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Kaufman J, Overmars I, Fong J, Tudravu J, Devi R, Volavola L, Vodonaivalu L, Jenkins K, Leask J, Seale H, Mohamed Y, Joshi K, Datt H, Sagan S, Dynes M, Hoq M, Danchin M. Training health workers and community influencers to be Vaccine Champions: a mixed-methods RE-AIM evaluation. BMJ Glob Health 2024; 9:e015433. [PMID: 39251236 DOI: 10.1136/bmjgh-2024-015433] [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: 02/26/2024] [Accepted: 08/22/2024] [Indexed: 09/11/2024] Open
Abstract
INTRODUCTION Increasing trust and confidence in vaccines is a global priority, as countries have grappled with delivering COVID-19 vaccines, maintaining routine childhood vaccination rates and introducing new vaccines. Community-based vaccine promotion interventions are commonly implemented, but effectiveness evidence is limited. In 2022, supported by the Australian Government and in partnership with Fiji's Ministry of Health and UNICEF, we codesigned, delivered and comprehensively evaluated a vaccine education and communication training programme for health workers and community influencers to promote COVID-19 and routine immunisation. METHODS The Vaccine Champions programme included three phases: (1) codesign with Fiji stakeholders; (2) vaccine education and communication training for Vaccine Champions and (3) support for Champions to deliver community vaccine discussion sessions over 6 months.The RE-AIM framework evaluation measured programme reach, effectiveness, adoption, implementation and maintenance. Mixed-methods data were collected through interviews, surveys and field notes, integrating qualitative and quantitative data to triangulate findings. Primary outcomes included Champions' knowledge, communication self-efficacy, trust in COVID-19 vaccines, programme satisfaction and community members' intention to vaccinate. RESULTS We trained 35 Champions (27/35 female), including health workers, faith and community influencers. Half had a health background (17/35). Champions conducted 54 discussion sessions, reaching 1717 community members. Most Champions (22/35) conducted at least 1 session, with 16 running 3 or more. Champions who did not run sessions reported barriers like lack of confidence and competing duties. Training increased Champions' communication self-efficacy and trust in COVID-19 vaccines. Community member intention to vaccinate increased from 41% (394/960) to 83% (822/991) before and after a session. The programme was well received with interest in continued engagement. CONCLUSION Training health workers and community Vaccine Champions can promote vaccine confidence. Programmes require government support and engagement for sustainability. Robust evaluation frameworks are needed to build the evidence base.
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Affiliation(s)
- Jessica Kaufman
- Vaccine Uptake Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- The University of Melbourne Department of Paediatrics, Parkville, Victoria, Australia
| | - Isabella Overmars
- Vaccine Uptake Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - James Fong
- Republic of Fiji Ministry of Health, Suva, Rewa, Fiji
| | | | - Rachel Devi
- Republic of Fiji Ministry of Health, Suva, Rewa, Fiji
| | | | - Luisa Vodonaivalu
- Vaccine Uptake Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Kylie Jenkins
- Vaccine Uptake Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Julie Leask
- School of Public Health, The University of Sydney Faculty of Medicine and Health, Camperdown, New South Wales, Australia
| | - Holly Seale
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Yasmin Mohamed
- Vaccine Uptake Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | | | | | | | - Michelle Dynes
- UNICEF East Asia and Pacific Regional Office, Bangkok, Thailand
| | - Monsurul Hoq
- Vaccine Uptake Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Clinical Epidemiology and Biostatistics, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Margie Danchin
- Vaccine Uptake Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- The University of Melbourne Department of Paediatrics, Parkville, Victoria, Australia
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Sathirapanya C, Trijun J, Sathirapanya P. Integrating the Sufficiency Economy Royal Philosophy and Participatory Action Research Approach to Promote Self-Care for Stroke Prevention in Selected Communities of Southern Thailand. Healthcare (Basel) 2024; 12:1367. [PMID: 39057510 PMCID: PMC11275373 DOI: 10.3390/healthcare12141367] [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: 04/30/2024] [Revised: 06/28/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
(1) Introduction: Effective control of stroke risk factors can reduce stroke incidence. Motivation for participatory action of community dwellers to practice self-care to modify stroke risk after providing them with knowledge of stroke risk factors is considered useful under a situation of limited healthcare resources. This study aimed to evaluate the outcomes of integrating the sufficiency economy philosophy (SEP), a royal economic philosophy in Thailand, and the participatory action research (PAR) approach on stroke risk factors control among selected communities. (2) Methods: Villagers who had medium to high stroke risk from two provinces with leading stroke incidences in southern Thailand were invited to participate in an eight-month SEP-PAR program conducted in 2019. Group meetings among the study participants, local healthcare providers, the researchers, and relevant