Positive deviance approaches to improving vaccination coverage rates within healthcare systems: a systematic review

J Comp Eff Res. 2019 Oct;8(13):1055-1065. doi: 10.2217/cer-2019-0056. Epub 2019 Oct 3.


Aim: Our objective was to systematically review the use of the positive deviance approach to identify strategies to improve vaccination coverage rates. Materials & methods: We searched English language articles in Medline, Embase, Cochrane Library, CINAHL and PsycINFO without any date restrictions on 4 October 2017. We compiled a list of all strategies and evaluated the quality of these studies using the QATSDD tool. Results: After a review of 241 citations, we included eight studies. These studies focused on a wide variety of vaccines and settings. Core strategies that support vaccine uptake include the importance of tailoring and targeting in both messaging and delivery of vaccines and tracking delivery of vaccines. Patient and provider education, reminders, feedback loops, community collaborations, immunization registries and use of a medical home were also identified as other strategies. Conclusion: Our findings highlight several useful core strategies, which can be used to promote vaccination coverage. PROSPERO: CRD42017078221.

Keywords: comparative effectiveness research; systematic review; vaccines.

Publication types

  • Systematic Review

MeSH terms

  • Communication
  • Cooperative Behavior
  • Delivery of Health Care / organization & administration*
  • Delivery of Health Care / standards
  • Health Education / organization & administration
  • Humans
  • Patient-Centered Care / organization & administration
  • Registries
  • Reminder Systems
  • Vaccination Coverage / organization & administration*
  • Vaccination Coverage / statistics & numerical data*