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Wachinger J, Reñosa MDC, Guevarra JR, Landicho-Guevarra J, Demonteverde MP, Silvestre C, Endoma V, Landicho J, Aligato MF, Bravo TA, Chase RP, McMahon SA. Keeping the Customer Satisfied: Applying a Kano Model to Improve Vaccine Promotion in the Philippines. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2300199. [PMID: 38071542 PMCID: PMC10749646 DOI: 10.9745/ghsp-d-23-00199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/08/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION The success of global health interventions heavily relies on reaching populations in a way that aligns with their priorities and needs. This warrants novel approaches to determine the design of meaningful interventions and targeted delivery pathways. To date, global health scholarship and practice have largely underused approaches already established in fields that emphasize customer satisfaction, such as quality management or consumer psychology. METHODS In our study, we apply Kano methodology-originally designed to understand how product attributes nonlinearly influence customer satisfaction-to inform design decisions regarding a video-based vaccine intervention in the Philippines. Between September 2021 and April 2022, we administered a Kano questionnaire to 205 caregivers of small children. Data were analyzed following routine Kano approaches, supplemented by cultural consensus analysis (CCA), which is an approach used largely in anthropology to identify distinct cultural groups and competencies. RESULTS Applying Kano and CCA methodologies allowed us to make informed design decisions in terms of optimizing accessibility and credibility of an intervention that ultimately proved successful in bolstering vaccine intentions. Results guided us to include national and international logos, to appreciate the value of summarizing key messages, and to recognize the importance of fact- or story-based communication as attributes that influenced respondent satisfaction one-dimensionally. We found that involving trusted messengers and including text-based information were required to avoid dissatisfaction. Interacting with someone after viewing the product and creating opportunities to share the promotional material via social media were attractive attributes whose presence would increase satisfaction but would not spark severe dissatisfaction if omitted. Other attributes (short duration, video- or animation-based intervention, delivering the intervention at health centers or in group settings) played a limited role in respondent satisfaction. CONCLUSIONS Global health research and practice can benefit from applying approaches established in other fields when making evidence-based prioritization decisions to tailor interventions.
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Affiliation(s)
- Jonas Wachinger
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Mark Donald C. Reñosa
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine – Department of Health, Muntinlupa, Philippines
| | - Jerric Rhazel Guevarra
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine – Department of Health, Muntinlupa, Philippines
| | - Jhoys Landicho-Guevarra
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine – Department of Health, Muntinlupa, Philippines
| | - Maria Paz Demonteverde
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine – Department of Health, Muntinlupa, Philippines
| | - Catherine Silvestre
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine – Department of Health, Muntinlupa, Philippines
| | - Vivienne Endoma
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine – Department of Health, Muntinlupa, Philippines
| | - Jeniffer Landicho
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine – Department of Health, Muntinlupa, Philippines
| | - Mila F. Aligato
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine – Department of Health, Muntinlupa, Philippines
| | - Thea Andrea Bravo
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine – Department of Health, Muntinlupa, Philippines
| | - Rachel P. Chase
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Department of Research Information Technology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Shannon A. McMahon
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Bridi L, Kaki DA, Behnam R, Khan X, Albahsahli B, Bencheikh N, Aljenabi R, Ahmadi N, Dajani R, Al-Rousan T. Attitudes toward dementia and cognitive aging among Syrian refugees resettled in Jordan: a qualitative study. BMC Public Health 2023; 23:2307. [PMID: 37990313 PMCID: PMC10664261 DOI: 10.1186/s12889-023-17183-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 11/08/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Mounting evidence is revealing disparities in cognitive function and heightened dementia risk among refugees, yet research in this area remains scant. Despite bearing most of the world's refugee burden, limited-resource countries like Jordan are facing challenges when dealing with refugee health. There is a lack of research on the attitudes toward dementia and the cognitive healthcare gaps among refugees in Jordan. METHODS 32 older (≥ 55 years) Syrian refugees resettled in Jordan were recruited through a local community-based organization and interviewed in four focus groups (2 female and 2 male groups). Interviews were transcribed and translated, then coded using inductive thematic analysis. RESULTS Mean age of the sample was 60.1 years and 53.1% were female. Only 34.4% rated their memory as good or excellent. Themes were organized using the socioecological model: 1) At the individual level, participants believed high levels of stress, including low socioeconomic status, poor health, and traumatic history from their refugee experience increased their dementia risk. 2) Interpersonally, there is a fear of dementia due to the possible impact and burden on loved ones, particularly with the stigma surrounding dementia. 3) At the community level, participants noted that resettlement in Jordan - with a shared language, religion, and culture - offered protective effects due to facilitated access to social connection, information, and mental health self-care. 4) At the institution and policy level, participants believed older refugees faced restrictive policies for economic aid, healthcare, and employment, presenting a significant barrier to healthy aging. CONCLUSIONS Findings from this study are the first to examine the attitudes of Syrian refugees in Jordan toward dementia and cognitive aging. These results could provide essential data inclusive of refugees as Jordan develops its National Dementia Plan. Investing in dementia awareness interventions and age-friendly neighborhoods may benefit aging refugees in limited-resources settings.
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Affiliation(s)
- Lana Bridi
- School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Dahlia A Kaki
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Rawnaq Behnam
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA
| | - Xara Khan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA
- School of Social Sciences, University of California, San Diego, San Diego, CA, USA
| | - Behnan Albahsahli
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA
| | - Nissma Bencheikh
- School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Raghad Aljenabi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA
- School of Social Sciences, University of California, San Diego, San Diego, CA, USA
| | - Nargis Ahmadi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA
| | - Rana Dajani
- Department of Biology and Biotechnology, The Hashemite University, Zarqa, Jordan
| | - Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA.
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Reñosa MDC, Wachinger J, Guevarra JR, Landicho-Guevarra J, Aligato MF, Endoma V, Landicho J, Bravo TA, Malacad C, Demonteverde MP, Silvestre C, Bärnighausen K, Bärnighausen T, Chase RP, McMahon SA. Human-centred design bolsters vaccine confidence in the Philippines: results of a randomised controlled trial. BMJ Glob Health 2023; 8:e012613. [PMID: 37865401 PMCID: PMC10603469 DOI: 10.1136/bmjgh-2023-012613] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 09/22/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND The public's confidence in vaccinations has eroded, and anti-vaccination movements have gained traction around the world, including in the Philippines. 'Salubong', a Filipino term, refers to welcoming someone back into one's life and elicits ideas about friendship and family relationships. We extended this concept to vaccines in efforts to design an intervention that would re-welcome vaccines into homes. METHODS Using human-centred design, we developed and refined a story-based intervention that engages Filipino families, community leaders and community health workers. We conducted a randomised controlled trial among 719 caregivers of small children to test the developed intervention against a control video. We assessed the binary improvement (improvement vs no improvement) and the amount of improvement in vaccine attitudes and intentions after intervention exposure. RESULTS Although the intervention group began with marginally higher baseline vaccine attitude scores, we found that 62% of the intervention group improved their vaccine attitude scores versus 37% of the control group (Fisher's exact, p<0.001). Among individuals whose scores improved after watching the assigned video, the intervention group saw higher mean attitude score improvements on the 5-point scale (Cohen's d=0.32 with 95% CI 0.10 to 0.54, two-sided t-test, p<0.01). We observed similar patterns among participants who stated that they had previously delayed or refused a vaccine for their child: 67% of 74 in the intervention group improved their vaccine attitude scores versus 42% of 54 in the control group (Fisher's exact, p<0.001). Among the subset of these individuals whose scores improved after watching the assigned video, the intervention group saw higher mean attitude score improvements on the 5-point scale that were marginally significant (Cohen's d=0.35 with 95% CI -0.01 to 0.70, two-sided t-test, p=0.06). CONCLUSIONS Our results provide solid evidence for the potential of co-designed vaccine confidence campaigns and regulations.
