Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
Navrongo Health Research Centre, Navrongo, Ghana.
Glob Health Sci Pract. 2023 Jun 21;11(3). doi: 10.9745/GHSP-D-22-00496.
Coverage rates for second year of life (2YL) vaccination still lag behind infant vaccination in most settings. We conducted a qualitative baseline study of community barriers and enablers to acceptance of 2YL vaccines in Ghana 4 years after introducing the second dose of the measles-containing vaccine.
We conducted 26 focus group discussions in 2016 with men and women caregivers from mixed urban, peri-urban, and rural areas, as well as pastoralists, using semistructured topic guides based on the Health Belief Model theory. We conducted a thematic analysis of the discussion using NVivo software. We use Normalization Process Theory to contextualize results as a snapshot of a dynamic process of community adaptation to change to a well-established routine immunization schedule following 2YL introduction.
Routine immunization for infants enjoys resilient demand, grounded in strong community norms despite surprisingly low levels of vaccine literacy. Despite best practices like integration with the established 18-month "weighing visit," demand for 2YL vaccination is still conditional on individual awareness and competition for limited maternal time, household resources, and other health concerns. An embedded norm that children should be fully vaccinated by 12 months originally sustained Expanded Programme for Immunization goals but now discouraged some caregivers from seeking vaccines for children perceived to be "too old" to vaccinate. Caregivers cited greater costs and inconvenience of taking older, heavier children in for vaccination and anticipated criticism from both community members and health care providers for coming "too late."
Closing the 2YL vaccination coverage gap will ultimately require modifying embedded norms among caregivers and health care providers alike. Time is necessary but not sufficient to reach this goal. Progress can be accelerated by increasing the level of community and institutional engagement and adapting services where possible to minimize added costs to caregivers of vaccinating older children.
在大多数情况下，儿童两岁时（2YL）的疫苗接种覆盖率仍落后于婴儿疫苗接种。在引入含麻疹疫苗的第二剂疫苗四年后，我们在加纳进行了一项定性的基线研究，以了解社区对接受 2YL 疫苗的障碍和促进因素。
我们于 2016 年使用基于健康信念模型理论的半结构化主题指南，对来自混合城市、城乡结合部和农村地区以及牧民的男女照顾者进行了 26 次焦点小组讨论。我们使用 NVivo 软件对讨论进行了主题分析。我们使用规范过程理论将结果置于社区适应向既定常规免疫计划转变的动态过程的背景下，这是 2YL 引入后的一个快照。
尽管疫苗知识水平较低，但婴儿常规免疫的需求仍然很旺盛，这是基于强大的社区规范。尽管有最佳实践，如与既定的 18 个月“称重访问”相结合，但 2YL 疫苗接种的需求仍然取决于个人意识以及对有限的母亲时间、家庭资源和其他健康问题的竞争。最初维持扩大免疫规划目标的一个嵌入式规范是，儿童应在 12 个月前完全接种疫苗，但现在一些照顾者认为儿童“太老”而不寻求疫苗，这阻碍了他们的需求。照顾者提到带年龄较大、较重的孩子去接种疫苗的成本和不便增加，并且预计会受到社区成员和卫生保健提供者的批评，因为他们“来得太晚”。
最终，要缩小 2YL 疫苗接种覆盖率差距，需要对照顾者和卫生保健提供者的嵌入式规范进行修改。时间是必要的，但不是达到这一目标的充分条件。通过增加社区和机构参与的程度，并在可能的情况下调整服务，以尽量减少照顾者为接种年龄较大的儿童而增加的成本，可加速这一进程。
