.] Vaccine hesitancy is the delay in accepting or refusing vaccination despite the availability of vaccination services. 13 this context, health education emerges as a strategy, defined by the WHO as any combination of learning experiences designed to help individuals and communities improve their health with increased knowledge, influence on motivation, and improved health literacy, promoting the development of knowledge and skills that enable action to address the determinants of health. 14erefore, this rapid review is justified by the increasing difficulty of vaccination, which makes health education a feasible and cheap strategy to combat vaccine hesitancy and, consequently, to encourage vaccination in children.Knowing that governments and public health authorities must be proactive to mitigate potential losses in vaccine acceptance, the objective was to summarize the evidence on how to use health education to encourage the vaccination of children.

Study Design
This rapid review is a highly efficient method primarily used for developing public policies.Despite its speed, it maintains a high level of methodological rigor, ensuring quick and effective evidence synthesis. 15rom August to September 2023, we conducted the bibliographic survey, data collection, and analysis with precision and thoroughness.

Research Question
The acronym Population, Concept, and Context (PCC) was used to formulate the guiding question. 16he following were adopted: P: Children, C: Health education, C: Incentive to vaccination, generating the question: "How to use health education to encourage vaccination of children?" After creating the question, we evaluated it using the acronym FINER (Feasible, Interesting, New, Ethical, and Relevant). 17he question appeared feasible as a rapid review is a low-cost alternative that did not require financing; interesting, motivating the team to seek answers and inspiring managers and policymakers to act on those answers; new, gaining prominence in recent years and capable of expanding current findings; ethical, meeting current ethical principles and requiring the team to reference the articles correctly; and relevant, as the results could summarize evidence to improve vaccination levels in children and support public policies.

Eligibility Criteria
We adopted the following inclusion criteria: original (primary) articles, without language or geographic restrictions, within the review's scope, and answering the research question, using the last five years (2018-2023) as a timeframe.We excluded articles without intervention, review articles, letters to the editor, book chapters, duplicate articles, theses, dissertations, and those that did not answer the guiding question.

Data Collection
For the bibliographic survey, we consulted two databases and an electronic library: the Medical We exported all identified studies to EndNote® Web software to identify and remove duplicates, then transferred them to the Rayyan web application. 18wo reviewers evaluated the studies' eligibility, with a third reviewer intervening in cases of disagreement.The studies were selected independently and masked by three reviewers, following the PRISMA 2020 statement steps. 19e first searched the databases, applied filters according to the inclusion criteria, and removed duplicate records.
In the screening stage, we selected records for reading titles and abstracts, as well as the complete text.Therefore, the full text of the selected articles was read, which led to the selection of studies to be included.

RESULTS
Initially, the researchers identified 2,666 documents, which were reduced to 526 articles using automation tools and the removal of duplicates.
During the screening process, they read the titles and abstracts of the remaining articles, selecting 32 for full reading.Ultimately, 12 articles met the inclusion criteria and were included in this rapid review.Figure 1 shows the flowchart of this process.

DISCUSSION
The present study focuses on vaccine education, a subset of health education aimed at neutralizing the growing global hesitancy towards vaccines and encouraging the development of systems that increase public engagement with vaccination.
Given the prevalence of diseases, epidemics, and pandemics, studies in this field are essential for enabling professionals to quickly advance in their practical roles through vaccination education, developing vaccine policies, and promoting patient immunization. 33e findings underscore the importance of promoting health education.Digital media has provided the public with unrestricted access to health information, presenting challenges for professionals, governments, and health organizations to manage this vast information and ensure its quality and reliability to prevent harm.In this dynamic landscape, health education remains a cornerstone of public health, continually evolving with new concepts and strategies.Its content, methods, and communication channels are designed to inspire behavior modification and develop enduring, transferable skills. 34 is crucial to identify the intervention sites for health education strategies to be effective.The studies described the following locations for health education: primary health care, 24,27 community/home, 21,24,28 schools, 22,29 general hospitals, 26,30 obstetric hospitals, 32 pediatric hospitals, 31 vaccination posts, 23 and neonatal intensive care units. 25e between Basic Health Units and public schools. 35us, it is clear that strengthening this program as a public policy is necessary.In addition to covering most identified intervention locations, it includes the target populations, as described below. 36e intervention's target populations, a key focus of this research, are notably diverse.They include children, 22 health staff, 24 pregnant women, 30,32 community leaders, 28 and parents/guardians/caregivers of children, 21,[23][24][25][26][27]29,31 all of whom are crucial in the context of improving vaccination rates.
The results of addressing different audiences during interventions align with the literature, which suggests that high and equitable vaccine adherence can only be achieved through research and engagement with target groups.Therefore, before interventions, it is essential to consider social and cultural support, norms, and identity, including various religious, educational, or philosophical views that may influence attitudes towards vaccination and social determinants such as socioeconomic status, years of schooling, and ethnicity. 37e instruments used in these interventions varied and included educational applications,23 vaccination calendars, 30 posters, 23 educational booklets, leaflets, health manuals, 23,26,[30][31][32] games, 22 social networks, 25 slides, 26,29 photos, 26 and videos. 21,22,26,32alth professionals, as the primary advocates for vaccination, play a pivotal role in promoting trust, validating parents' concerns for their children's well-being, avoiding coercive language, and valuing clear and positive communication.Negative or strained communication between providers and patients can reduce patient confidence and negatively impact health outcomes over time.

Limitations
The main limitation of this study lies in the lack of details in some studies regarding the method of conducting the intervention, which makes replication difficult and demonstrates the need for further research on the topic.These new studies should be conducted with high methodological rigor, enabling their execution in different contexts and contributing to the scientific literature and the creation of effective strategies for the use of health education.

Contributions to Clinical Practice
The

Chart 1 .
following variables: authorship, year of publication, country of study, study title, type of study, place of study, participants, and main results.Both reviewers performed data extraction, compared the information collected, and synthesized it for inclusion in the review.After extraction, we organized the data into tables.To summarize the findings, we used the data reduction method, critical reading, and classification of results into conceptual categories for discussion. 20periodicos.ufpi.brRev Pre Infec e Saúde.2024;10:5301 Strategies used to search for articles in the databases.MeSH Terms] OR Children[All Fields]) AND ("Health Education"[MeSH Terms] OR "Education, Health"[All Fields] OR "Community Health Education"[All Fields] OR "Education, Community Health"[All Fields] OR "Health Education, Community"[All Fields]) AND (Vaccination[MeSH Terms] OR Vaccinations[All Fields] OR "Immunization, Active"[All Fields] OR "Active Immunization"[All Fields] OR "Active Immunizations"[All Fields] OR "Immunizations, Active"[All Fields]) WoS TM (ALL=(Child*)) AND (ALL=("Health Education") OR ALL=("Education, Health") OR ALL=("Community Health Education") OR ALL=("Education, Community Health") OR ALL=("Health Education, Community")) AND (ALL=(Vaccination*) OR ALL=("Immunization,

Figure 1 .
Figure 1.Flowchart of the process of identifying, screening, and including articles.