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© Afiong Oboko Oku, 2019
Series of dissertations submitted to the Faculty of Medicine, University of Oslo
ISBN 978-82-8377-490-0
All rights reserved. No part of this publication may be
reproduced or transmitted, in any form or by any means, without permission.
Cover: Hanne Baadsgaard Utigard.
Print production: Reprosentralen, University of Oslo.
ii Contents
Acknowledgements ... 1
Abbreviations ... 2
List of papers... 3
Norsk Sammendrag ... 5
1.0 Introduction ... 9
1.1 The immunisation situation in Nigeria ... 11
1.1.1 The Expanded Programme on Immunisation ... 11
1.1.2 Target Groups/eligibility for immunisation ... 12
1.2 Immunisation Coverage in Nigeria ... 13
1.3 Causes of poor routine vaccination coverage in Nigeria: ... 14
1.3.1 Health system factors ... 14
1.3.2 Inadequate human resources ... 14
1.3.3 Neglect of routine immunisation in favour of polio campaigns ... 14
1.3.4 Poor service delivery and missed opportunities ... 15
1.3.5 Ineffective supply chain and logistics ... 15
1.3.6 Lack of funding and financial delays ... 16
1.3.7 Low demand, health care provider attitudes and skills and lack of community involvement ... 16
1.3.8 Poor coordination in the healthcare structure of Nigeria ... 17
1.4 Recipient oriented factors influencing immunization delivery ... 18
1.4.1 Vaccine hesitancy ... 18
1.4.2 Family characteristics ... 21
1.4.2.1 Maternal education... 21
1.4.2.2 Income... 21
1.4.2.3 Urban vs rural communities ... 22
1.4.2.4 Utilization of health facilities for other services ... 22
1.4.2.5 Characteristics of the child... 22
iii
1.5 Strategies to improve immunisation coverage ... 23
1.6 The role of health communication in childhood vaccination ... 23
1.7 The COMMVAC PROJECT ... 26
1.8 The ‘Communicate to vaccinate’ (COMMVAC) taxonomy... 27
1.9 Problem statement ... 32
1.10 Aims and objectives ... 34
2.0 Methodology ... 36
2.1 Study Area: Nigeria ... 36
2.2 Study sites ... 37
2.3 Study design ... 38
2.4 Justification for methods used in this thesis ... 40
2.4.1 Interviews ... 40
2.4.2 Document review ... 40
2.4.3 Direct observation ... 40
2.4.4 Focus group discussions ... 41
2.5 Methods used in Paper I ... 42
2.5.1 Interviews ... 42
2.5.2 Document review ... 43
2.5.3 Observation ... 43
2.5.4 Data management and analysis ... 44
2.6 Methods used in Paper II ... 45
2.6.1 Interviews ... 45
2.6.2 Data management and analysis ... 45
2.7 Methods used in Paper III ... 46
2.7.1 Focus group discussions ... 46
2.7.2 In-depth interviews with health workers ... 48
2.7.3 Interviews with traditional and religious leaders ... 48
2.7.4 Observation of communication activities ... 49
2.7.5 Data management and analysis ... 49
2.8 Ethical clearance ... 50
3.0 Results synopses of the papers ... 51
iv 3.1 Sub-study 1: Communication Strategies to Promote the uptake of childhood vaccination in
Nigeria: A Systematic Map ... 51
3.2 Sub-study 2: Factors affecting the Implementation of Childhood Vaccination Communication Strategies in Nigeria: a Qualitative Study ... 52
3.3 Sub-study 3: Perceptions and Experiences of Childhood Vaccination Communication Strategies among Caregivers and Health Workers in Nigeria: A Qualitative Study ... 53
4.0 Discussion ... 54
4.1 Methodological considerations ... 54
4.1.1 Appropriateness of qualitative design ... 54
4.1.2 Sampling procedure (purposive sampling): ... 56
4.1.3 Triangulation ... 58
4.1.4 Respondent validation ... 60
4.1.5 Data analysis ... 62
4.2 Discussion of the study findings ... 64
4.2.1 Perceived usefulness of the COMMVAC Taxonomy by stakeholders in vaccination communication ... 64