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Affiliation(s)
- Mark Donald C Reñosa
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Philippines
| | - Jonas Wachinger
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - Jerric Rhazel Guevarra
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Philippines
| | - Jhoys Landicho-Guevarra
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Philippines
| | - Mila F Aligato
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Philippines
| | - Vivienne Endoma
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Philippines
| | - Jeniffer Landicho
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Philippines
| | - Thea Andrea Bravo
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Philippines
| | - Carol Malacad
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Philippines
| | - Maria Paz Demonteverde
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Philippines
| | - Catherine Silvestre
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Philippines
| | - Kate Bärnighausen
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- School of Public Health, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- Africa Health Research Institute, Durban, South Africa
| | - Rachel P Chase
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- International Health Department, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Tejero LMS, Seva RR, Petelo Ilagan BJ, Almajose KL. Determinants of COVID-19 vaccination decision among Filipino adults. BMC Public Health 2023; 23:851. [PMID: 37165332 PMCID: PMC10170431 DOI: 10.1186/s12889-023-15712-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 04/19/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND With a number of vaccines against COVID-19 now widely available globally, it is opportune to determine what tips the decision to get vaccinated. In most countries like the Philippines where the government provides these vaccines for free to all its citizens, their COVID-19 vaccine awareness and COVID-19 information sources as well as their socio-demographic profile were considered as primary factors that could possibly affect vaccination decisions. Participants' income level was considered as a possible financial consideration that can affect vaccination decision as transport to vaccination sites might entail costs to them. METHODS This study used a cross sectional survey design wherein participants came from all regions of the Philippines. An online questionnaire was voluntarily answered by Filipinos aged 18-80 years of age. RESULTS A total of 2,268 participated in the survey with 1,462 having complete responses which were included in the analysis. Those who are younger, with higher educational attainment, with public health insurance, with employers requiring vaccination, high awareness about COVID-19 vaccination, and high vaccine confidence are more likely to get vaccinated. On the other hand, those with long-standing illness and those residing outside the national capital region are less likely to get vaccinated. CONCLUSION Vaccination decisions among Filipinos are determined by their age, educational attainment, health insurance, employer requirement, high awareness of the disease, and a high level of vaccine confidence.
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Affiliation(s)
| | - Rosemary Ruiz Seva
- Industrial and Systems Engineering, De La Salle University, Manila, Philippines
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Dadari I, Belt RV, Iyengar A, Ray A, Hossain I, Ali D, Danielsson N, Sodha SV. Achieving the IA2030 Coverage and Equity Goals through a Renewed Focus on Urban Immunization. Vaccines (Basel) 2023; 11:809. [PMID: 37112721 PMCID: PMC10147013 DOI: 10.3390/vaccines11040809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/24/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023] Open
Abstract
The 2021 WHO and UNICEF Estimates of National Immunization Coverage (WUENIC) reported approximately 25 million under-vaccinated children in 2021, out of which 18 million were zero-dose children who did not receive even the first dose of a diphtheria-tetanus-pertussis-(DPT) containing vaccine. The number of zero-dose children increased by six million between 2019, the pre-pandemic year, and 2021. A total of 20 countries with the highest number of zero-dose children and home to over 75% of these children in 2021 were prioritized for this review. Several of these countries have substantial urbanization with accompanying challenges. This review paper summarizes routine immunization backsliding following the COVID-19 pandemic and predictors of coverage and identifies pro-equity strategies in urban and peri-urban settings through a systematic search of the published literature. Two databases, PubMed and Web of Science, were exhaustively searched using search terms and synonyms, resulting in 608 identified peer-reviewed papers. Based on the inclusion criteria, 15 papers were included in the final review. The inclusion criteria included papers published between March 2020 and January 2023 and references to urban settings and COVID-19 in the papers. Several studies clearly documented a backsliding of coverage in urban and peri-urban settings, with some predictors or challenges to optimum coverage as well as some pro-equity strategies deployed or recommended in these studies. This emphasizes the need to focus on context-specific routine immunization catch-up and recovery strategies to suit the peculiarities of urban areas to get countries back on track toward achieving the targets of the IA2030. While more evidence is needed around the impact of the pandemic in urban areas, utilizing tools and platforms created to support advancing the equity agenda is pivotal. We posit that a renewed focus on urban immunization is critical if we are to achieve the IA2030 targets.
