{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T19:28:45Z","timestamp":1777577325920,"version":"3.51.4"},"reference-count":49,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2023,1,20]],"date-time":"2023-01-20T00:00:00Z","timestamp":1674172800000},"content-version":"unspecified","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100023699","name":"Health Data Research UK","doi-asserted-by":"crossref","award":["LOND1"],"award-info":[{"award-number":["LOND1"]}],"id":[{"id":"10.13039\/501100023699","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100015652","name":"Barts Charity","doi-asserted-by":"publisher","award":["MGU0419"],"award-info":[{"award-number":["MGU0419"]}],"id":[{"id":"10.13039\/100015652","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,1,11]]},"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Call and recall systems provide actionable intelligence to improve equity and timeliness of childhood vaccinations, which have been disrupted during the COVID-19 pandemic. We will evaluate the effectiveness, fidelity and sustainability of a data-enabled quality improvement programme delivered in primary care using an Active Patient Link Immunisation (APL-Imms) call and recall system to improve timeliness and equity of uptake in a multiethnic disadvantaged urban population. We will use qualitative methods to evaluate programme delivery, focusing on uptake and use, implementation barriers and service improvements for clinical and non-clinical primary care staff, its fidelity and sustainability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This is a mixed-methods observational study in 284 general practices in north east London (NEL). The target population will be preschool-aged children eligible to receive diphtheria, tetanus and pertussis (DTaP) or measles, mumps and rubella (MMR) vaccinations and registered with an NEL general practice. The intervention comprises an in-practice call and recall tool, facilitation and training, and financial incentives. The quantitative evaluation will include interrupted time Series analyses and Slope Index of Inequality. The primary outcomes will be the proportion of children receiving at least one dose of a DTaP-containing or MMR vaccination defined, respectively, as administered between age 6 weeks and 6 months or between 12 and 18 months of age. The qualitative evaluation will involve a \u2018Think Aloud\u2019 method and semistructured interviews of stakeholders to assess impact, fidelity and sustainability of the APL-Imms tool, and fidelity of the implementation by facilitators.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The research team has been granted permission from data controllers in participating practices to use deidentified data for audit purposes. As findings will be specific to the local context, research ethics approval is not required. Results will be disseminated in a peer-reviewed journal and to stakeholders, including parents, health providers and commissioners.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-064364","type":"journal-article","created":{"date-parts":[[2023,1,20]],"date-time":"2023-01-20T11:37:19Z","timestamp":1674214639000},"page":"e064364","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Implementation of a quality improvement programme using the Active Patient Link call and recall system to improve timeliness and equity of childhood vaccinations: protocol for a mixed-methods evaluation"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5825-0609","authenticated-orcid":false,"given":"Milena","family":"Marszalek","sequence":"first","affiliation":[{"name":"Wolfson Institute of Population Health, Yvonne Carter Building, Queen Mary University, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1519-2458","authenticated-orcid":false,"given":"Meredith K D","family":"Hawking","sequence":"additional","affiliation":[{"name":"Wolfson Institute of Population Health, Yvonne Carter Building, Queen Mary University, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana","family":"Gutierrez","sequence":"additional","affiliation":[{"name":"Wolfson Institute of Population Health, Yvonne Carter Building, Queen Mary University, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabel","family":"Dostal","sequence":"additional","affiliation":[{"name":"Wolfson Institute of Population Health, Yvonne Carter Building, Queen Mary University, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zaheer","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Wolfson Institute of Population Health, Yvonne Carter Building, Queen Mary University, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5213-5044","authenticated-orcid":false,"given":"Nicola","family":"Firman","sequence":"additional","affiliation":[{"name":"Wolfson Institute of Population Health, Yvonne Carter Building, Queen Mary University, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Robson","sequence":"additional","affiliation":[{"name":"Wolfson Institute of Population Health, Yvonne Carter Building, Queen Mary University, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helen","family":"Bedford","sequence":"additional","affiliation":[{"name":"Great Ormond Street Institute of Child Health, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Billington","sequence":"additional","affiliation":[{"name":"Wolfson Institute of Population Health, Yvonne Carter Building, Queen Mary University, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ngawai","family":"Moss","sequence":"additional","affiliation":[{"name":"Wolfson Institute of Population Health, Yvonne Carter Building, Queen Mary University, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carol","family":"Dezateux","sequence":"additional","affiliation":[{"name":"Wolfson Institute of Population Health, Yvonne Carter Building, Queen Mary University, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,1,20]]},"reference":[{"key":"2025121408295790000_13.1.e064364.1","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1016\/S1473-3099(17)30590-X","article-title":"The imperative of vaccination","volume":"17","year":"2017","journal-title":"Lancet Infect Dis"},{"key":"2025121408295790000_13.1.e064364.2","unstructured":"World Health Organization . Seventh meeting of the european regional verification commission for measles and rubella elimination (RVC); 2018."},{"key":"2025121408295790000_13.1.e064364.3","unstructured":"Public Health England . Quarterly vaccination coverage statistics for children aged up to 5 years in the UK (COVER programme): April to June 2021. Contract no: 16; 2021."},{"key":"2025121408295790000_13.1.e064364.4","unstructured":"Public Health England . National immunisation programme: health equity audit. London,"},{"key":"2025121408295790000_13.1.e064364.5","unstructured":"Public Health England . Measles cases in england: January to December 2018. 2019. Available: https:\/\/www.gov.uk\/government\/publications\/measles-mumps-and-rubella-laboratory-confirmed-cases-in-england-2018\/measles-cases-in-england-january-to-december-2018"},{"key":"2025121408295790000_13.1.e064364.6","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.m2392","article-title":"Routine vaccination during covid-19 pandemic response","volume":"369","author":"Saxena","year":"2020","journal-title":"BMJ"},{"key":"2025121408295790000_13.1.e064364.7","unstructured":"NHS Digital . Childhood vaccination coverage statistics. 2021. Available: https:\/\/digital.nhs.uk\/data-and-information\/publications\/statistical\/nhs-immunisation-statistics"},{"key":"2025121408295790000_13.1.e064364.8","unstructured":"Public Health England . Impact of COVID-19 on childhood vaccination counts to week 4 in 2021, and vaccine coverage to decemeber 2020 in england: interim analyses. Contract no: 3; 2021."},{"key":"2025121408295790000_13.1.e064364.9","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2022-066288","article-title":"Impact of the COVID-19 pandemic on timeliness and equity of measles, mumps and rubella vaccinations in north east london: a longitudinal study using electronic health records","volume":"12","author":"Firman","year":"2022","journal-title":"BMJ Open"},{"key":"2025121408295790000_13.1.e064364.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2017.10.085"},{"key":"2025121408295790000_13.1.e064364.11","doi-asserted-by":"crossref","first-page":"6726","DOI":"10.1016\/j.vaccine.2018.09.032","article-title":"Inequalities in childhood vaccination timing and completion in london","volume":"36","author":"Tiley","year":"2018","journal-title":"Vaccine"},{"key":"2025121408295790000_13.1.e064364.12","unstructured":"British Medical Association, National Health Service . Quality and outcomes framework guidance for 2021\/22. 