4.2.2 Communication intervention maps across the three COMMVAC study countries ... 67
4.2.2.1 Vaccination context across the three COMMVAC countries ... 68
4.2.2.2 Target groups across the three COMMVAC countries: ... 69
4.2.2.3 Communication interventions with different purposes across the three COMMVAC countries... 70
4.2.3 Vaccine hesitancy ... 72
4.2.3.1 Religious Beliefs... 72
4.2.3.2. Clinic environment ... 73
4.2.4 Funding gaps ... 73
4.2.5. Political factors ... 74
4.2.6 Communication preferences among caregivers ... 75
5.0 Conclusion ... 77
5.1 Implications for practice... 79
5.2 Implications for future research ... 79
REFERENCES ... 81
APPENDICES ... 91
v
APPENDIX 1: Semi- structured interview guides ... 91
Interview Guide (PROGRAMME MANAGERS /SOC MOB OFFICERS, PARTNERS) .. 91
Focus Group Discussion Guide (caregivers) ... 94
In-depth interview guide (health workers) ... 96
Appendix 2: List of interviewees for the macro study ... 98
Appendix 3: Key domains of the SURE Framework for the identification of factors affecting the implementation of policy options (adapted from the SURE Framework) ... 99
Appendix 4: Observation guide/ checklist ... 100
Appendix 5:The ‘Communicate to vaccinate’ taxonomy –purposes and definitions(178) ... 101
Appendix 6: The ‘Communicate to Vaccinate’ taxonomy: Interventions to improve communication about childhood vaccination ... 102
Bauchi Communication Intervention Map ... 102
Cross River Communication Intervention Map... 106
Appendix 6: Ethical Approvals Cross River and Bauchi States ... 110
Papers I- III ... 112
ϭ
Acknowledgements
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List of papers
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&DSEODQFK*DEULHO5DGDDQG6LPRQ/HZLQPerceptions and experiences of childhood vaccination communication strategies among caregivers and health workers in Nigeria: A qualitative study3/R62QHH
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&DSEODQFK*DEULHO5DGDDQG6LPRQ/HZLQFactors affecting the implementation of childhood vaccination communication strategies in Nigeria: A qualitative study%0&
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&DSEODQFK*DEULHO5DGDDQG6LPRQ/HZLQCommunication strategies to promote the uptake of childhood vaccination in Nigeria: A systematic map*OREDO+HDOWK$FWLRQ
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$PHV-HVVLFD.DXIPDQ6RSKLH+LOO<XUL&DUWLHU;DYLHU%RVFK&DSEODQFK*DEULHO5DGD 6LPRQ/HZLQUsing the COMMVAC taxonomy to map vaccination communication
interventions in Mozambique*OREDO+HDOWK$FWLRQ'2,
+HDWKHU0HODQLH5$PHV'LDQJKD0DEHO1MDQJ&ODLUH*OHQWRQ$WOH)UHWKHLP-HVVLFD
.DXIPDQ6RSKLH+LOO$ILRQJ2NX-XOLH&OLII<XUL&DUWLHU;DYLHU%RVFK&DSEODQFK*DEULHO 5DGD$UWXU0XOROLZD$QJHOD2\R,WD6LPRQ/HZLQMapping how information about
childhood vaccination is communicated in two regions of Cameroon: What is done and where are the gaps?%0&3XEOLF+HDOWK
KWWSVEPFSXEOLFKHDOWKELRPHGFHQWUDOFRPDUWLFOHVV
4 Heather Melanie R Ames; Diangha Mabel Njang; Claire Glenton; Atle Fretheim; Jessica
Kaufman; Sophie Hill; Afiong Oku; Julie Cliff; Yuri Cartier; Xavier Bosch-Capblanch; Gabriel Rada; Artur Muloliwa; Angela Oyo-Ita; Awah Paschal Kum; Simon Lewin. Stakeholder
perceptions of communication about vaccination in two regions of Cameroon: A qualitative case study. PLoS ONE 2017,12(8): e0183721.https://doi.org/10.1371/journal.pone.0183721 Jessica Kaufman, Heather Ames, Xavier Bosch-Capblanch, Yuri Cartier, Julie Cliff, Claire Glenton, Simon Lewin, Artur Manuel Muloliwa, Afiong Oku, Angela Oyo-Ita, Gabriel Rada, Sophie Hill. The comprehensive 'Communicate to Vaccinate' taxonomy of communication interventions for childhood vaccination in routine and campaign contexts. BMC Public Health. 201717:423. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889- 017- 4320-x (1)