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Affiliation(s)
- Ibrahim Dadari
- Coverage & Equity Unit, Immunization Section, PG-Health, UNICEF Headquarters, 3 UN Plaza, New York, NY 10017, USA
- College of Public Health, University of South Florida, Tampa, FL 33612, USA
| | - Rachel V. Belt
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, 75 George Street, Oxford OX1 2JD, UK
| | - Ananya Iyengar
- Coverage & Equity Unit, Immunization Section, PG-Health, UNICEF Headquarters, 3 UN Plaza, New York, NY 10017, USA
- Johns Hopkins Bloomberg School of Public Health, International Vaccine Access Center (IVAC), Baltimore, MD 21231, USA
| | - Arindam Ray
- New Vaccines and Immunization Systems, Bill and Melinda Gates Foundation, New Delhi 110067, India
| | - Iqbal Hossain
- John Snow, Inc., 2733 Crystal Drive, Arlington, VA 22202, USA
| | - Daniel Ali
- Johns Hopkins Bloomberg School of Public Health, International Vaccine Access Center (IVAC), Baltimore, MD 21231, USA
| | - Niklas Danielsson
- Coverage & Equity Unit, Immunization Section, PG-Health, UNICEF Headquarters, 3 UN Plaza, New York, NY 10017, USA
| | - Samir V. Sodha
- Department of Immunization Vaccines and Biologicals, WHO Headquarters, Avenue Appia 20, 1211 Geneva, Switzerland
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Chi DL, Kerr D, Patiño Nguyen D, Shands ME, Cruz S, Edwards T, Carle A, Carpiano R, Lewis F. A conceptual model on caregivers' hesitancy of topical fluoride for their children. PLoS One 2023; 18:e0282834. [PMID: 36947522 PMCID: PMC10032489 DOI: 10.1371/journal.pone.0282834] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/23/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Topical fluoride hesitancy is a well-documented and growing public health problem. Despite extensive evidence that topical fluoride is safe and prevents tooth decay, an increasing number of caregivers are hesitant about their children receiving topical fluoride, leading to challenges in clinical settings where caregivers refuse preventive care. PURPOSE To explore the determinants of topical fluoride hesitancy for caregivers with dependent children. METHODS In this qualitative study, we interviewed 56 fluoride-hesitant caregivers to develop an inductive conceptual model of reasons why caregivers are hesitant. RESULTS The core construct of the conceptual model of topical fluoride hesitancy centered on caregivers "wanting to protect and not mess up their child". Six domains comprised this core construct: thinking topical fluoride is unnecessary, wanting to keep chemicals out of my child's body, thinking fluoride is harmful, thinking there is too much uncertainty about fluoride, feeling pressured to get topical fluoride, and feeling fluoride should be a choice. CONCLUSIONS Topical fluoride hesitancy is complex and multifactorial. Study findings provide insight for future efforts to understand and optimize caregivers' preventive care decision making.
