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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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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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