{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T17:52:56Z","timestamp":1781632376437,"version":"3.54.5"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100007071","name":"Harran University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100007071","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Health Care Anal"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>This study evaluated the impact of transferring the thirteen\u2011year tetanus-diphtheria booster from schools to Family Health Centers on vaccination coverage after 1 July 2020. In a two\u2011component descriptive cross\u2011sectional design conducted in the central districts of \u015eanl\u0131urfa Province, annual non\u2011vaccination from 2018 to 2022 was tracked using administrative records; in addition, reasons for non\u2011vaccination were classified through face\u2011to\u2011face interviews with family physicians and on\u2011screen verification in nineteen Family Medicine Units selected by two\u2011stage stratified sampling. The primary outcome was non\u2011vaccination for the tetanus-diphtheria dose at age thirteen. In the research group, non\u2011vaccination was 23.5% in 2018, 27.2% in 2019, 22.2% in 2020 (annual total), 13.2% in 2021 and 12.3% in 2022; within 2020, rates were 32.4% before July and 11.9% after July. The absolute pre\u2011 versus post\u2011policy difference was 14.4% points and the relative risk was 0.47; the three districts likewise showed consistent declines in 2021-2022 compared with 2018-2019. Leading reasons for non\u2011vaccination were failure to attend after expressing intent (49.1%), outright refusal (20.9%), migration\u2011related mobility (13.5%), and doses administered elsewhere that were not visible in the records (8.6%). Relocating delivery to Family Health Centers strengthened access and follow\u2011up and was associated with improved coverage; yet intention-behaviour gaps, mobility and data fragmentation still limit attainment of the national threshold. A hybrid model combining school\u2011based visits with targeted completion at Family Health Centers may provide a pragmatic, low\u2011cost route to reach remaining groups.<\/jats:p>","DOI":"10.1007\/s10728-025-00557-8","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T12:01:50Z","timestamp":1769169710000},"page":"149-161","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["From School-Based Immunization to Family Health Centers: the Impact of a 2020 Policy Change on 13-Year-Old Tetanus-Diphtheria Vaccine Coverage in Turkey"],"prefix":"10.1007","volume":"34","author":[{"given":"Ufuk","family":"Acar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burcu","family":"Beyazg\u00fcl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feyyaz","family":"Barlas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harun Mesut","family":"Atmacao\u011flu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0130brahim","family":"Koruk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"issue":"19","key":"557_CR1","doi-asserted-by":"publisher","first-page":"1981","DOI":"10.1056\/NEJMsa0806477","volume":"360","author":"SB Omer","year":"2009","unstructured":"Omer, S. B., Salmon, D. A., Orenstein, W. A., deHart, M. P., & Halsey, N. (2009). Vaccine refusal, mandatory immunization, and the risks of vaccine\u2013preventable diseases. New England Journal of Medicine, 360(19), 1981\u20131988. https:\/\/doi.org\/10.1056\/NEJMsa0806477","journal-title":"New England Journal of Medicine"},{"key":"557_CR2","doi-asserted-by":"publisher","unstructured":"Plotkin, S. A., Orenstein, W. A., Offit, P. A., & Edwards, K. M. (Eds.). (2018). Plotkin\u2019s vaccines (7th ed.). Elsevier. https:\/\/doi.org\/10.1016\/C2013-0-18914-3","DOI":"10.1016\/C2013-0-18914-3"},{"issue":"40","key":"557_CR3","doi-asserted-by":"publisher","first-page":"4293","DOI":"10.1016\/j.vaccine.2013.07.013","volume":"31","author":"A Sadaf","year":"2013","unstructured":"Sadaf, A., Richards, J. L., Glanz, J., Salmon, D. A., Rowhani\u2013Rahbar, A., & Omer, S. B. (2013). A systematic review of interventions for reducing parental vaccine refusal and vaccine hesitancy. 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