Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA 19104, USA.
Department of Nutrition Sciences, Drexel University College of Nursing and Health Professions, Philadelphia, PA 19101, USA.
Vaccine. 2021 Mar 5;39(10):1516-1527. doi: 10.1016/j.vaccine.2021.01.033. Epub 2021 Jan 22.
Incomplete childhood vaccination is associated with caregiver vaccine hesitancy, conceptualized by "3 Cs": high complacency, low confidence, and low convenience. To expand on existing evidence drawn primarily from the Americas and Europe, and develop culturally appropriate interventions, this research explored drivers of vaccine hesitancy in the Central Asian country of Tajikistan.
In twelve diverse districts, clinic-based immunization record abstraction identified purposive samples of children who were up-to-date (N = 300) or not (N = 300) on all first year vaccines. Using a modified case-control design, the structured face-to-face in-home survey of 600 caregivers compared knowledge, attitudes and practices regarding childhood vaccination by up-to-date status. Socio-demographic and psychological factors associated with hesitancy were identified, using a 22-item vaccine hesitancy scale, with subscales measuring complacency, confidence, and convenience. Overall contribution of vaccine hesitancy to up-to-date status was modeled, adjusting for other significant covariates.
Caregivers of not up-to-date children were more likely to report their child's health as poor, and report many logistical barriers to vaccination. Knowledge of vaccine-preventable illnesses was low, and complacency regarding vaccination was high among not up-to-date caregivers. In final multivariable models of predisposing, enabling and reinforcing influences on vaccination status, urban children, those with transportation and employed mothers were more likely to be up-to-date, while not up-to-date children included those born at home, seen as having fair or poor health, or reportedly told by clinicians to avoid immunization. Reinforcing factors included having a "vaccine passport", receiving useful information from medical providers, and believing that vaccine-preventable illnesses are serious and that most in their community are vaccinated. Additionally, vaccine hesitancy was negatively associated with up-to-date status (odds ratio 0.15, 95% C.I. 0.08, 0.26).
Results confirm that in this traditional culture, there is a strong need for tailored communication campaigns to address vaccine hesitancy, while continuing to address systems-level barriers.
不完全的儿童疫苗接种与看护者疫苗犹豫有关，可被概念化为“3C”：高自满、低信心和低便利。为了扩大主要来自美洲和欧洲的现有证据，并制定文化上适宜的干预措施，本研究探索了塔吉克斯坦这个中亚国家疫苗犹豫的驱动因素。
在 12 个不同的地区，基于诊所的免疫记录摘要确定了按时（N=300）或未按时（N=300）接种所有第一年疫苗的儿童的有目的样本。使用改良的病例对照设计，对 600 名看护者进行了结构化的面对面家访调查，比较了按时接种和未按时接种儿童在儿童疫苗接种方面的知识、态度和做法。使用 22 项疫苗犹豫量表，确定与犹豫相关的社会人口统计学和心理因素，量表的子量表分别衡量自满、信心和便利。在调整其他重要协变量后，对疫苗犹豫对按时接种状态的总体贡献进行建模。
未按时接种儿童的看护者更有可能报告其子女健康状况不佳，并报告了许多接种疫苗的实际障碍。对可预防疾病的认识很低，未按时接种疫苗的看护者对疫苗接种的自满情绪很高。在对疫苗接种状况有影响的倾向、促成和强化因素的最终多变量模型中，城市儿童、有交通工具和有工作的母亲更有可能按时接种疫苗，而未按时接种疫苗的儿童包括在家中出生、被认为健康状况一般或较差或被临床医生告知避免免疫接种的儿童。强化因素包括有“疫苗接种证”、从医疗服务提供者那里获得有用的信息以及相信疫苗可预防疾病是严重的，并且大多数人在其社区接种疫苗。此外，疫苗犹豫与按时接种状态呈负相关（比值比 0.15，95%置信区间 0.08，0.26）。
结果证实，在这种传统文化中，强烈需要量身定制的沟通运动来解决疫苗犹豫问题，同时继续解决系统层面的障碍。