stakeholders in the communities were held to co-design a health behaviors program targeting lower waist circumference (WC), body weight (BW), blood pressure (BP), fasting blood sugar, blood lipids, and smoking and alcohol consumption rates. Follow-up physical measurements and blood tests were compared with the baseline results for significant differences by descriptive statistics (p < 0.05) using the R program. (3) Results: Of 126 participants, 75.4% were female. Moderate and high stroke risk levels were found in 58.2% and 19.8%, respectively. Elevated baseline WC, BW, BP, and blood test results were found in 50-80% of the participants. The co-designed health behaviors in this study were dietary control, regular exercise, relieving psychological stress, and stopping smoking and alcohol consumption. Overall, the participants had significant adherence to the co-designed health behaviors. At the end of the program, the follow-up tests showed significant reductions in BW, BP, fasting blood sugar, and lipids, but not in WC. (4) Conclusions: A combined SEP and PAR approach was effective for stroke risk factors control among the community dwellers. Motivation for self-care is a significant strategic outcome expected of this approach. Longer follow-up studies in larger populations are needed.
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Affiliation(s)
- Chutarat Sathirapanya
- Department of Family Medicine and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Jamaree Trijun
- Department of Pharmacy, Khaochaison Hospital, Phatthalung Provincial Public Health Office, Khaochaison, Phatthalung 93130, Thailand;
| | - Pornchai Sathirapanya
- Department of Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand;
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Crawshaw AF, Kitoko LM, Nkembi SL, Lutumba LM, Hickey C, Deal A, Carter J, Knights F, Vandrevala T, Forster AS, Hargreaves S. Co-designing a theory-informed, multicomponent intervention to increase vaccine uptake with Congolese migrants: A qualitative, community-based participatory research study (LISOLO MALAMU). Health Expect 2024; 27:e13884. [PMID: 37831054 PMCID: PMC10726157 DOI: 10.1111/hex.13884] [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: 05/26/2023] [Revised: 08/11/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023] Open
Abstract
INTRODUCTION Disparities in the uptake of routine and COVID-19 vaccinations have been observed in migrant populations, and attributed to issues of mistrust, access and low vaccine confidence. Participatory research approaches and behaviour change theory hold the potential for developing tailored vaccination interventions that address these complex barriers in partnership with communities and should be explored further. METHODS This study used a theory-informed, community-based participatory research approach to co-design a culturally tailored behaviour change intervention aimed at increasing COVID-19 vaccine uptake among Congolese migrants in London, United Kingdom (2021-2022). It was designed and led by a community-academic partnership in response to unmet needs in the Congolese community as the COVID-19 pandemic started. Barriers and facilitators to COVID-19 vaccination, information and communication preferences, and intervention suggestions were explored through qualitative in-depth interviews with Congolese migrants, thematically analysed, and mapped to the theoretical domains framework (TDF) and the capability, opportunity, motivation, behaviour model to identify target behaviours and strategies to include in interventions. Interventions were co-designed and tailored in workshops involving Congolese migrants. RESULTS Thirty-two Congolese adult migrants (24 (75%) women, mean 14.3 (SD: 7.5) years in the United Kingdom, mean age 52.6 (SD: 11.0) years) took part in in-depth interviews and 16 (same sample) took part in co-design workshops. Fourteen barriers and 10 facilitators to COVID-19 vaccination were identified; most barrier data related to four TDF domains (beliefs about consequences; emotion; social influences and environmental context and resources), and the behavioural diagnosis concluded interventions should target improving psychological capability, reflective and automatic motivations and social opportunities. Strategies included culturally tailored behaviour change techniques based on education, persuasion, modelling, enablement and environmental restructuring, which resulted in a co-designed intervention comprising community-led workshops, plays and posters. Findings and interventions were disseminated through a community celebration event. CONCLUSIONS Our study demonstrates how behavioural theory can be applied to co-designing tailored interventions with underserved migrant communities through a participatory research paradigm to address a range of health issues and inequalities. Future research should build on this empowering approach, with the goal of developing more sensitive vaccination services and interventions which respond to migrant communities' unique cultural needs and realities. PATIENT OR PUBLIC CONTRIBUTION Patient and public involvement (PPI) were embedded in the participatory study design and approach, with community members co-producing all stages of the study and co-authoring this paper. An independent PPI board (St George's Migrant Health Research Group Patient and Public Involvement Advisory Board) comprising five adult migrants with lived experience of accessing healthcare in the United Kingdom were also consulted at significant points over the course of the study.
