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Vadrevu L, Jain M, Parsekar SS. Analyzing the usage of theories of change for routine immunization programs -- a review of impact evaluations from LMICs. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:141. [PMID: 39252041 PMCID: PMC11386364 DOI: 10.1186/s41043-024-00615-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 08/11/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND In this article we analyzed the extent of the usage of Theories of Change (TOCs) and causal pathways in the evaluation of immunization programs to identify the challenges to generating evidence on how interventions improve immunization. METHODS We analyzed the use of the TOC in impact evaluations (IEs) of immunization interventions published after 2010, and its associated articles. The review includes studies from Evidence Gap Map and Yale review that were conducted in May and March of 2020, respectively. We synthesized data on six domains using NVIVO - program theory, context, assumptions, usage of TOC, use in evaluation, and description causal pathways. RESULTS Our review included 47 large-scale and 45 small-to medium-scale interventions. Of the included studies, 19% used a TOC, 56% described a causal pathway or used a conceptual diagram with varying degrees of detail, and 25% of the IEs did not provide any information on how their intervention was expected to affect change. Only 19 of the 92 IEs explicitly outlined any assumptions associated with the implementation of the interventions. Forty studies measured the outputs or intermediate outcomes leading to improved immunization coverage. CONCLUSION Future implementers and evaluators need to develop clear TOCs that are based on established theory and have clearly articulated the underlying assumptions. Large-scale health system strengthening initiatives implemented by governments, also need to build TOCs and integrate them into their results frameworks. Additionally, there is a need to combine both impact and process evaluations to understand the how context affects the causal pathways.
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Affiliation(s)
- Lalitha Vadrevu
- Impact Evaluation Initiative (3ie), 3ie, Unit no. 306, 3rd Floor, Rectangle-1, D-4, Saket District Centre, New Delhi, 110017, India.
| | - Monica Jain
- Impact Evaluation Initiative (3ie), 3ie, Unit no. 306, 3rd Floor, Rectangle-1, D-4, Saket District Centre, New Delhi, 110017, India
| | - Shradha S Parsekar
- Impact Evaluation Initiative (3ie), 3ie, Unit no. 306, 3rd Floor, Rectangle-1, D-4, Saket District Centre, New Delhi, 110017, India
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Frampton S, Orievulu K, Matthews PC, Giubilini A, Hordern J, Burns L, Elias S, Friederich E, Majozi N, Martin S, Stevenson A, Vanderslott S, Seeley J. Pandemic preparedness: why humanities and social sciences matter. Front Public Health 2024; 12:1394569. [PMID: 39220463 PMCID: PMC11361931 DOI: 10.3389/fpubh.2024.1394569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024] Open
Abstract
Whilst many lessons were learned from the COVID-19 pandemic, ongoing reflection is needed to develop and maintain preparedness for future outbreaks. Within the field of infectious disease and public health there remain silos and hierarchies in interdisciplinary work, with the risk that humanities and social sciences remain on the epistemological peripheries. However, these disciplines offer insights, expertise and tools that contribute to understanding responses to disease and uptake of interventions for prevention and treatment. In this Perspective, using examples from our own cross-disciplinary research and engagement programme on vaccine hesitancy in South Africa and the United Kingdom (UK), we propose closer integration of expertise, research and methods from humanities and social sciences into pandemic preparedness.
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Affiliation(s)
- Sally Frampton
- Faculty of History, University of Oxford, Oxford, United Kingdom
| | - Kingsley Orievulu
- Africa Health Research Institute, Durban, South Africa
- Centre for China-Africa Studies, University of Johannesburg, Johannesburg, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Philippa C. Matthews
- The Francis Crick Institute, London, United Kingdom
- Division of Infection and Immunity, University College London, London, United Kingdom
- Department of Infectious Diseases, University College London Hospital, London, United Kingdom
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Alberto Giubilini
- Uehiro Oxford Institute, Humanities Division, University of Oxford, Oxford, United Kingdom
| | - Joshua Hordern
- Faculty of Theology of Religion, Harris Manchester College, University of Oxford, Oxford, United Kingdom
| | - Lizzie Burns
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom
| | - Sean Elias
- Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Ethan Friederich
- Wellcome Centre for Ethics and Humanities, Ethox Centre and Centre for the History of Science, Medicine and Technology, University of Oxford, Oxford, United Kingdom
| | | | - Sam Martin
- Oxford Vaccine Group, University of Oxford and NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
- Rapid Research Evaluation and Appraisal Lab (RREAL), Department of Targeted Intervention, University College London (UCL), London, United Kingdom
| | - Austin Stevenson
- School of Ministry, Palm Beach Atlantic University, West Palm Beach, FL, United States
| | - Samantha Vanderslott
- Oxford Vaccine Group, University of Oxford and NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Janet Seeley
- Africa Health Research Institute, Durban, South Africa
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Al Zahrani EM. The Role of Healthcare Leaders in Promoting Vaccine Acceptance in Saudi Arabia. J Healthc Leadersh 2024; 16:279-286. [PMID: 39072262 PMCID: PMC11277817 DOI: 10.2147/jhl.s470522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/16/2024] [Indexed: 07/30/2024] Open
Abstract
Background Several vaccines have been recommended by the health authorities in recent years and have been opposed by debates, lack of public trust, and variable levels of hesitance that resulted in increased anti-vaccination advocacy and a subsequent reduction in vaccination rates worldwide. Purpose This study aimed to explore the community's perceptions of the role of healthcare leadership in promoting vaccine acceptance. Methods This cross-sectional study used a validated questionnaire designed according to the study's objectives for a heterogeneous purposive sample of individuals over 18 years old in Saudi Arabia. Participants completed the questionnaire online via a link provided by multiple social media platforms. Results The study included 7159 participants with various demographical features. On a five-point Likert scale, the average level of agreement on the role of healthcare executives in promoting vaccines was 3.76. The average level of agreement about the role of healthcare leaders in promoting vaccines was 3.76 out of five. Men were more likely than women to agree on healthcare worker's influence, 63.6% and 58.6%, respectively (P < 0.001). The ages of participants showed a favorable correlation with their level of agreement on the role of healthcare leaders in promoting vaccines (P < 0.001). The level of agreement on healthcare leader's role in promoting vaccines was inversely proportional to the education level (P < 0.001). The retired group reported the highest score, followed by the employed ones (P < 0.001). Conclusion Unlike other political and religious leaders, this study indicates that healthcare professionals significantly impact vaccine hesitancy and uptake. Despite rising vaccine hesitancy, healthcare leaders remain more trustworthy providers of guidance and influence over vaccination decisions than others. In addition, the health leader's factual message boosts people's self-esteem and helps them decide to be vaccinated.