2021. Available: https:\/\/www.england.nhs.uk\/wp-content\/uploads\/2021\/03\/B0456-update-on-quality-outcomes-framework-changes-for-21-22-.pdf"},{"key":"2025121408295790000_13.1.e064364.13","unstructured":"NHS Digital . Update on vaccination and immunisation changes for 2021\/22. London, Available: https:\/\/www.england.nhs.uk\/wp-content\/uploads\/2021\/03\/B0434_Update-on-vaccination-and-immunisation-changes-for-202122-v4.pdf"},{"key":"2025121408295790000_13.1.e064364.14","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1186\/s12913-016-1711-0","article-title":"\u201c I\u2019\u2019s a complex mesh\u201d-how large-scale health system reorganisation affected the delivery of the immunisation programme in england: a qualitative study","volume":"16","author":"Chantler","year":"2016","journal-title":"BMC Health Serv Res"},{"key":"2025121408295790000_13.1.e064364.15","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2016-207572"},{"key":"2025121408295790000_13.1.e064364.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2017.08.015"},{"key":"2025121408295790000_13.1.e064364.17","unstructured":"Queen Mary University of London Clinical Effectiveness Group . Software tools to improve clinical management and recording. 2022. Available: https:\/\/www.qmul.ac.uk\/blizard\/ceg\/resources\/"},{"key":"2025121408295790000_13.1.e064364.18","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp14X679697"},{"key":"2025121408295790000_13.1.e064364.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2018.06.028"},{"key":"2025121408295790000_13.1.e064364.20","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.d5703","article-title":"Improving MMR vaccination rates: herd immunity is a realistic goal","volume":"343","author":"Cockman","year":"2011","journal-title":"BMJ"},{"key":"2025121408295790000_13.1.e064364.21","first-page":"712","article-title":"Boosting uptake of influenza immunisation: a randomised controlled trial of telephone appointing in general practice","volume":"52","author":"Hull","year":"2002","journal-title":"Br J Gen Pract"},{"key":"2025121408295790000_13.1.e064364.22","doi-asserted-by":"crossref","DOI":"10.1136\/bmjoq-2019-000783","article-title":"Preventing strokes in people with atrial fibrillation by improving ABC","volume":"8","author":"Chahal","year":"2019","journal-title":"BMJ Open Qual"},{"key":"2025121408295790000_13.1.e064364.23","unstructured":"One London . Pathfinder projects to tackle london\u2019s health challenges using the power of data at scale. 2022. Available: https:\/\/www.onelondon.online\/pathfinder-projects-to-tackle-londons-health-challenges-using-the-power-of-data-at-scale\/"},{"key":"2025121408295790000_13.1.e064364.24","unstructured":"Office for National Statistics . Estimates of the population for the UK, england, wales, scotland and northern ireland - office for national statistics (ons.gov.UK); 2020."},{"key":"2025121408295790000_13.1.e064364.25","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1186\/s13012-018-0824-8","article-title":"A process evaluation of how the routine vaccination programme is implemented at GP practices in england","volume":"13","author":"Crocker-Buque","year":"2018","journal-title":"Implement Sci"},{"key":"2025121408295790000_13.1.e064364.26","unstructured":"NHS England . General medical services statement of financial entitlements directions. 2021. Available: https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/975395\/GMS_SFE_2021.pdf"},{"key":"2025121408295790000_13.1.e064364.27","unstructured":"Ministry of Housing Communities & Local Government . The english indices of deprivation 2019 - frequently asked questions (FAQs). 2016. Available: https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/853811\/IoD2019_FAQ_v4.pdf"},{"key":"2025121408295790000_13.1.e064364.28","unstructured":"Office for National Statistics . Research report on population estimates by characteristics; 2020."},{"key":"2025121408295790000_13.1.e064364.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2018.05.026"},{"key":"2025121408295790000_13.1.e064364.30","unstructured":"Statistical Methodology and Applications Branch . Joinpoint regression program. In: Surveillance Research Program. National Cancer Institute, 2020."},{"key":"2025121408295790000_13.1.e064364.31","unstructured":"Public Health England . PHEIndicatorMethods; 2021."