Enhancing Adolescent Vaccine Acceptance: A Multi‐Component Intervention Study on 13‐Year‐Old Tetanus‐Diphtheria Vaccination

OBJECTIVE: This study aimed to evaluate the impact of Turkey's 2020 policy shift from school-based to family physician-based individual vaccination for the adolescent Tetanus-Diphtheria (Td) vaccine and to assess the effectiveness of a multi-component intervention (education, reminders, and on-site vaccination) in improving vaccine uptake among initially unvaccinated adolescents. METHODS: The study consisted of two phases: first, a cross-sectional analysis comparing Td vaccination coverage rates from 2018 to 2024 before and after the policy change; second, a quasi-experimental intervention involving 1007 high school students in Haliliye district during the 2023-2024 academic year. The intervention included structured educational sessions, monthly reminders, and on-site vaccination services. Data were analyzed using descriptive statistics, Cochran's Q test, and McNemar tests. RESULTS: Following the shift to family physician-based individual vaccination in 2020, Td coverage initially decreased from 71.3% to 64.3% but increased gradually to 79.3% by 2024. The multi-component intervention increased vaccination coverage from 77.8% to 98.4% (p < 0.001). Major barriers overcome included lack of awareness (51.3%) and reluctance or time constraints (27.7%). CONCLUSION: Transitioning from school-based to family physician-based individual vaccination increased coverage gradually but left many adolescents unvaccinated. A multi-component intervention significantly improved vaccine uptake, supporting a hybrid school- and physician-based model.