Heather Melanie R Ames; Diangha Mabel Njang; Claire Glenton; Atle Fretheim; Jessica Kaufman; Sophie Hill; Afiong Oku; Julie Cliff; Yuri Cartier; Xavier Bosch-Capblanch; Gabriel Rada; Artur Muloliwa; Angela Oyo-Ita; Simon Lewin. Mapping how information about
childhood vaccination is communicated in two regions of Cameroon: What is done and where are the gaps? BMC Public Health. 201515:1264.
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-2557-9 (2) Heather Melanie R Ames; Diangha Mabel Njang; Claire Glenton; Atle Fretheim; Jessica Kaufman; Sophie Hill; Afiong Oku; Julie Cliff; Yuri Cartier; Xavier Bosch-Capblanch; Gabriel Rada; Artur Muloliwa; Angela Oyo-Ita; Awah Paschal Kum; Simon Lewin. Stakeholder
perceptions of communication about vaccination in two regions of Cameroon: A qualitative case study. PLoS ONE 2017,12(8): e0183721.https://doi.org/10.1371/journal.pone.0183721 Kaufman J, Ryan R, Bosch-Capblanch X, Cartier Y, Cliff J, Glenton C, Lewin S, Rada G, Ames H, Muloliwa AM, Oku A, Oyo-Ita A, Hill S. Outcomes mapping study for childhood
vaccination communication: too few concepts were measured in too many ways. Journal of Clinical Epidemiology 2016, 72:33-44. doi: 10.1016/j.jclinepi.2015.10.003.
http://www.sciencedirect.com/science/article/pii/S0895435615004679
ϱ
Norsk Sammendrag
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6 Konklusjon
Helsemyndighetene bør ta høyde for forhold som kan vanskeliggjøre god vaksinekommunikasjon, og bør satse på kunnskapsbaserte strategier for å fremme god kommunikasjon med foresatte om
barnevaksinasjon.
7
Abstract
Background
Improved communication about childhood vaccination, directed at parents, communities and healthcare providers, is key to increasing vaccine uptake, overcoming barriers to childhood vaccination, and tackling vaccine hesitancy. However, communication strategies are rarely seen as a priority component of vaccination programmes and are rarely designed in a systematic way to increase vaccination uptake. This thesis aimed to:
1) Identify the communication strategies used in two states in Nigeria, and map these strategies using a vaccination communication taxonomy.
2) Explore policy makers’ and other stakeholders’ views of possible factors affecting the delivery of vaccination communication in Nigeria.
3) Explore the perceptions and experiences of parents/caregivers and healthcare providers in Nigeria on vaccination communication strategies implemented in their settings.
Methods
We conducted the study in Bauchi State and Cross River State in northern and southern Nigeria respectively – using a range of qualitative approaches. In the first study, we identified
vaccination communication interventions through interviews with purposively selected
stakeholders in the health services and relevant agencies, through direct observations in health facilities, and by reviewing relevant documents. We then used a vaccination communication taxonomy to create a Nigerian interventions map. In the second study, we identified factors affecting the implementation of communication interventions, by interviewing purposively selected stakeholders in the health services. We then organized identified factors (barriers and facilitators) using an implementation framework. Lastly, we explored healthcare providers’ and parents’/caregivers’ perceptions and experiences of vaccination communication activities.