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Affiliation(s)
- Donald L Chi
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington, United States of America
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington, United States of America
| | - Darragh Kerr
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington, United States of America
| | - Daisy Patiño Nguyen
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington, United States of America
| | - Mary Ellen Shands
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington, United States of America
| | - Stephanie Cruz
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington, United States of America
| | - Todd Edwards
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington, United States of America
| | - Adam Carle
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
- Department of Psychology, University of Cincinnati College of Arts and Sciences, Cincinnati, Ohio, United States of America
| | - Richard Carpiano
- University of California Riverside, School of Public Policy, Riverside, California, United States of America
| | - Frances Lewis
- Department of Child, Family and Population Health Nursing, University of Washington School of Nursing, Seattle, Washington, United States of America
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Yanto TA, Lugito NPH, Hwei LRY, Virliani C, Octavius GS. Prevalence and Determinants of COVID-19 Vaccine Acceptance in South East Asia: A Systematic Review and Meta-Analysis of 1,166,275 Respondents. Trop Med Infect Dis 2022; 7:361. [PMID: 36355903 PMCID: PMC9696885 DOI: 10.3390/tropicalmed7110361] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 09/15/2023] Open
Abstract
Despite its importance in guiding public health decisions, studies on COVID-19 vaccination acceptance and its determinants in South East Asia (SEA) are lacking. Therefore, this study aims to determine the prevalence of COVID-19 vaccine acceptance and the variables influencing the vaccine's acceptance. This review is registered under PROSPERO CRD42022352198. We included studies that reported vaccination acceptance from all SEA countries, utilising five academic databases (Pubmed, MEDLINE, Cochrane Library, Science Direct, and Google Scholar), three Indonesian databases (the Indonesian Scientific Journal Database, Neliti, and Indonesia One Search), two pre-print databases (MedRxiv and BioRxiv), and two Thailand databases (ThaiJo and Thai-Journal Citation Index). The analysis was conducted using STATA 17.0 with metaprop commands. The prevalence for COVID-19 vaccination acceptance in SEA was 71% (95%CI 69-74; I2 99.87%, PI: 68.6-73.5). Myanmar achieved the highest COVID-19 vaccination acceptance prevalence, with 86% (95%CI 84-89), followed by Vietnam with 82% (95% CI 79-85; I2 99.04%) and Malaysia with 78% (95%CI 72-84; I2 99.88%). None of the ten determinants studied (age, sex, education, previous COVID-19 infections, smoking and marriage status, health insurance, living together, chronic diseases, and healthcare workers) were significantly associated with acceptance. This result will be useful in guiding vaccination uptake in SEA.
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Affiliation(s)
- Theo Audi Yanto
- Department of Internal Medicine, Universitas Pelita Harapan, Tangerang 15811, Indonesia
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Wachinger J, Reñosa MDC, Endoma V, Aligato MF, Landicho-Guevarra J, Landicho J, Bravo TA, McMahon SA. Bargaining and gendered authority: a framework to understand household decision-making about childhood vaccines in the Philippines. BMJ Glob Health 2022; 7:bmjgh-2022-009781. [PMID: 36180099 PMCID: PMC9528616 DOI: 10.1136/bmjgh-2022-009781] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/29/2022] [Indexed: 11/03/2022] Open
Abstract
IntroductionTargeted vaccination promotion efforts aimed at building vaccine confidence require an in-depth understanding of how and by whom decisions about vaccinating children are made. While several studies have highlighted how parents interact with other stakeholders when discussing childhood vaccination, less is known about the way in which vaccination uptake is negotiated within households.MethodsWe conducted 44 in-depth interviews with caregivers of children under five in the Philippines who had delayed or refused vaccination. Interviews were conducted between August 2020 and March 2021 and were audio-recorded, transcribed verbatim and translated into English. Notions of intra-household vaccination bargaining emerged early during systematic debriefings and were probed more pointedly throughout data collection.ResultsParents as well as paternal and maternal families proved to be dominant stakeholders in intra-household bargaining for childhood vaccination. Although bargaining among these stakeholders was based on engrained, gender-based power imbalances, disadvantaged stakeholders could draw on a range of interrelated sources of bargaining power to nevertheless shape decision-making. Sources of bargaining power included, in descending order of their relevance for vaccination, (1) physical presence at the household (at the time of vaccination decision-making), (2) interest in the topic of vaccination and conviction of one’s own position, (3) previous vaccination and caregiving experience, and (4) access to household resources (including finances). The degree to which each household member could draw on these sources of bargaining power varied considerably over time and across households.ConclusionOur findings highlight how bargaining due to intra-household disagreement coins decisions regarding childhood vaccination. Considering the risks for public health associated with vaccine hesitancy globally, we advocate for acknowledging intra-household dynamics in research and practice, such as by purposefully targeting household members with decision-making capacity in vaccination promotion efforts, aligning promotion efforts with available bargaining capacity or further empowering those convinced of vaccination.