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Affiliation(s)
- Eidan M Al Zahrani
- Physical Therapy Department, Prince Sultan Military College of Health Sciences, Dhahran, Saudi Arabia
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Song MY, Blake-Hepburn D, Karbasi A, Fadel SA, Allin S, Ataullahjan A, Ruggiero ED. Public health partnerships with faith-based organizations to support vaccination uptake among minoritized communities: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002765. [PMID: 38837963 DOI: 10.1371/journal.pgph.0002765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/22/2024] [Indexed: 06/07/2024]
Abstract
Faith-based vaccine initiatives are of growing interest to public health agencies who are looking to increase vaccine confidence among ethnoracially minoritized populations. Despite evidence that support faith-based organizations' (FBOs) partnerships with public health agencies (PHAs) to increase vaccine confidence, reviews on the scope and efforts to ensure equitable vaccination delivery for ethnoracially minoritized populations are scarce. We aimed to understand how public health agencies collaborate with FBOs or faith communities to improve vaccine confidence among minoritized communities in high-, low- and middle- income countries. We conducted a scoping review by searching OVID MEDLINE, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), SCOPUS, and PROQUEST from 2011 to 2023. We included case studies, news reports, observational studies, experimental, and quasi-experimental studies and multimedia content that describes PHA-FBO partnerships that created vaccine initiatives for marginalized and minoritized communities. The data was extracted, summarized, and results were described narratively. We included 167 initiatives reported in 160 publications; 83.8% of the included articles were published between 2019 to 2023. The interventions carried out by PHA-FBO partnerships attempted to increase vaccine uptake using any or all the following methods. First, the initiatives provided digital and in-person platforms for interfaith learning and established training programs to empower faith leaders to become vaccine ambassadors. Second, the initiatives designed and disseminated education and awareness materials that aimed to be sensitive to religious and gender norms. Third, PHA-FBO partnered to apply equity and faith-based frameworks and provided wrap-around support to enable equitable vaccine access. Majority of the initiatives reported that PHA-FBO partnerships improved vaccine confidence and uptake (71.3%). About 22.2% of the initiatives reported quantitative outcomes post-intervention. PHA-FBO initiatives over the past decade increased vaccine uptake and acceptance among diverse ethnoracially minoritized populations. Reporting of faith-based initiatives are subject to publication bias and can be strengthened by examining more evaluation studies and establishment of key outcome indicators to critically appraise intervention outcomes.
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Affiliation(s)
- Melodie Yunju Song
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Anna Karbasi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Shaza A Fadel
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Clinical Public Health Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sara Allin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Anushka Ataullahjan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- School of Health Studies, Faculty of Health Sciences, Western University, London, Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Xie YJ, Liao X, Lin M, Yang L, Cheung K, Zhang Q, Li Y, Hao C, Wang HH, Gao Y, Zhang D, Molassiotis A, Siu GKH, Leung AYM. Community Engagement in Vaccination Promotion: Systematic Review and Meta-Analysis. JMIR Public Health Surveill 2024; 10:e49695. [PMID: 38478914 PMCID: PMC11127135 DOI: 10.2196/49695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/27/2023] [Accepted: 02/27/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Community engagement plays a vital role in global immunization strategies, offering the potential to overcome vaccination hesitancy and enhance vaccination confidence. Although there is significant backing for community engagement in health promotion, the evidence supporting its effectiveness in vaccination promotion is fragmented and of uncertain quality. OBJECTIVE This review aims to systematically examine the effectiveness of different contents and extent of community engagement for promoting vaccination rates. METHODS This study was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive and exhaustive literature search was performed in 4 English databases (PubMed, Embase, Web of Science, and Cochrane Library) and 2 Chinese databases (CNKI and Wan Fang) to identify all possible articles. Original research articles applying an experimental study design that investigated the effectiveness of community engagement in vaccination promotion were eligible for inclusion. Two reviewers independently performed the literature search, study selection, quality assessment, and data extraction. Discrepancies were resolved through discussion, with the arbitration of a third reviewer where necessary. RESULTS A total of 20 articles out of 11,404 records from 2006 to 2021 were retrieved. The studies used various designs: 12 applied single-group pre-post study designs, 5 were cluster randomized controlled trials (RCTs), and 3 were non-RCTs. These studies targeted multiple vaccines, with 8 focusing on children's immunization, 8 on human papillomavirus vaccine, 3 on hepatitis B virus vaccine, and 1 on COVID-19 vaccine. The meta-analysis revealed significant increases in vaccination rates both in pre-post comparison (rate difference [RD] 0.34, 95% CI 0.21-0.47, I2=99.9%, P<.001) and between-group comparison (RD 0.18, 95% CI 0.07-0.29, I2=98.4%, P<.001). The meta-analysis revealed that participant recruitment had the largest effect size (RD 0.51, 95% CI 0.36-0.67, I2=99.9%, P<.001), followed by intervention development (RD 0.36, 95% CI 0.23-0.50, I2=100.0%, P<.001), intervention implementation (RD 0.35, 95% CI 0.22-0.47, I2=99.8%, P<.001), and data collection (RD 0.34, 95% CI 0.19-0.50, I2=99.8%, P<.001). The meta-analysis indicated that high community engagement extent yielded the largest effect size (RD 0.49, 95% CI 0.17-0.82, I2=100.0%, P<.001), followed by moderate community engagement extent (RD 0.45, 95% CI 0.33-0.58, I2=99.6%, P<.001) and low community engagement extent (RD 0.15, 95% CI 0.05-0.25, I2=99.2%, P<.001). The meta-analysis revealed that "health service support" demonstrated the largest effect sizes (RD 0.45, 95% CI 0.25-0.65, I2=99.9%, P<.001), followed by "health education and discussion" (RD 0.39, 95% CI 0.20-0.58, I2=99.7%, P<.001), "follow-up and reminder" (RD 0.33, 95% CI 0.23-0.42, I2=99.3%, P<.001), and "social marketing campaigns and community mobilization" (RD 0.24, 95% CI 0.06-0.41, I2=99.9%, P<.001). CONCLUSIONS The results of this meta-analysis supported the effectiveness of community engagement in vaccination promotion with variations in terms of engagement contents and extent. Community engagement required a "fit-for-purpose" approach rather than a "one-size-fits-all" approach to maximize the effectiveness of vaccine promotion. TRIAL REGISTRATION PROSPERO CRD42022339081; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=339081.