Results
Most of the childhood vaccination communication strategies we identified were meant to inform and educate people, and to remind them about vaccine appointments. These strategies were primarily used in the context of campaigns, rather than in routine immunization programmes.
The main targets for most interventions were parents/caregivers and community members, with few interventions directed at healthcare providers. Commonly reported health system barriers to implementing communication interventions included: funding constraints; human resource factors (health worker shortages, training deficiencies, and poor attitudes); inadequate infrastructure and equipment; and weak political will. Negative attitudes of community
stakeholders and parents/caregivers were other identified barriers to vaccination communication.
Political support, engagement of traditional and religious institutions and the use of organized communication committees appeared to facilitate communication activities. Barriers to vaccination communication pointed out by parents and caregivers included the clinic
environment, health worker attitudes and long waiting times, while healthcare providers pointed at poor interpersonal communication skills, poor motivation, and attitudes of community
members, including vaccine resistance.
8 Conclusions
Decision makers need to look at how to address barriers to vaccination communication, so as to facilitate the implementation at scale of evidence-informed strategies for communicating with parents and caregivers about childhood immunization.
.
ϵ
1.0 Introduction
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10 vaccine, poor access, lack of trust in the vaccine or the provider, illiteracy and other social and political factors (5, 8).
Globally, people’s interest in vaccination communication has grown with its emergence as a potentially effective strategy to address vaccine hesitancy (16-19). Increasingly, substantial resources are used for vaccination communication to try to reach key vaccination targets. The availability of new vaccines has also led to an increased focus on vaccination communication where various approaches are used to adequately inform relevant stakeholders of the benefits of including these new vaccines into the routine immunisation schedule (20). In most settings, parents, and informal caregivers now have access to a broad and growing spectrum of information sources of varying quality. In some settings, an absolute lack of information and communication constitute a significant barrier to addressing vaccine hesitancy and improving vaccination uptake and coverage (21).
Vaccination communication is essential to create and maintain demand for childhood vaccination and it has played a fundamental role in the successes achieved in childhood vaccination (22, 23).
In this thesis, a communication intervention is defined as “a purposeful, structured, repeatable, and adaptable strategy to inform and influence individual and community decisions in relation to personal and public health participation, disease prevention and promotion, policy making, service improvement and research (24).” Communication interventions are crucial for achieving the goal of having knowledgeable parents, caregivers, and communities who constitute important contributors to improving child health in low income settings (25, 26). Effective communication with parents and communities is particularly crucial in reaching the hard-to reach populations, with the aim of building trust in vaccines as well as tackling any form of vaccine hesitancy (22, 27-29). Effective communication strategies can address some of the vaccine hesitancy factors, by making more people aware of the benefits of immunisation; correcting false beliefs, rumours, or concerns that prevent people from getting immunised; and informing people where and when to get immunised, thereby potentially increasing vaccination rates (9-12).
The next section will provide more detailed information on childhood immunisation situation in Nigeria; how the Childhood Immunisation programme commenced in Nigeria through the Expanded Programme on immunisation (EPI), target groups/ eligibility for immunisation,
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1.1 The immunisation situation in Nigeria
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1.1.1 The Expanded Programme on Immunisation
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ϭϮ 1.1.2 Target Groups/eligibility for immunisation
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ϭϯ 1.2 Immunisation Coverage in Nigeria
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ϭϰ 1.3 Causes of poor routine vaccination coverage in Nigeria:
1.3.1 Health system factors
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1.3.2 Inadequate human resources
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1.3.3 Neglect of routine immunisation in favour of polio campaigns
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1.3.5 Ineffective supply chain and logistics
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1.3.7 Low demand, health care provider attitudes and skills and lack of community involvement
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1.4 Recipient oriented factors influencing immunization delivery
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1.4.1 Vaccine hesitancy
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19 behaviour. The declining public confidence in vaccines worldwide, has been identified as a +major concern and challenge to the health of the populace (58, 59). Rapid global sharing of public concerns and uncertainty around vaccines (21) have led to a rise in the number of people concerned about vaccines, seeking alternative vaccination schedules (21, 60-62) and delaying or refusing vaccination (63).