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Affiliation(s)
- Jonas Wachinger
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Mark Donald C Reñosa
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Philippines
| | - Vivienne Endoma
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Philippines
| | - Mila F Aligato
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Philippines
| | - Jhoys Landicho-Guevarra
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Philippines
| | - Jeniffer Landicho
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Philippines
| | - Thea Andrea Bravo
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Philippines
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Miao Y, Li Y, Zhang W, Wu J, Gu J, Wang M, Wei W, Ye B, Miao C, Tarimo CS, Dong W. The Psychological Experience of COVID-19 Vaccination and Its Impact on the Willingness to Receive Booster Vaccines among the Chinese Population: Evidence from a National Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095464. [PMID: 35564859 PMCID: PMC9100074 DOI: 10.3390/ijerph19095464] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/22/2022] [Accepted: 04/28/2022] [Indexed: 12/15/2022]
Abstract
The purpose of this study was to assess the psychological experience of COVID-19 basic vaccination, the willingness to receive booster vaccines, and to determine their relationships among Chinese people. Between 6 August 2021 and 9 August 2021, a research firm performed a national cross-sectional online survey among Chinese individuals (aged over 18), using the snowball sampling approach, with 26,755 participants. Factor analysis and binary logistic regression were used to evaluate the existing associations. The overall COVID-19 vaccination psychological experience score of the participants was 25.83 (25.78~25.89; scores ranged from 7–35). A total of 93.83% (95%CI = 93.54~94.12) of respondents indicated a willingness to receive booster vaccines. After classifying psychological experiences associated with COVID-19 vaccination into positive and negative experiences and adjusting for confounding factors, for the former, the willingness to receive booster vaccines for participants with the highest scores of 13–15 was 3.933 times higher (OR = 3.933, 95%CI = 3.176~4.871) than participants who obtained scores of 3–9, and for the latter, the willingness to receive booster vaccines for participants with the highest scores of 19–20 was 8.871 times higher (OR = 8.871, 95%CI = 6.240~12.612) than participants who obtained scores of 4–13. Our study suggests that a good psychological experience with vaccination is positively associated with an increased willingness to receive booster vaccines.
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Affiliation(s)
- Yudong Miao
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou 450001, China; (Y.M.); (Y.L.); (W.Z.); (J.W.); (B.Y.); (C.M.); (C.S.T.)
- Henan Research Center for HTA, Zhengzhou 450001, China
| | - Yi Li
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou 450001, China; (Y.M.); (Y.L.); (W.Z.); (J.W.); (B.Y.); (C.M.); (C.S.T.)
- Henan Research Center for HTA, Zhengzhou 450001, China
| | - Wanliang Zhang
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou 450001, China; (Y.M.); (Y.L.); (W.Z.); (J.W.); (B.Y.); (C.M.); (C.S.T.)
- Henan Research Center for HTA, Zhengzhou 450001, China
| | - Jian Wu
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou 450001, China; (Y.M.); (Y.L.); (W.Z.); (J.W.); (B.Y.); (C.M.); (C.S.T.)
