Peer-reviewed article
The role of school-based health education in promoting childhood and adolescent vaccination: A systematic review and Meta-analysis.
Annalisa Rosso, Marianna Riccio, Erika Renzi, Federica Patania, Valentina Baccolini et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review examined 38 studies on school-based health education programmes designed to increase childhood and adolescent vaccination rates. Most programmes improved children's knowledge about vaccines, though effects on attitudes and willingness to vaccinate were less consistent. When looking specifically at HPV vaccination uptake in randomised trials, the programmes showed a significant positive effect. The review concludes that school-based education can help increase vaccination, but more high-quality evidence is needed.
Key points
- 38 studies included: 9 RCTs/cluster-RCTs, 14 controlled quasi-experimental studies, and 15 pre-post studies conducted between 1985-2024
- Most interventions significantly improved vaccine knowledge among students aged 6-18 years
- HPV vaccination was the most frequently studied vaccine (26 of 38 studies)
- Meta-analysis of randomised trials showed significant effect on HPV uptake (RR 4.18, 95% CI 1.41-12.37)
- Effects on vaccine attitudes and intention to vaccinate were less consistent across studies
Limitations
The review found high heterogeneity among studies and variable methodological quality, making it difficult to draw firm conclusions. The exclusion of COVID-19 vaccination studies and predominant focus on HPV vaccination limit the generalisability of findings to other vaccine types.
Abstract
BACKGROUND: Childhood and adolescent vaccination is a cornerstone of public health, yet coverage has stagnated or declined in several regions, partly due to vaccine hesitancy. Schools offer a unique setting to promote vaccination by reaching children and adolescents during formative years. This systematic review and meta-analysis aimed to synthesize evidence on the effectiveness of school-based health education interventions in improving vaccine-related knowledge, attitudes, intentions, and uptake. METHODS: Following PRISMA guidelines, we searched six databases up to August 2024 for interventional studies evaluating school-based educational programmes targeting students aged 6-18 years. Randomized controlled trials and quasi-experimental studies assessing outcomes related to vaccine knowledge, attitudes, intention to vaccinate, or uptake were included. Studies focusing on COVID-19 vaccination were excluded. Risk of bias was assessed using validated tools. A random-effects meta-analysis was conducted for HPV vaccination uptake. RESULTS: Thirty-eight studies (1985-2024) were included: 9 RCTs/cluster-RCTs, 14 controlled quasi-experimental studies, and 15 pre-post studies. HPV vaccination was the most frequently studied vaccine (26/38). Most interventions significantly improved vaccine knowledge, while effects on attitudes and intention were less consistent. Eleven studies assessed vaccine uptake, with most reporting post-intervention increases. Meta-analysis of randomized trials showed a significant effect on HPV uptake (RR 4.18, 95% CI 1.41-12.37), although heterogeneity was high and methodological quality varied. CONCLUSIONS: School-based health education appears to improve vaccine knowledge and may contribute to increased uptake, particularly for HPV. However, evidence is limited by heterogeneity and risk of bias. More rigorous, theory-informed, and sustainable whole-school approaches are needed.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- School-based health education programmes targeting vaccine knowledge, attitudes, and uptake
- Population
- Children and adolescents aged 6-18 years in school settings
Key finding
Most interventions significantly improved vaccine knowledge