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Affiliation(s)
- Alison F. Crawshaw
- The Migrant Health Research Group, Institute for Infection and ImmunitySt George's University of LondonLondonUK
| | | | | | | | | | - Anna Deal
- The Migrant Health Research Group, Institute for Infection and ImmunitySt George's University of LondonLondonUK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical MedicineLondonUK
| | - Jessica Carter
- The Migrant Health Research Group, Institute for Infection and ImmunitySt George's University of LondonLondonUK
| | - Felicity Knights
- The Migrant Health Research Group, Institute for Infection and ImmunitySt George's University of LondonLondonUK
| | - Tushna Vandrevala
- Centre for Applied Health and Social Care Research, Faculty of Health, Science, Social Care and EducationKingston University LondonLondonUK
| | | | - Sally Hargreaves
- The Migrant Health Research Group, Institute for Infection and ImmunitySt George's University of LondonLondonUK
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Longworth GR, Erikowa-Orighoye O, Anieto EM, Agnello DM, Zapata-Restrepo JR, Masquillier C, Giné-Garriga M. Conducting co-creation for public health in low and middle-income countries: a systematic review and key informant perspectives on implementation barriers and facilitators. Global Health 2024; 20:9. [PMID: 38233942 PMCID: PMC10795424 DOI: 10.1186/s12992-024-01014-2] [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: 09/11/2023] [Accepted: 01/09/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND There has been an increase in the use of co-creation for public health because of its claimed potential to increase an intervention's impact, spark change and co-create knowledge. Still, little is reported on its use in low-and-middle-income countries (LMICs). This study offers a comprehensive overview of co-creation used in public-health-related interventions, including the interventions' characteristics, and reported implementation barriers and facilitators. METHODS We conducted a systematic review within the Scopus and PubMed databases, a Google Scholar search, and a manual search in two grey literature databases related to participatory research. We further conducted eight interviews with first authors, randomly selected from included studies, to validate and enrich the systematic review findings. RESULTS Through our review, we identified a total of twenty-two studies conducted in twenty-four LMIC countries. Majority of the interventions were designed directly within the LMIC setting. Aside from one, all studies were published between 2019 and 2023. Most studies adopted a co-creation approach, while some reported on the use of co-production, co-design, and co-development, combined either with community-based participatory research, participatory action research or citizen science. Among the most reported implementation barriers, we found the challenge of understanding and accounting for systemic conditions, such as the individual's socioeconomic status and concerns related to funding constraints and length of the process. Several studies described the importance of creating a safe space, relying on local resources, and involving existing stakeholders in the process from the development stage throughout, including future and potential implementors. High relevance was also given to the performance of a contextual and/or needs assessment and careful tailoring of strategies and methods. CONCLUSION This study provides a systematic overview of previously conducted studies and of reported implementation barriers and facilitators. It identifies implementation barriers such as the setting's systemic conditions, the socioeconomic status and funding constrains along with facilitators such as the involvement of local stakeholders and future implementors throughout, the tailoring of the process to the population of interest and participants and contextual assessment. By incorporating review and interview findings, the study aims to provide practical insights and recommendations for guiding future research and policy.
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Affiliation(s)
| | | | - Ebuka Miracle Anieto
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- School of Health and Sports Sciences, University of Suffolk, Ipswich, UK
| | | | - Jorge Raul Zapata-Restrepo
- Faculty of Psychology, Education and Sport Sciences, Universitat Ramon Llul, Blanquerna, Barcelona, Spain
| | - Caroline Masquillier
- Family Medicine and Population Health'- FAMPOP, Faculty of Medical and Health Sciences & 'Centre for Family, Population and Health, Faculty of Social sciences, University of Antwerp, Belgium, Belgium
| | - Maria Giné-Garriga
- Faculty of Psychology, Education and Sport Sciences, Universitat Ramon Llul, Blanquerna, Barcelona, Spain
- Faculty of Health Sciences, Universitat Ramon Llull, Blanquerna, Barcelona, Spain
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