In recent years, there has been increasing attention drawn to “vaccine hesitancy” (64-66).
Previously, the phenomenon was described as “vaccine resistance” or “vaccine opposition”, but these expressions have since been abandoned, and the term, “vaccine hesitancy” emerged, to communicate the spectrum of parental attitudes towards vaccination (62). Recognizing the importance of vaccine hesitancy and its potential to impact on vaccine coverage, the Strategic Advisory Group of Experts (SAGE) on Immunisation of the World Health Organization (WHO) established a Working Group to deal with vaccine hesitancy issues in 2012 (67). The SAGE working group first defined “vaccine hesitancy” as:
“A behaviour, influenced by a number of factors including issues of confidence [do not trust vaccine or provider], complacency [do not perceive a need for a vaccine, do not value the vaccine], and convenience [access]” (68 p.4163)
The SAGE working group further defined vaccine hesitancy as “a delay in acceptance or refusal of vaccines despite availability of vaccination services, and vaccine-hesitant individuals as a heterogeneous group holding varying degrees of indecision with regards to specific vaccines or vaccination in general and are in the middle of a continuum ranging from total acceptors to complete refusers”. These “hesitant” individuals may reject some vaccines, but accept others, delay vaccines, or under doubt accept vaccines (69, 70). Factors that may determine an individual’s vaccine hesitancy have been described in three domains: contextual influences including socio-cultural and health systems factors, individual and group influences including those arising from personal perceptions of a vaccine, and vaccine- or vaccination-specific issues including individual assessments of risks and benefits and the effects of the mode of
administration (2).
20 Several systematic reviews have investigated factors that influence vaccine hesitancy across different populations (71-73), and there are indications to suggest that not all potentially relevant factors have been identified or thoroughly investigated (74, 75). These reviews identified; family characteristics, parental attitudes and knowledge, limitations in immunization-related
communication and information and negative beliefs/attitudes towards immunization, to be significantly associated with suboptimal compliance. Also, healthcare system factors such as skepticism/doubts regarding provided health related information, inadequate support from healthcare providers, lack of available health structures, and problems concerning transportation and accessibility to immunization clinics.
Furthermore, a comprehensive analysis of the drivers of vaccine hesitancy indicates that in low- and middle-income countries, a lack of knowledge and awareness of required vaccines,
immunisation or immunisation services still persist. For low-income countries, geographical barriers were the most frequently cited contributors to vaccine hesitancy (76). In high-income countries, the reasons for vaccine hesitancy have evolved around risk versus benefit of
immunisation, in particular issues related to adverse events following immunisation (AEFIs) and safety of the vaccine (76).
Vaccine hesitancydue to religious belief has been found to becommon across all strata of income and WHO regions. It has been linked with philosophical beliefs or moral convictions regarding health and immunity, such as a preference for “natural” over “artificial” medicines.
Orthodox Protestants in The Netherlands and the Amish in the United States are religious communities well-known for rejecting vaccination for religious motives (77, 78). In Nigeria, several studies have reported that parental disapproval owing to religious concerns played an influential role on non-immunisation (10, 79, 80). Rejections of polio vaccination by parents or religious bodies in northern Nigeria (81) led to a vaccine boycott in several northern states in 2003 (79). In these states, political and religious leaders perceived the polio vaccine as a plan by outsiders (enemies of Islam) to reduce the Muslim population through fortification of the vaccine with contraceptives or the HIV virus. This led to a decrease in immunisation uptake in Northern Nigeria in 2003 (79, 82). With a constant delivery of correct vaccination information, it is possible that this boycott could have been prevented. The next section will discuss some of the drivers of vaccine hesitancy which may ultimately affect vaccination coverage.