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Affiliation(s)
- Yao Jie Xie
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
- Research Centre for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Xiaoli Liao
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Meijuan Lin
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Lin Yang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Kin Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Qingpeng Zhang
- Musketeers Foundation Institute of Data Science, The University of Hong Kong, Hong Kong, China (Hong Kong)
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Yan Li
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Chun Hao
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Harry Hx Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- Usher Institute, Deanery of Molecular, Genetic & Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Yang Gao
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China (Hong Kong)
| | - Dexing Zhang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Alex Molassiotis
- Health and Social Care Research Centre, University of Derby, Derby, United Kingdom
| | - Gilman Kit Hang Siu
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Angela Yee Man Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
- Research Institute on Smart Aging (RISA), The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
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Oyo-Ita A, Oduwole O, Arikpo D, Effa EE, Esu EB, Balakrishna Y, Chibuzor MT, Oringanje CM, Nwachukwu CE, Wiysonge CS, Meremikwu MM. Interventions for improving coverage of childhood immunisation in low- and middle-income countries. Cochrane Database Syst Rev 2023; 12:CD008145. [PMID: 38054505 PMCID: PMC10698843 DOI: 10.1002/14651858.cd008145.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Immunisation plays a major role in reducing childhood morbidity and mortality. Getting children immunised against potentially fatal and debilitating vaccine-preventable diseases remains a challenge despite the availability of efficacious vaccines, particularly in low- and middle-income countries. With the introduction of new vaccines, this becomes increasingly difficult. There is therefore a current need to synthesise the available evidence on the strategies used to bridge this gap. This is a second update of the Cochrane Review first published in 2011 and updated in 2016, and it focuses on interventions for improving childhood immunisation coverage in low- and middle-income countries. OBJECTIVES To evaluate the effectiveness of intervention strategies to boost demand and supply of childhood vaccines, and sustain high childhood immunisation coverage in low- and middle-income countries. SEARCH METHODS We searched CENTRAL, MEDLINE, CINAHL, and Global Index Medicus (11 July 2022). We searched Embase, LILACS, and Sociological Abstracts (2 September 2014). We searched WHO ICTRP and ClinicalTrials.gov (11 July 2022). In addition, we screened reference lists of relevant systematic reviews for potentially eligible studies, and carried out a citation search for 14 of the included studies (19 February 2020). SELECTION CRITERIA Eligible studies were randomised controlled trials (RCTs), non-randomised RCTs (nRCTs), controlled before-after studies, and interrupted time series conducted in low- and middle-income countries involving children that were under five years of age, caregivers, and healthcare providers. DATA COLLECTION AND ANALYSIS We independently screened the search output, reviewed full texts of potentially eligible articles, assessed the risk of bias, and extracted data in duplicate, resolving discrepancies by consensus. We conducted random-effects meta-analyses and used GRADE to assess the certainty of the evidence. MAIN RESULTS Forty-one studies involving 100,747 participants are included in the review. Twenty studies were cluster-randomised and 15 studies were individually randomised controlled trials. Six studies were quasi-randomised. The studies were conducted in four upper-middle-income countries (China, Georgia, Mexico, Guatemala), 11 lower-middle-income countries (Côte d'Ivoire, Ghana, Honduras, India, Indonesia, Kenya, Nigeria, Nepal, Nicaragua, Pakistan, Zimbabwe), and three lower-income countries (Afghanistan, Mali, Rwanda). The interventions evaluated in the studies were health education (seven studies), patient reminders (13 studies), digital register (two studies), household incentives (three studies), regular immunisation outreach sessions (two studies), home visits (one study), supportive supervision (two studies), integration of immunisation services with intermittent preventive treatment of malaria (one study), payment for performance (two studies), engagement of community leaders (one study), training on interpersonal communication skills (one study), and logistic support to health facilities (one study). We judged nine of the included studies to have low risk of bias; the risk of bias in eight studies was unclear and 24 studies had high risk of bias. We found low-certainty evidence that health education (risk ratio (RR) 1.36, 95% confidence interval (CI) 1.15 to 1.62; 6 studies, 4375 participants) and home-based records (RR 1.36, 95% CI 1.06 to 1.75; 3 studies, 4019 participants) may improve coverage with DTP3/Penta 3 vaccine. Phone calls/short messages may have little or no effect on DTP3/Penta 3 vaccine uptake (RR 1.12, 95% CI 1.00 to 1.25; 6 studies, 3869 participants; low-certainty evidence); wearable reminders probably have little or no effect on DTP3/Penta 3 uptake (RR 1.02, 95% CI 0.97 to 1.07; 2 studies, 1567 participants; moderate-certainty evidence). Use of community leaders in combination with provider intervention probably increases the uptake of DTP3/Penta 3 vaccine (RR 1.37, 95% CI 1.11 to 1.69; 1 study, 2020 participants; moderate-certainty evidence). We are uncertain about the effect of immunisation outreach on DTP3/Penta 3 vaccine uptake in children under two years of age (RR 1.32, 95% CI 1.11 to 1.56; 1 study, 541 participants; very low-certainty evidence). We are also uncertain about the following interventions improving full vaccination of children under two years of age: training of health providers on interpersonal communication skills (RR 5.65, 95% CI 3.62 to 8.83; 1 study, 420 participants; very low-certainty evidence), and home visits (RR 1.29, 95% CI 1.15 to 1.45; 1 study, 419 participants; very low-certainty evidence). The same applies to the effect of training of health providers on interpersonal communication skills on the uptake of DTP3/Penta 3 by one year of age (very low-certainty evidence). The integration of immunisation with other services may, however, improve full vaccination (RR 1.29, 95% CI 1.16 to 1.44; 1 study, 1700 participants; low-certainty evidence). AUTHORS' CONCLUSIONS Health education, home-based records, a combination of involvement of community leaders with health provider intervention, and integration of immunisation services may improve vaccine uptake. The certainty of the evidence for the included interventions ranged from moderate to very low. Low certainty of the evidence implies that the true effect of the interventions might be markedly different from the estimated effect. Further, more rigorous RCTs are, therefore, required to generate high-certainty evidence to inform policy and practice.
