Findley Et Al. (2008) Utilize

¶ … Findley et al. (2008) utilize an analytical observational study design to explore childhood immunization outcomes. Specifically the researchers employed a quasi-experimental, retrospective, matching birth cohort design geared at evaluation of a comprehensive outreach and education program for childhood immunizations in an urban Latino community (Findley et al. 2008). As is the case in analytic observational studies, the researchers measured the impact of outreach, education, and reminders on the immunization of children in the experimental groups.

This study was a cohort study. In the study students were either assigned to a group where they were targeted with these services or they were entered into a control group that was not exposed to these services (Gay, 1999). This model was designed from the National Immunization Survey methodology and the researchers designated four annual cohorts of children from 19 to 35 months of age as of April 1 from the year 2002 to 2005 (Findley et al., 2008). The goal was to determine whether or not exposure to interventions such as outreach, education, and reminders impacted the rate of immunization of the Latino children participating in the study.

What was the rationale for this study?

The rationale for this study included the belief that community driven interventions rather than intervention programs would demonstrate results in the immunization of at-risk children. In particular the interventions of outreach, education, and reminders were believed to achieve marked improvement in the immunization of at-risk children. The researchers studied the impact of a program that encompassed these elements, the Start Right Program. This program was designed through a 23 partner collaboration utilizing national and local material to make up its educational immunization materials. These materials were then utilized in the training or peer health educators who conducted outreach to at-risk families as well as providing ongoing provider support for immunization administration (Findley et al., 2008).

Briefly outline the methodology for this study?

The study consisted of 10857 children who were born at the primary community hospital between April of 1999 and September of 2003 and who resided in the area that the community program was designated to serve (Findley et al., 2008). Four annual birth cohorts of children were identified based on age as of April 1 of each year. The cohorts were further divided into intervention and control groups with the study being conducted in 2006 and 2007. Researchers utilized hospital databases to obtain demographic information as well as the New York Citywide Immunization Registry (CIR) for population-based immunization records (Findley et al., 2008). Outcome measures included whether or not immunizations were up-to-date as well as tracking timeliness of administration by identifying how long these immunizations were overdue. The researchers utilized the c2 test and the unpaired 2-sample Student's t test to measure the significance of timeliness for immunization coverage. Logistic regression was also employed to assess adjusted odd rations for the impact of the intervention of immunization of the children while controlling for both Medicaid enrollment and Latino ethnicity (Findley et al., 2008).

What were the conclusions of the study?

The researchers found that when compared to the control group that the children who received the Start Right services were more likely to be enrolled in Medicaid as well as to be of Latino ethnicity. Further, the children who participated in the Start Right program were found to have a significantly higher rate of immunization that their control counterparts as well as having completed their immunization series sooner than the control group by 11 days (Findley et al., 2008). Despite the increased prevalence of children of Latino ethnicity and who were receiving Medicaid, this factor was not found to be significant to immunization outcomes.

Limitations of this study

A major limitation of this study that was identified by the researchers was the provider's incomplete data reporting to the CIR (Findley et al., 2008). This may have resulted in an overrepresentation of the number of children who lacked proper immunization. When compared to the parent maintained immunization cards, the researchers found that 24% of immunizations were on the cards but not entered into the CIR database. This reliance on the CIR database for records may have skewed the picture of lack of follow through of immunizations to be worse.

The results of this study can be applied to the general population with caution. These designs can lack internal validity due to the inability to ensure that the groups can adequately be compared to one another and that there is not something else, confounding variables, that exists in this group that is causing the results seen (Creswell, 2009). Therefore this lack of randomization makes it difficult to determine causality. However, external validity is stronger as participants can be observed as they would in their natural environments (AllPsych and Heffner Media Group Inc., 2004).

Alternative Research Study Design