- Henan Research Center for HTA, Zhengzhou 450001, China
| | - Jianqin Gu
- Research Center for Lifestyle Medicine, School of Medicine, Southern University of Science and Technology, Shenzhen 518055, China;
| | - Meiyun Wang
- Department of Hypertension, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou 450003, China; (M.W.); (W.W.)
| | - Wei Wei
- Department of Hypertension, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou 450003, China; (M.W.); (W.W.)
| | - Beizhu Ye
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou 450001, China; (Y.M.); (Y.L.); (W.Z.); (J.W.); (B.Y.); (C.M.); (C.S.T.)
- Henan Research Center for HTA, Zhengzhou 450001, China
| | - Chengyuan Miao
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou 450001, China; (Y.M.); (Y.L.); (W.Z.); (J.W.); (B.Y.); (C.M.); (C.S.T.)
- Henan Research Center for HTA, Zhengzhou 450001, China
| | - Clifford Silver Tarimo
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou 450001, China; (Y.M.); (Y.L.); (W.Z.); (J.W.); (B.Y.); (C.M.); (C.S.T.)
- Henan Research Center for HTA, Zhengzhou 450001, China
| | - Wenyong Dong
- Department of Hypertension, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou 450003, China; (M.W.); (W.W.)
- Correspondence: author: ; Tel.: +86-187-037-17579
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10
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Khan YH, Rasheed M, Mallhi TH, Salman M, Alzarea AI, Alanazi AS, Alotaibi NH, Khan SUD, Alatawi AD, Butt MH, Alzarea SI, Alharbi KS, Alharthi SS, Algarni MA, Alahmari AK, Almalki ZS, Iqbal MS. Barriers and facilitators of childhood COVID-19 vaccination among parents: A systematic review. Front Pediatr 2022; 10:950406. [PMID: 36507133 PMCID: PMC9731120 DOI: 10.3389/fped.2022.950406] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 09/14/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The acceptance of vaccination against COVID-19 among parents of young children plays a significant role in controlling the current pandemic. A wide range of factors that influence vaccine hesitancy in adults has been reported worldwide, but less attention has been given to COVID-19 vaccination among children. Vaccine hesitancy is considered a major challenge in achieving herd immunity, and it is more challenging among parents as they remain deeply concerned about their child's health. In this context, a systematic review of the current literature is inevitable to assess vaccine hesitancy among parents of young children to ensure a successful ongoing vaccination program. METHOD A systematic search of peer-reviewed English literature indexed in Google Scholar, PubMed, Embase, and Web of science was performed using developed keywords between 1 January 2020 and August 2022. This systematic review included only those studies that focused on parental concerns about COVID-19 vaccines in children up to 12 years without a diagnosis of COVID-19. Following PRISMA guidelines, a total of 108 studies were included. The quality appraisal of the study was performed by Newcastle-Ottawa Scale (NOS). RESULTS The results of 108 studies depict that vaccine hesitancy rates differed globally with a considerably large number of factors associated with it. The highest vaccine hesitancy rates among parents were reported in a study from the USA (86.1%) and two studies from Saudi Arabia (>85%) and Turkey (89.6%). Conversely, the lowest vaccine hesitancy rates ranging from 0.69 and 2% were found in two studies from South Africa and Switzerland, respectively. The largest study (n = 227,740) was conducted in Switzerland while the smallest sample size (n = 12) was represented by a study conducted in the USA. The most commonly reported barriers to childhood vaccination were mothers' lower education level (N = 46/108, 43%), followed by financial instability (N = 19/108, 18%), low confidence in new vaccines (N = 13/108, 12%), and unmonitored social media platforms (N = 5/108, 4.6%). These factors were significantly associated with vaccine refusal among parents. However, the potential facilitators for vaccine uptake among respondents who intended to have their children vaccinated include higher education level (N = 12/108, 11%), followed by information obtained through healthcare professionals (N = 9/108, 8.3%) and strong confidence in preventive measures taken by the government (N = 5/81, 4.6%). CONCLUSION This review underscores that parents around the globe are hesitant to vaccinate their kids against COVID-19. The spectrum of factors associated with vaccine hesitancy and uptake varies across the globe. There is a dire need to address vaccine hesitancy concerns regarding the efficacy and safety of approved vaccines. Local context is inevitable to take into account while developing programs to reduce vaccine hesitancy. There is a dire need to devise strategies to address vaccine hesitancy among parents through the identification of attributing factors.