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Affiliation(s)
- Angela Oyo-Ita
- Department of Community Health, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Olabisi Oduwole
- Department of Medical Laboratory Science, Achievers University, Owo, Nigeria
| | - Dachi Arikpo
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Emmanuel E Effa
- Internal Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Ekpereonne B Esu
- Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Yusentha Balakrishna
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | - Moriam T Chibuzor
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Chioma M Oringanje
- GIDP Entomology and Insect Science, University of Tucson, Tucson, Arizona, USA
| | | | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Vaccine-Preventable Diseases Programme, World Health Organization Regional Office for Africa, Cité du Djoué, Brazzaville, Congo
| | - Martin M Meremikwu
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria
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Speers SJ, Lau LL, Neufeld HT, Servano D, Go DJ, Kipp A, Brubacher LJ, Dodd W. Caring in crisis: The experiences of local religious leaders meeting community food needs in the Philippines during the COVID-19 pandemic. WELLBEING, SPACE AND SOCIETY 2023; 5:100154. [PMID: 37360611 PMCID: PMC10278461 DOI: 10.1016/j.wss.2023.100154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/27/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023]
Abstract
To respond to the unintended consequences of prevention measures to reduce COVID-19 transmission, individuals and groups, including religious leaders, have collaborated to provide care to those negatively impacted by these measures. Amid these various efforts and interventions, there is a need to deepen our understanding of diverse expressions of care across various geographical and social contexts. To address this need, the objective of this study was to investigate how religious leaders in the Philippines practiced care for their communities by meeting emergency food needs amid the COVID-19 pandemic. Guided by an ethics of care theoretical orientation, we conducted 25 remote semi-structured interviews with Filipino religious leaders who partnered with a Philippines-based non-governmental organization (NGO) to mobilize essential food aid to their local communities. Through defining the efforts and activities of these religious leaders as care work, we found that religious leader experiences revolved around navigating care responsibilities, caring alongside others, and engaging holistically with the care work. Additionally, we observed how contextual factors such as the humanitarian settings where religious leaders worked, the partnership with an NGO, and the positionality of local religious leaders within their communities, fundamentally shaped the care work. This study expands our understanding of how care is practiced and experienced and also brings greater visibility to the experiences and efforts of local religious leaders in responding to humanitarian emergencies.
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Affiliation(s)
- Shoshannah Joanna Speers
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada, N2L 3G1
| | - Lincoln Leehang Lau
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada, N2L 3G1
- International Care Ministries, Unit 1701, 17th Floor, West Tower, Philippine Stock Exchange Center, Exchange Road, Ortigas Center, Pasig City, Metro Manila, Philippines, 1605
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, Canada, M5T 3M7
| | - Hannah Tait Neufeld
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada, N2L 3G1
| | - Danilo Servano
- International Care Ministries, Unit 1701, 17th Floor, West Tower, Philippine Stock Exchange Center, Exchange Road, Ortigas Center, Pasig City, Metro Manila, Philippines, 1605
| | - Daryn Joy Go
- International Care Ministries, Unit 1701, 17th Floor, West Tower, Philippine Stock Exchange Center, Exchange Road, Ortigas Center, Pasig City, Metro Manila, Philippines, 1605
| | - Amy Kipp
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada, N2L 3G1
| | - Laura Jane Brubacher
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada, N2L 3G1
| | - Warren Dodd
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada, N2L 3G1
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Afsharinia B, Gurtoo A. Role of leadership and incentive-based programs in addressing vaccine hesitancy in India. Vaccine X 2023; 15:100346. [PMID: 37577213 PMCID: PMC10413069 DOI: 10.1016/j.jvacx.2023.100346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 08/15/2023] Open
Abstract
The current study goes beyond the popular 5Cs model of vaccine hesitancy to explore perceived social norms, role of leadership and the role of incentive-based intervention for improving the likelihood of vaccination, in a population-representative sample of adults in India (N = 1129). We investigated differences in socio-demographic status, perceived descriptive norms like vaccine behaviours, beliefs, experience and perceived injunctive norms like community and political leadership within the context of the COVID-19 pandemic are related to vaccination. Further, we examined the role of incentive-based intervention as a potentially salient predictor of adults' vaccine uptake. The study is based on a cross-sectional survey conducted in July-November 2021, which included questions about impacts of pandemic collected by phone call interview from adults' beneficiaries of Government free food schemes, across 11 states in India. The data include 81 % vaccinated and 19 % vaccine hesitant participants, with a higher proportion of business or self-employed (53.1 %) as vaccine hesitant. We performed the t-test to assess the variation between vaccinated and vaccine hesitant adults, and Exploratory Factor Analysis to uncover the underlying dimension of vaccine hesitancy. Subsequently, Binary Logistic Regression model probed the factors associated with likelihood of vaccination uptake. In contrast to the prevailing evidence, results demonstrated community and political leadership has significant negative impact on vaccination (p-value < 0.06, 95 % CI, 0.57-1.01). Incentive-based intervention offer a vital leverage to enhance positive attitude towards vaccination (p-value < 0.05, 95 % CI, 1.01-1.80). The results thus broadly highlight the limited role of political and community leaders in leveraging their influence on vaccination, the role of timely, accurate information, applications of telemedicine as an important tool to provide healthcare and the need for optimal design of incentive-based vaccination programs recommended by trusted sources.