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1.4.2 Family characteristics
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1.4.2.2 Income
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1.4.2.3 Urban vs rural communities
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1.4.2.4 Utilization of health facilities for other services
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1.4.2.5 Characteristics of the child
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1.5 Strategies to improve immunisation coverage
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1.6 The role of health communication in childhood vaccination
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24 different ways we ‘seek patients and caregivers who are more knowledgeable and competent, able to express their views and beliefs, make decisions alone or with health professionals, supported or supportive, minimizing risks and harms, accessing high quality information and quality services and participating in policy, research, governance and delivery’ (116). Willis and colleagues further noted that health communication describes actions carried out by an
individual, exchange between two persons and communities. As well as employment of various media channels including new forms of technology e.g. e-health and m-health which have led to greater levels of interpersonal connectivity (117-119).
Growing evidence exist that communication can help people adopt positive health behaviours and create demand for preventive and curative services (16). Childhood vaccination, an example of a preventive service, has benefited immensely from the fundamental role played by health communication since the introduction of the first childhood vaccine (120).
The definitions of health communication are neither simple nor brief. In 2013, Schiavo defined health communication as:
“A multifaceted and multi-disciplinary field of research theory, and practice concerned with reaching different populations and groups to exchange health-related ideas, and methods in order to influence, engage, empower, and support individuals, communities, health-care professionals, patients, policymakers, organizations, special groups, and the public so that they will champion, introduce, adopt, or sustain a health or social
behaviour, practice, or policy that will ultimately improve individual, community and public health outcomes” (120 p.8).
Health communication also creates a receptive and favorable environment where information can be shared, understood, absorbed and discussed by the programmes intended audiences (120).
Communication interventions for vaccination can take many forms and can operate at individual, interpersonal, organizational, community, and public health sector levels (29, 121, 122). Such interventions may target parents, health professionals, whole communities, or health
organizations or multiple different groups at once. Effective health communication may also provide a safe and an efficient way to improve a broad range of health outcomes (20, 123, 124).
25 Schiavo has noted that health communication cannot replace a lack of infrastructure (such as the absence of appropriate health services) or capacity (such as limited number of health care
providers in relation to population size). But communication can advocate for change, create a receptive environment to support health service delivery, allocation of additional funding for research, improve access to existing treatments or services, or help with the recruitment of health care professionals in new medical specialties or underserved communities. Schiavo further stressed that effective health communication may help secure political commitment, stakeholder endorsement and community involvement for change, and improved health outcomes (120).
Ϯϲ 1.7 The COMMVAC PROJECT
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Ϯϳ 1.8 The ‘Communicate to vaccinate’ (COMMVAC) taxonomy
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28 identified from the COMMVAC primary studies in the three study countries: Cameroon,
Mozambique and Nigeria. The research findings from this thesis therefore contributed to the development of the comprehensive taxonomy. The categories of the communication
interventions included in the second version of the COMMVAC taxonomy, as well as their definitions and some examples, are described in Table 3.
29 Table 2: COMMVAC taxonomy showing several intervention types across three target groups.
TARGET
Parents or expectant parents
Communities,
community members or volunteers
Health professionals
P U R P O S E
Inform or educate
One on one interactions Group interactions Mail (postcards, letters or email)
Phone-based (calls, hotlines or SMS)
Device or tool
Audio visual / performance Printed material
Web-based
One on one interactions Group interactions Mail (postcards, letters or email)
Phone-based (calls, hotlines or SMS) Device or tool
Audio visual / performance Printed material
Web-based Media campaign
Community event/meeting Celebrity spokespeople Media campaign
Phone-based (calls, hotlines or SMS)
Remind or recall
One on one interactions Mail (postcards, letters or email)
Phone-based (calls, hotlines or SMS)
Device or tool
One on one interactions Device or tool
Teach skills Training in how to communicate / provide education to others
Training in how to communicate / provide education to others
Training in how to communicate / provide education to others Provide support One on one interactions
Group interactions
Phone-based (calls, hotlines or SMS)
Facilitate decision making
Decision aids Decision aids
Enable
communication
Interpreters
30 Enhance
community ownership
Program delivery Local opinion leaders Community input Programme delivery Community coalition Partnership building
31 Table 3: The ‘Communicate to vaccinate’ taxonomy –purposes and definitions (29)
Taxonomy
categories Definition Example
Inform or
Educate Interventions to enable consumers to understand the meaning and relevance of vaccination to their health and the health of their family or community. Interventions are sometimes tailored to address low literacy levels and can also serve to address misinformation.