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Affiliation(s)
- Yusra Habib Khan
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Maria Rasheed
- Institute of Pharmacy, Lahore College for Women University, Lahore, Pakistan
| | - Tauqeer Hussain Mallhi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Muhammad Salman
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore, Pakistan
| | - Abdulaziz Ibrahim Alzarea
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Abdullah Salah Alanazi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Nasser Hadal Alotaibi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Salah-Ud-Din Khan
- Department of Biochemistry, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Ahmed D Alatawi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Muhammad Hammad Butt
- Department of Medicinal Chemistry, Faculty of Pharmacy, Uppsala University, Uppsala, Sweden
| | - Sami I Alzarea
- Department of Pharmacology, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Khalid Saad Alharbi
- Department of Pharmacology, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | | | - Majed Ahmed Algarni
- Department of Clinical Pharmacy, College of Pharmacy, Taif University, Taif, Saudi Arabia
| | - Abdullah K Alahmari
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Ziyad Saeed Almalki
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Muhammad Shahid Iqbal
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
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11
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Amit AML, Pepito VCF, Sumpaico-Tanchanco L, Dayrit MM. COVID-19 vaccine brand hesitancy and other challenges to vaccination in the Philippines. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000165. [PMID: 36962166 PMCID: PMC10021706 DOI: 10.1371/journal.pgph.0000165] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/22/2021] [Indexed: 11/19/2022]
Abstract
Effective and safe COVID-19 vaccines have been developed at a rapid and unprecedented pace to control the spread of the virus, and prevent hospitalisations and deaths. However, COVID-19 vaccine uptake is challenged by vaccine hesitancy and anti-vaccination sentiments, a global shortage of vaccine supply, and inequitable vaccine distribution especially among low- and middle-income countries including the Philippines. In this paper, we explored vaccination narratives and challenges experienced and observed by Filipinos during the early vaccination period. We interviewed 35 individuals from a subsample of 1,599 survey respondents 18 years and older in the Philippines. The interviews were conducted in Filipino, Cebuano, and/or English via online platforms such as Zoom or via phone call. All interviews were recorded, transcribed verbatim, translated, and analysed using inductive content analysis. To highlight the complex reasons for delaying and/or refusing COVID-19 vaccines, we embedded our findings within the social ecological model. Our analysis showed that individual perceptions play a major role in the decision to vaccinate. Such perceptions are shaped by exposure to (mis)information amplified by the media, the community, and the health system. Social networks may either positively or negatively impact vaccination uptake, depending on their views on vaccines. Political issues contribute to vaccine brand hesitancy, resulting in vaccination delays and refusals. Perceptions about the inefficiency and inflexibility of the system also create additional barriers to the vaccine rollout in the country, especially among vulnerable and marginalised groups. Recognising and addressing concerns at all levels are needed to improve COVID-19 vaccination uptake and reach. Strengthening health literacy is a critical tool to combat misinformation that undermines vaccine confidence. Vaccination systems must also consider the needs of marginalised and vulnerable groups to ensure their access to vaccines. In all these efforts to improve vaccine uptake, governments will need to engage with communities to 'co-create' solutions.
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Affiliation(s)
- Arianna Maever L Amit
- School of Medicine and Public Health, Ateneo de Manila University, Manila, Philippines
| | | | - Lourdes Sumpaico-Tanchanco
- School of Medicine and Public Health, Ateneo de Manila University, Manila, Philippines
- The Medical City, Manila, Philippines
| | - Manuel M Dayrit
- School of Medicine and Public Health, Ateneo de Manila University, Manila, Philippines
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