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Affiliation(s)
- Bita Afsharinia
- Senior Research Scholar, Department of Management Studies, Indian Institute of Science, Bangalore 560012, India
| | - Anjula Gurtoo
- Senior Research Scholar, Department of Management Studies, Indian Institute of Science, Bangalore 560012, India
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Omale UI, Ewah RL, Amuzie CI, Ikegwuonu CO, Nkwo GE, Iwegbulam CC, Ekwuazi LC. Study protocol for a cluster-randomised controlled trial of hybrid parents and health workers adaptive intervention for optimal routine childhood immunisation coverage in the communities of Ebonyi state, Nigeria: the AGINTOPIC trial protocol. BMJ Open 2023; 13:e068953. [PMID: 37438066 DOI: 10.1136/bmjopen-2022-068953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION Vaccine-preventable infectious diseases (VPDs) are major causes of morbidity/mortality among children under 5 years of age worldwide and in Nigeria/Ebonyi state. Routine childhood immunisation is an invaluable prevention strategy for many VPDs. Due to suboptimal coverage and untimely receipt/delay in receipt of vaccinations, outbreaks of VPDs such as measles, yellow fever, diphtheria and others continue to reoccur around the world and in Nigeria/Ebonyi state. This study aims to evaluate the effectiveness of hybrid parents and health workers adaptive intervention in increasing the optimal/timely (cumulative age-appropriate) routine childhood immunisation coverage in the communities in Ebonyi state, Nigeria. METHODS AND ANALYSES A two-arm, parallel, open label, covariate-constrained cluster-randomised controlled trial with 1:1 allocation of 16 geographical clusters (the nearest catchment areas for at least one public primary healthcare (PHC) facility with at least 500 households or a population size of 3000) will be used to evaluate the effects of hybrid/combined parents and PHC workers adaptive engagement compared with control. The primary outcomes are the optimal/timely (cumulative age-appropriate) receipt of the recommended vaccines in the routine childhood immunisation schedule by children aged 5-9 completed months and 10-11 completed months and the age-appropriate vaccines receipt score for the recommended vaccines. The outcomes will be measured through a population-based household survey of at least 15 children aged 5-9 and 10-11 months per cluster at baseline and at the end of the study using a structured interviewer-administered questionnaire in KoBoCollect installed in android devices. All analyses will be done using a cluster-level method on as-randomised basis. ETHICS AND DISSEMINATION Ethical approval for the trial was obtained from the Ebonyi State Health Research and Ethics Committee (EBSHREC/01/06/2022-31/05/2023) and verbal consent will be obtained from participants. Study findings will be reported at local/national and international levels as appropriate. TRIAL REGISTRATION NUMBER ISRCTN59811905.
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Affiliation(s)
- Ugwu I Omale
- Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
| | - Richard L Ewah
- Anaesthesia, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
- Surgery, Anaesthesia Unit, Ebonyi State University, Abakaliki, Nigeria
| | - Chidinma I Amuzie
- Community Medicine, Federal Medical Centre Umuahia, Umuahia, Nigeria
| | - Cordis O Ikegwuonu
- Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
| | - Glory E Nkwo
- Community Medicine, Federal Medical Centre Umuahia, Umuahia, Nigeria
| | | | - Louisa C Ekwuazi
- Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
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Bell J, Lartey B, Fernandez M, Darrell N, Exton-Smith H, Gardner C, Richards E, Akilo A, Odongo E, Ssenkungu J, Kotchi Kouadio R, Cissé M, Rérambyah ABAI, Adou M, West R, Sharma S. A structural equation modelling approach to understanding the determinants of childhood vaccination in Nigeria, Uganda and Guinea. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001289. [PMID: 36989212 PMCID: PMC10058155 DOI: 10.1371/journal.pgph.0001289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/23/2023] [Indexed: 03/30/2023]
Abstract
Vaccines have contributed to reductions in morbidity and mortality from preventable diseases globally, but low demand for vaccination threatens to reverse these gains. Explorations of the determinants of vaccination uptake may rely on proxy variables to describe complex phenomena and construct models without reference to underlying theories of vaccine demand. This study aimed to use the results of a formative qualitative study (described elsewhere) to construct and test a model to explain the determinants of vaccination uptake. Using the results of a survey among more than 3,000 primary caregivers of young children in Nigeria, Uganda and Guinea, factor analysis produced six explanatory factors. We then estimated the effects of each of these factors on uptake of immunization using a structural equation model. The results showed that the probability that a child is fully vaccinated increases if a caregiver has support from others to vaccinate them (B = 0.33, β = 0.21, p<0.001) and if caregivers had poor experiences with the healthcare system (B = 0.09, β = 0.09, p = 0.007). Conversely, the probability of full vaccination decreases if the caregiver's husband exerts control over her decision-making ability (B = -0.29, β = -0.20, p<0.001), or if the caregiver perceives vaccines to be of low importance (B = -0.37, β = -0.27, p<0.001). Belief in religious protection (B = -0.07, β = -0.05, p = 0.118) and a belief that vaccines are harmful (B = -0.12, β = -0.04, p = 0.320) did not have an observed effect on vaccination status. This research suggests that interventions may benefit from that including entire families and communities in their design.
