Open Access Highly Accessed Research article

Barriers to the use of reminder/recall interventions for immunizations: a systematic review

Jennifer A Pereira1*, Susan Quach1, Christine L Heidebrecht1, Sherman D Quan2, Faron Kolbe3, Michael Finkelstein34, Jeffrey C Kwong456 and the Public Health Agency of Canada/Canadian Institutes of Health Research Influenza Research Network (PCIRN) Vaccine Coverage Theme Group

Author Affiliations

1 Surveillance and Epidemiology, Public Health Ontario, 480 University Ave., Suite 300, Toronto, ON, M5G 1V2, Canada

2 University Health Network, Toronto, Canada

3 Toronto Public Health, Toronto, Canada

4 Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

5 Department of Family and Community Medicine, University of Toronto, Toronto, Canada

6 Institute for Clinical Evaluative Sciences, Toronto, Canada

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BMC Medical Informatics and Decision Making 2012, 12:145  doi:10.1186/1472-6947-12-145

Published: 17 December 2012



Although many studies have demonstrated the benefits of reminder/recall (RR) measures to address patient under-immunization and improve immunization coverage, they are not widely implemented by healthcare providers. We identified providers’ perceived barriers to their use from existing literature.


We conducted a systematic review of relevant articles published in English between January 1990 and July 2011 that examined the perceptions of healthcare providers regarding barriers to tracking patient immunization history and implementing RR interventions. We searched MEDLINE, PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Academic Search Premier, and PsychINFO. Additional strategies included hand-searching the references of pertinent articles and related reviews, and searching keywords in Google Scholar and Google.


Ten articles were included; all described populations in the United States, and examined perceptions of family physicians, pediatricians, and other immunization staff. All articles were of moderate-high methodological quality; the majority (n=7) employed survey methodology. The most frequently described barriers involved the perceived human and financial resources associated with implementing an RR intervention, as well as low confidence in the accuracy of patient immunization records, given the lack of data sharing between multiple immunization providers. Changes to staff workflow, lack of appropriate electronic patient-tracking functionalities, and uncertainty regarding the success of RR interventions were also viewed as barriers to their adoption.


Although transitioning to electronic immunization records and registries should facilitate the implementation of RR interventions, numerous perceived barriers must still be overcome before the full benefits of these methods can be realized.

Reminder; Recall; Immunization; Systematic review; Barriers