},{"key":"2025121408295790000_13.1.e064364.32","doi-asserted-by":"crossref","first-page":"1440783","DOI":"10.1080\/16549716.2018.1440783","article-title":"Health equity assessment toolkit plus (heat plus): software for exploring and comparing health inequalities using uploaded datasets","volume":"11","author":"Hosseinpoor","year":"2018","journal-title":"Glob Health Action"},{"key":"2025121408295790000_13.1.e064364.33","unstructured":"Public Health Wales . Measuring inequalities - trends in mortality and life expectancy in wales. 2011. Available: https:\/\/phw.nhs.wales\/services-and-teams\/observatory\/data-and-analysis\/measuring-inequalities-2011\/"},{"key":"2025121408295790000_13.1.e064364.34","unstructured":"RStudio Team . RStudio: integrated development for R. Boston, MA: PBC, 2020."},{"key":"2025121408295790000_13.1.e064364.35","doi-asserted-by":"crossref","first-page":"100474","DOI":"10.1016\/j.conctc.2019.100474","article-title":"Simulation-based power and sample size calculation for designing interrupted time series analyses of count outcomes in evaluation of health policy interventions","volume":"17","author":"Liu","year":"2020","journal-title":"Contemp Clin Trials Commun"},{"key":"2025121408295790000_13.1.e064364.36","doi-asserted-by":"crossref","first-page":"197","DOI":"10.2147\/CLEP.S176723","article-title":"Sample size and power considerations for ordinary least squares interrupted time series analysis: a simulation study","volume":"11","author":"Hawley","year":"2019","journal-title":"Clin Epidemiol"},{"key":"2025121408295790000_13.1.e064364.37","doi-asserted-by":"publisher","DOI":"10.1186\/1741-7015-8-63"},{"key":"2025121408295790000_13.1.e064364.38","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2014-003627"},{"key":"2025121408295790000_13.1.e064364.39","doi-asserted-by":"publisher","DOI":"10.1177\/1049732315617444"},{"key":"2025121408295790000_13.1.e064364.40","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1080\/2159676X.2017.1331501","article-title":"The think aloud method: what is it and how do I use it?","volume":"9","author":"Eccles","year":"2017","journal-title":"Qual Res Sport Exerc Health"},{"key":"2025121408295790000_13.1.e064364.41","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"2025121408295790000_13.1.e064364.42","doi-asserted-by":"publisher","DOI":"10.1177\/1077800410383121"},{"key":"2025121408295790000_13.1.e064364.43","unstructured":"UK Public Involvement Standards Development Partnership . UK standards for public involvement: better public involvement for better health and social care research; 2019."},{"key":"2025121408295790000_13.1.e064364.44","unstructured":"Barts Research Centre for Women\u2019s Health . Katie\u2019s team. 2022. Available: https:\/\/www.barc-research.org\/katies-team"},{"key":"2025121408295790000_13.1.e064364.45","unstructured":"NHS, Health Research Authority . HRA approval. 2020. Available: https:\/\/www.hra.nhs.uk\/approvals-amendments\/what-approvals-do-i-need\/hra-approval\/"},{"key":"2025121408295790000_13.1.e064364.46","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2015-004411"},{"key":"2025121408295790000_13.1.e064364.47","doi-asserted-by":"crossref","first-page":"1782","DOI":"10.1016\/S0140-6736(20)32394-1","article-title":"Action needed now to prevent further increases in measles and measles deaths in the coming years","volume":"396","author":"Mulholland","year":"2020","journal-title":"Lancet"},{"key":"2025121408295790000_13.1.e064364.48","unstructured":"European Centre for Disease Prevention and Control . Vaccination coverage for second dose of a measles-containing vaccine, EU\/EEA, 2018. 2021 Available: https:\/\/www.ecdc.europa.eu\/en\/publications-data\/vaccination-coverage-second-dose-measles-containing-vaccine-eueea-2018"},{"key":"2025121408295790000_13.1.e064364.49","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1136\/bmj.o51","article-title":"Is the NHS overwhelmed?","volume":"376","author":"Alderwick","year":"2022","journal-title":"BMJ"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2022-064364","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T16:30:08Z","timestamp":1765729808000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2022-064364"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1]]},"references-count":49,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1,20]]},"published-print":{"date-parts":[[2023,1]]}},"alternative-id":["10.1136\/bmjopen-2022-064364"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2022-064364","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1]]}}}