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Affiliation(s)
- James Bell
- Ipsos Healthcare, London, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Rebecca West
- Ipsos Healthcare, London, United Kingdom
- Boston University School of Public Health, Boston, Massachusetts, United States of America
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Ampofo AG, Mackenzie L, Boyes AW. HPV vaccination: Intention to participate among female senior high school students in Ghana. Vaccine 2023; 41:159-169. [PMID: 36411133 DOI: 10.1016/j.vaccine.2022.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cervical cancer is the second most common cancer and the second leading cause of cancer death among women in Ghana. HPV vaccination is expected to be added to the national vaccination schedule in 2023. This study aimed to: i) describe intentions to participate in HPV vaccination and ii) explore factors associated with vaccination intentions among female senior high school students in Ghana. METHODS Female students (aged 16-24) were recruited from 17 senior high schools in Ashanti Region. A cross-sectional anonymous self-report paper-and-pen survey assessed students' HPV vaccination intentions using three items, and a range of correlates (individual, parent/family, social networks, service provision). Descriptive statistics were calculated for vaccination intentions, and correlates of intention scores (where higher scores indicate stronger intentions) were explored with a linear mixed-effect model. RESULTS Of 2400 participants, 64% (95%CI: 62%, 67%) agreed with at least one vaccination intention item. Uncertainty and disagreement with at least one item were endorsed by 51% (95%CI: 49%, 53%) and 44% (95%CI: 42%, 46%) of students, respectively. One-quarter of the students (25%, 95%CI: 23%, 26%) agreed, 12% (95% 11%, 13%) disagreed, and 11% (95%CI: 10%,13%) indicated uncertainty, on all three vaccination intention items. Vaccination uptake was 4.5%. Students were likely to have higher vaccination intention scores if: they had stronger beliefs about vaccine effectiveness; vaccination was recommended by parents, religious leaders and service providers, and vaccinated peers; and it was free. Students were likely to have lower vaccination intention scores if they perceived barriers to vaccination (e.g., side effects). CONCLUSIONS While two-thirds of students had some intention to participate in HPV vaccination, vaccine hesitancy (i.e., uncertainty or disagreement) was apparent. Alongside the rollout of a free national vaccination programme, messaging about vaccination benefits and effectiveness targeting students, as well as parents, religious leaders, service providers and peers would be beneficial given their influential role in students' vaccination intentions.
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Affiliation(s)
- Ama Gyamfua Ampofo
- Health Behavior Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia; Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Lisa Mackenzie
- Health Behavior Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia; Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Allison W Boyes
- Health Behavior Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia; Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Lee L, Moo E, Angelopoulos T, Yashadhana A. Integrated people-centered eye care: A scoping review on engaging communities in eye care in low- and middle-income settings. PLoS One 2023; 18:e0278969. [PMID: 36656849 PMCID: PMC9851534 DOI: 10.1371/journal.pone.0278969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/24/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Community engagement has been endorsed as a key strategy to achieving integrated people-centered eye care that enables people and communities to receive a full spectrum of eye care across their life-course. Understanding the ways communities are engaged in eye care, to what degree participation is achieved, and the factors associated with intervention implementation is currently limited. OBJECTIVE The scoping review aimed to assess how community engagement is approached and implemented in eye care interventions in low- and middle-income countries, and to identify the barriers and facilitators associated with intervention implementation. METHODS Searches were conducted across five databases for peer-reviewed research on eye care interventions engaging communities published in the last ten years (January 2011 to September 2021). Studies were screened, reviewed and appraised according to Cochrane Rapid Reviews methodology. A hybrid deductive-inductive iterative analysis approach was used. RESULTS Of 4315 potential studies screened, 73 were included in the review. Studies were conducted across 28 countries and 55 targeted populations across more than one life-course stage. A variety of community actors were engaged in implementation, in four main domains of eye care: health promotion and education; drug and supplement distribution and immunization campaigns; surveillance, screening and detection activities; and referral and pathway navigation. With the approaches and level of participation, the majority of studies were community-based and at best, involved communities, respectively. Involving community actors alone does not guarantee community trust and therefore can impact eye care uptake. Community actors can be integrated into eye care programs, although with varying success. Using volunteers highlighted sustainability issues with maintaining motivation and involvement when resources are limited. CONCLUSION This scoping review provides researchers and policy makers contextual evidence on the breadth of eye care interventions and the factors to be considered when engaging and empowering communities in integrated people-centered eye care programs.
