A qualitative evaluation to explore the suitability, feasibility and acceptability of using a ‘celebration card’ intervention in primary care to improve the uptake of childhood vaccinations

The celebrate and protect programme—a communication intervention

NHS Barking and Dagenham, a Primary Care Trust (PCT),1 in partnership with Sanofi Pasteur MSD (SPMSD), a vaccine manufacturer, developed the Celebrate and Protect programme in 2012. The initiative was part of a wider Olympic and Paralympic Host Borough health legacy programme linked to the London 2012 Olympic Games. The programme aimed to increase uptake of childhood vaccination by supplementing current General Practitioner (GP) practices’ current call/recall activities and through improved engagement between families and GP practices. The intervention consisted of a celebration card and immunisation schedule sent out by the GP practice staff to families of children before their vaccination was scheduled. The celebration card was intended to act as a ‘call to action’ for the parents/carers of children under five to attend an initial 6–8 week check (new-borns) and vaccination appointments (1 year olds and 4 year olds) with their GP practice.

The first wave of the programme was initiated in July 2012 in nine London PCTs: Barking Dagenham, Bexley, Greenwich, Kensington Chelsea, Hammersmith Fulham, Newham, Tower Hamlets, Waltham Forest and Westminster. Part of the scope of the initial wave was to assess the feasibility and acceptability of the programme through engaging with a range of stakeholders and iterative development of the intervention to allow a tailored rollout across additional PCTs in London and possibly further afield. During the first wave, practices across the PCTs were contacted and asked to participate with the aim of engaging 50 % of practices. Across the nine PCTs, 66.3 % (n?=?177) of GP practices were recruited, ranging from 42 to 100 % of practices within the PCTs.

A personalised celebration card and an information leaflet with a vaccination schedule was co-designed with parents/carers. Workshops were held with parents/carers of children to assess the response to the design of the cards, which included a central character and the inclusion of landmarks from east and central London associated with the Olympic and Paralympic games. In addition, the celebration cards included a statement on the back regarding partnership between the NHS and Sanofi Pasteur MSD.

Following training sessions for practice nurses and managers, the celebration cards were delivered to participating practices. The programme management team arranged for an appropriate number of celebration cards and pre-franked (second class postage) envelopes to be dispatched to the individual GP practices according to the number of registered children within each cohort, plus a 5 % uplift. The cards were subsequently sent out by the GP practice to parents/carers registered at the practice following the birth of a child or prior to the first or fourth birthday of a child registered at the practice. The card intended to celebrate the birth of a child or a child’s birthday and act as a ‘call to action’ for the parent/carers to contact the practice and book a health check or vaccination.

The card for new-borns included a message inviting parents/carers to make an appointment with the practice to come and discuss any questions they had about the baby’s health and for the baby to be examined, at which time it is usual for babies to receive their first set of vaccinations. Cards distributed within PCTs that had a universal tuberculosis (TB) vaccination programme (i.e. where the incidence of TB is greater than 40/100,000 population) included an additional message for parents/carers to make an appointment for TB vaccination [16].

Birthday cards for 1 year olds included a message that the child’s vaccinations were due and an invitation to contact the GP practice to make an appointment. Birthday cards sent to the 4 year olds also had a message to contact their GP practice to make an appointment. However, this card was only sent to those children who had not yet received their immunisations, so this card acted as a failsafe. The cards also contained information signposting parents/carers to the ‘Red Book’, the Personal Child Health Record which is a national standard health and development record given to parents/carers at a child’s birth, and www.immunisation.nhs.uk, along with an insert with information about the schedule of vaccination as recommended by the DH.