Educational sessions for parents and caregivers in their local health facility, pamphlets, radio, telephone calls, television documentaries, church announcements, media campaigns etc
Remind or
Recall Interventions to remind consumers of required vaccinations and to recall those who are overdue. The purpose is to provide assistance or advice to parents outside of the traditional consultation environment about vaccination
Parent reminded through a mobile text message about their child’s next vaccination appointment. Others include; Letters, telephone calls, face to face interactions or tools (e.g. vaccination card)
Teach Skills Interventions focusing on the acquisition of skills related to accessing and communicating about vaccination. Such interventions aim to teach parents early parenting skills such as how to find access and utilise vaccination services. They also include interventions to train parents, communities and health care providers how to communicate or provide vaccination-related education to others
Teaching people to critically appraise information and information sources through mothers’ groups. This can include
suggestions for how a mother can
communicate to her child to reduce stress at vaccination appointments.
Provide
Support Interventions to assist people in addressing specific challenges to vaccination that arise within their day-to-day lives. This could include, for instance, social issues such as disagreement within a family regarding vaccinating their child or emotional issues such as stress or anxiety experienced by parents over vaccination., Interventions may be tailored or personalised and are aimed at individuals rather than communities.
In contrast to interventions to inform or educate about vaccination, interventions to provide support are more focused on addressing specific challenges that people face when deciding whether to vaccinate their child.
Biweekly parent support groups in the community or in health facilities, Support and information exchange between parents via an online chat forum
Facilitate Decision Making
Interventions to help parents understand the personal benefits or risks of vaccination and assist them to actively participate in decision-making.
Decision aid booklets sent to parents before a vaccination appointment
Enable
Communication Interventions to make communication possible. Employment of translators in a clinic to facilitate communication.
Enhance Community Ownership
Interventions to increase community participation and promote interaction between communities and health services. Interventions may build trust among consumers and generate awareness and understanding of vaccination. Interventions of this nature embrace collective decision-making and community involvement in planning, program delivery, research, advocacy or governance.
Organisations or community groups that consider the need for vaccines in their area, discuss the costs and benefits of vaccination, and develop action plans to address barriers to uptake.
Community coalitions charged with
overseeing the implementation of vaccination programmes; enlisting local opinion leaders such as village chiefs to serve as vaccination
‘champions’; recruiting community members to assist with vaccination programme delivery; or community input into the design of vaccination strategies
ϯϮ 1.9 Problem statement
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33 childhood vaccination, based on a comprehensive approach for identifying and organising these interventions by purpose and audience.
Also, implementing vaccination communication interventions at scale is not without challenges in the Nigerian context. An understanding of the factors affecting the delivery of communication interventions for childhood vaccination is highly pertinent to decision makers and may help them to plan communication interventions and to adapt these to local contexts. Such planning and adaptation require a thorough knowledge of caregivers’ views of the communication that they receive in relation to childhood vaccination, and what they would like to receive, as well as health care providers’ views of what is feasible to implement. Understanding these stakeholders' views and perspectives on communication interventions for childhood vaccination, including their preferences in relation to delivery and content, is a vital step towards planning and developing more effective communication strategies and achieving the goal of better-informed caregivers and communities. To date, however, these views have not been explored in detail in the Nigerian context.