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Affiliation(s)
- Ling Lee
- International Programs Division, The Fred Hollows Foundation Australia, Melbourne, Australia
- School of Optometry and Vision Science, The University of New South Wales, Sydney Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, Australia
- * E-mail:
| | - Elise Moo
- International Programs Division, The Fred Hollows Foundation Australia, Melbourne, Australia
| | - Tiffany Angelopoulos
- International Programs Division, The Fred Hollows Foundation Australia, Melbourne, Australia
| | - Aryati Yashadhana
- International Programs Division, The Fred Hollows Foundation Australia, Melbourne, Australia
- Centre for Primary Health Care and Equity, The University of New South Wales, Sydney, Australia
- School of Population Health, The University of New South Wales, Sydney, Australia
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Bell J, Lartey B, Spickernell G, Darrell N, Salt F, Gardner C, Richards E, Fasakin L, Egbeniyi S, Odongo E, Ssenkungu J, Kouadio RK, Cissé M, Rérambyah ABAI, Adou M, West R, Sharma S. Applying a social-ecological model to understand factors impacting demand for childhood vaccinations in Nigeria, Uganda, and Guinea. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:None. [PMID: 36531294 PMCID: PMC9748306 DOI: 10.1016/j.ssmqr.2022.100180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 10/08/2022] [Accepted: 10/11/2022] [Indexed: 06/17/2023]
Abstract
Vaccines have reduced child mortality across the world, but low levels of demand for vaccination threatens to undermine progress. Existing frameworks to understand demand tend to prioritise primary caregivers' decision-making processes. We aimed to build a wider understanding of vaccine demand by applying an adapted socio-ecological model to analyse 158 interviews with primary caregivers and fathers of young children, and community influencers in Nigeria, Uganda, and Guinea. We found that several factors come together to inform a primary caregiver's demand for vaccination, including their familial and social relationships, their interactions with government and healthcare institutions, and the wider social and cultural norms in their communities. The study suggests that interventions targeted at families and communities instead of individuals could be effective. The results could be used to ensure that vaccine demand frameworks used by researchers and intervention designers are comprehensive and consider a wider range of influences on the primary caregiver.
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Affiliation(s)
- James Bell
- Ipsos Healthcare, 3 Thomas More Square, London, E1W 1YW, UK
| | - Belinda Lartey
- Ipsos Healthcare, 3 Thomas More Square, London, E1W 1YW, UK
| | | | | | - Frances Salt
- Ipsos Healthcare, 3 Thomas More Square, London, E1W 1YW, UK
| | - Cassie Gardner
- Ipsos Healthcare, 3 Thomas More Square, London, E1W 1YW, UK
| | - Emily Richards
- Ipsos Healthcare, 3 Thomas More Square, London, E1W 1YW, UK
| | - Lanre Fasakin
- CMRG, 24A, Eric Moore Street, Wemabod Estate, Off Ajao Road, Ikeja, Lagos, Nigeria
| | - Shadrach Egbeniyi
- CMRG, 24A, Eric Moore Street, Wemabod Estate, Off Ajao Road, Ikeja, Lagos, Nigeria
| | - Emmanuel Odongo
- Ipsos Uganda, 3rd Floor Padre Pio House, Plot 32, Lumumba Avenue P.O. Box 21571, Kampala, Uganda
| | - James Ssenkungu
- Ipsos Uganda, 3rd Floor Padre Pio House, Plot 32, Lumumba Avenue P.O. Box 21571, Kampala, Uganda
| | | | - Mamadi Cissé
- Ciblage, En Face de l’Ecole les Ecureuils, Lambanyi, Ratoma, Conakry, Guinea
| | | | - Maikol Adou
- Ciblage, Face SODECI, Imm. Hué, Porte B10, Riviera Attoban, Cocody, 09 BP 799, Abidjan 09, Cote d’Ivoire
| | - Rebecca West
- Ipsos Healthcare, 3 Thomas More Square, London, E1W 1YW, UK
- Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, United States
| | - Sunny Sharma
- Ipsos Healthcare, 3 Thomas More Square, London, E1W 1YW, UK
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Kandasamy S, Ariyarajah A, Limbachia J, An D, Lopez L, Manoharan B, Pacht E, Silver A, Uddandam A, Vansjalia KM, Williams NC, Anand SS. South Asian Youth as Vaccine Agents of Change (SAY-VAC): evaluation of a public health programme to mobilise and empower South Asian youth to foster COVID-19 vaccine-related evidence-based dialogue in the Greater Toronto and Hamilton Area, Canada. BMJ Open 2022; 12:e061619. [PMID: 36153036 PMCID: PMC9511009 DOI: 10.1136/bmjopen-2022-061619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES There have been substantial amounts of misinformation surrounding the importance, safety and effectiveness of the COVID-19 vaccine. The impacts of this misinformation may be augmented as they circulate among ethnic communities, who may concurrently face other barriers related to vaccine uptake and access. To combat some of the key sources of COVID-19 vaccine misinformation among the South Asian communities of the Greater Toronto and Hamilton Area (GTHA), an interdisciplinary team of researchers and marketing experts established the South Asian Youth as Vaccine Agents of Change (SAY-VAC) programme to support and empower South Asian youth to disseminate COVID-19 vaccine information. DESIGN Cross-sectional and one-group pretest-post-test design. SETTING GTHA. PARTICIPANTS South Asian youth (18-29 years). INTERVENTION The team partnered with grass-roots South Asian organisations to collaborate on shared objectives, curate key concerns, create video products regarding the COVID-19 vaccine that would resonate with the community, disseminate the products using established social media channels and evaluate the effectiveness of this effort. OUTCOMES We assessed the change in self-reported knowledge about the COVID-19 vaccine and participant confidence to facilitate a conversation around the COVID-19 vaccine using pre-post surveys, after the implementation of the SAY-VAC programme. RESULTS In total, 30 South Asian youth (median age=23.2 years) from the GTHA participated in the programme. After completing the SAY-VAC programme, participants reported an increase in their self-reported knowledge regarding the COVID-19 vaccine from 73.3% to 100.0% (p=0.005), and their self-reported confidence to have a conversation about the vaccine with their unvaccinated community members increased from 63.6% to 100.0% (p=0.002). Overall, 51.9% of the participants reported being able to positively affect an unvaccinated/community member's decision to get vaccinated. CONCLUSIONS The SAY-VAC programme highlights the importance of community partnerships in developing and disseminating culturally responsive health communication strategies. A constant assessment of the evidence and utilisation of non-traditional avenues to engage the public are essential.
