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Wachinger J, Reñosa MDC, Endoma V, Landicho-Guevarra J, McMahon SA. Routines, disruptions, revised decisions: A biographical analysis of vaccination trajectories among Filipino caregivers. Vaccine 2024:S0264-410X(24)00736-9. [PMID: 38972765 DOI: 10.1016/j.vaccine.2024.06.062] [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: 03/26/2024] [Revised: 05/27/2024] [Accepted: 06/26/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Individuals' vaccine attitudes and practices are not static, but instead are shaped and iteratively revised based on new information and experiences. Understanding shifts over the life course could inform novel approaches and indicate opportune points for communicating vaccine information, but little is known about individuals' vaccination biographies, particularly in low- and middle-income countries. METHODS To explore vaccination biographies in a setting marked by high proportions of vaccine hesitancy and recent large-scale vaccination discourses, we conducted and biographically analyzed n = 29 narrative in-depth interviews with caregivers of small children in the Philippines. RESULTS Our results outline how the perceived relevance of vaccination and an individual's own attitudes and practices repeatedly changed over the course of their life. While respondents narrated vague memories of early vaccine encounters in their families, at schools, or during vaccination campaigns, vaccine relevance accelerated drastically during respondents' or their partner's first perinatal period. Over the following life phase as caregivers, respondents described iterative shifts in their vaccine stance (based on their own experiences, broader discourses, or changing contexts) until their youngest child 'graduated' from immunization. Respondents' later adulthood and old age were commonly marked by little engagement with immunization (except for the COVID-19 vaccines), until the birth of grandchildren sparked renewed motivation to guide younger generations (whether for or against vaccination). CONCLUSIONS The relevance of vaccination and associated attitudes or practices repeatedly change over the life course. Vaccine promotion efforts could incorporate these biographical dynamics to align with respondents' informational needs, for example by increased engagement in first perinatal periods, eye-level communication at later phases to acknowledge caregivers' increased sense of expertise, and encouragement of vaccine confident grandparents to engage in younger generations' vaccination decisions. Future research should explore transgenerational vaccine trajectories and the potential of biographically targeted promotion efforts.
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Affiliation(s)
- Jonas Wachinger
- Heidelberg Institute of Global Health, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany.
| | - Mark Donald C Reñosa
- Heidelberg Institute of Global Health, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, 9002 Research Drive, Filinvest City, Alabang, Muntinlupa City 1781 Philippines
| | - Vivienne Endoma
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, 9002 Research Drive, Filinvest City, Alabang, Muntinlupa City 1781 Philippines
| | - Jhoys Landicho-Guevarra
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, 9002 Research Drive, Filinvest City, Alabang, Muntinlupa City 1781 Philippines
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
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Kalbarczyk A, Brownlee N, Katz E. Of Money and Men: A Scoping Review to Map Gender Barriers to Immunization Coverage in Low- and Middle-Income Countries. Vaccines (Basel) 2024; 12:625. [PMID: 38932354 PMCID: PMC11209140 DOI: 10.3390/vaccines12060625] [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: 04/29/2024] [Revised: 05/22/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024] Open
Abstract
Among the multiple factors impeding equitable childhood immunization coverage in low- and middle-income countries (LMICs), gender barriers stand out as perhaps the most universal. Despite increasing recognition of the importance of gender considerations in immunization programming, there has not yet been a systematic assessment of the evidence on gender barriers to immunization. We conducted a scoping review to fill that gap, identifying 92 articles that described gender barriers to immunization. Studies documented a range of gender influencers across 43 countries in Africa and South Asia. The barrier to immunization coverage most frequently cited in the literature is women's lack of autonomous decision-making. Access to immunization is significantly impacted by women's time poverty; direct costs are also a barrier, particularly when female caregivers rely on family members to cover costs. Challenges with clinic readiness compound female caregiver's time constraints. Some of the most important gender barriers lie outside of the usual purview of immunization programming but other barriers can be addressed with adaptations to vaccination programming. We can only know how important these barriers are with more research that measures the impact of programming on gender barriers to immunization coverage.
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Affiliation(s)
- Anna Kalbarczyk
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Natasha Brownlee
- Global Center for Gender Equality, Washington, DC 20036, USA; (N.B.); (E.K.)
| | - Elizabeth Katz
- Global Center for Gender Equality, Washington, DC 20036, USA; (N.B.); (E.K.)
- Department of Economics, University of San Francisco, San Francisco, CA 94117, USA
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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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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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