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Affiliation(s)
- Sujane Kandasamy
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Archchun Ariyarajah
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jayneel Limbachia
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Derrick An
- DESALU Creative, Toronto, Ontario, Canada
| | - Luke Lopez
- DESALU Creative, Toronto, Ontario, Canada
| | - Baanu Manoharan
- Master of Public Health (MPH) Program, McMaster University, Hamilton, Ontario, Canada
| | - Evan Pacht
- DESALU Creative, Toronto, Ontario, Canada
| | | | - Abhilash Uddandam
- Life Sciences Program, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Sonia S Anand
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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15
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SAVADOGO M, RENMANS D, ALAMBEDJI RBADA, TARNAGDA Z, ANTOINE-MOUSSIAUX N. Using causal loop analysis to explore pathways for zoonosis control in low-income setting: the case of dog rabies vaccination in Burkina Faso. Prev Vet Med 2022; 203:105623. [DOI: 10.1016/j.prevetmed.2022.105623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 03/15/2022] [Accepted: 03/20/2022] [Indexed: 11/30/2022]
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Wijesinghe MSD, Ariyaratne VS, Gunawardana BMI, Rajapaksha RMNU, Weerasinghe WMPC, Gomez P, Chandraratna S, Suveendran T, Karunapema RPP. Role of Religious Leaders in COVID-19 Prevention: A Community-Level Prevention Model in Sri Lanka. JOURNAL OF RELIGION AND HEALTH 2022; 61:687-702. [PMID: 34812996 PMCID: PMC8609254 DOI: 10.1007/s10943-021-01463-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 05/05/2023]
Abstract
The COVID-19 pandemic has affected all countries irrespective of their state of development. In countries with traditional societies, religious leaders have been acknowledged as key stakeholders in community engagement activities, including disease prevention. A community-level prevention model was established in 2020 by the Health Promotion Bureau (HPB), Sri Lanka, which incorporated mobilisation of the clergy to support the prevention and response schemes to COVID-19 with non-governmental stakeholders. This model was part of a more extensive community engagement network established by the HPB in cooperation with the country offices for WHO and UNICEF. Building trust, empowering behavioural traits applicable to minimise risks from COVID-19, leadership and coordination, message dissemination, addressing stigma and discrimination, supporting testing procedures, contact tracing activities and vaccination, building community resilience, spiritual and psychosocial support, and welfare provision are some of the useful factors that were identified in the model. Furthermore, a much broader and holistic approach is needed to focus on health behaviours and social and cultural aspects in a multi-faceted nature. This paper highlights a novel COVID-19 prevention model with active involvement of religious leaders that can be implemented in low resource settings. Our experience from Sri Lanka demonstrates the feasibility of implementing this model to mitigate the disastrous situation following the COVID-19 outbreak.
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Affiliation(s)
| | - Vinya S. Ariyaratne
- Sarvodaya Shramadana Movement, No.98, Rawathawatta Road, Moratuwa, Sri Lanka
| | | | | | | | - Praveen Gomez
- Alliance Development Trust, No.95, Galle Road, Dehiwala, Sri Lanka
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Oyo-Ita AE, Hanlon P, Nwankwo O, Bosch-Capblanch X, Arikpo D, Esu E, Auer C, Meremikwu M. Cost-effectiveness analysis of an intervention project engaging Traditional and Religious Leaders to improve uptake of childhood immunization in southern Nigeria. PLoS One 2021; 16:e0257277. [PMID: 34529714 PMCID: PMC8445457 DOI: 10.1371/journal.pone.0257277] [Citation(s) in RCA: 3] [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: 08/14/2020] [Accepted: 08/27/2021] [Indexed: 11/18/2022] Open
Abstract
Vaccination is a cost-effective public health intervention, yet evidence abounds that vaccination uptake is still poor in many low- and middle-income countries. Traditional and Religious Leaders play a substantial role in improving the uptake of health services such as immunization. However, there is paucity of evidence on the cost-effectiveness of using such strategies. This study aimed to assess the cost-effectiveness of using a multi-faceted intervention that included traditional and religious leaders for community engagement to improve uptake of routine immunisation services in communities in Cross River State, Southern Nigeria. The target population for the intervention was traditional and religious leaders in randomly selected communities in Cross River State. The impact of the intervention on the uptake of routine vaccination among children 0 to 23 months was assessed using a cluster randomized trials. Outcome assessments were performed at the end of the project (36 months).The cost of the intervention was obtained from the accounting records for expenditures incurred in the course of implementing the intervention. Costs were assessed from the health provider perspective. The cost-effectiveness analysis showed that the incremental cost of the initial implementation of the intervention was US$19,357and that the incremental effect was 323 measles cases averted, resulting in an incremental cost-effectiveness ratio (ICER) of US$60/measles case averted. However, for subsequent scale-up of the interventions to new areas not requiring a repeat expenditure of some of the initial capital expenditure the ICER was estimated to be US$34 per measles case averted. Involving the traditional and religious leaders in vaccination is a cost-effective strategy for improving the uptake of childhood routine vaccinations.
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Affiliation(s)
- Angela E. Oyo-Ita
- Department of Community Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria
- Effective Health Care Alliance Programme, Institute of Tropical Disease, Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
- * E-mail:
| | - Patrick Hanlon
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Ogonna Nwankwo
- Department of Community Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Dachi Arikpo
- Effective Health Care Alliance Programme, Institute of Tropical Disease, Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Ekperonne Esu
- Effective Health Care Alliance Programme, Institute of Tropical Disease, Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
- Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Christian Auer
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Martin Meremikwu
- Effective Health Care Alliance Programme, Institute of Tropical Disease, Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
- Department of Paediatrics, College of Medical Sciences, University of Calabar, Calabar, Nigeria
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