Escoffery Cam, Ogutu Emily Awino, Sakas Zoe, Hester Kyra A, Ellis Anna, Rodriguez Katie, Jaishwal Chandni, Yang Chenmua, Dixit Sameer, Bose Anindya, Sarr Moussa, Kilembe William, Bednarczyk Robert A, Freeman Matthew C
Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Center for Molecular Dynamics Nepal, Kathmandu, Nepal.
Implement Sci Commun. 2023 Sep 4;4(1):109. doi: 10.1186/s43058-023-00489-1.
The fundamental components of a vaccine delivery system are well-documented, but robust evidence is needed on how the related processes and implementation strategies - including the facilitators and barriers - contribute to improvements in childhood vaccination coverage. The purpose of this study was to identify critical facilitators and barriers to the implementation of common interventions across three countries that have dramatically increased coverage of early childhood vaccination over the past 20 years, and to qualify common or divergent themes in their success.
We conducted 278 key informant interviews and focus group discussions with public health leaders at the regional, district, and local levels and community members in Nepal, Senegal, and Zambia to identify intervention activities and the facilitators and barriers to implementation. We used thematic analysis grounded in the Consolidated Framework for Implementation Research (CFIR) constructs of inner and outer settings to identify immunization program key facilitators and barriers.
We found that the common facilitators to program implementation across the countries were the CFIR inner setting constructs of (1) networks and communications, (2) goals and feedback, (3) relative priority, and (4) readiness for implementation and outer setting constructs of (5) cosmopolitanism and (6) external policies and mandates. The common barriers were incentives and rewards, available resources, access to knowledge and information, and patients' needs and resources. Critical to the success of these national immunization programs were prioritization and codification of health as a human right, clear chain of command and shared ownership of immunization, communication of program goals and feedback, offering of incentives at multiple levels, training of staff central to vaccination education, the provision of resources to support the program, key partnerships and guidance on implementation and adoption of vaccination policies.
Adequate organizational commitment, resources, communication, training, and partnerships were the most critical facilitators for these countries to improve childhood vaccination.
疫苗接种系统的基本组成部分已有详尽记录，但对于相关流程及实施策略（包括促进因素和障碍）如何推动儿童疫苗接种覆盖率的提高，仍需要有力证据。本研究的目的是确定在过去20年中大幅提高幼儿疫苗接种覆盖率的三个国家实施常见干预措施的关键促进因素和障碍，并明确其成功经验中的共同或不同主题。
我们在尼泊尔、塞内加尔和赞比亚与区域、地区和地方各级的公共卫生领导人以及社区成员进行了278次关键信息访谈和焦点小组讨论，以确定干预活动以及实施的促进因素和障碍。我们采用基于实施研究综合框架（CFIR）内部和外部环境构建的主题分析，来确定免疫规划的关键促进因素和障碍。
我们发现，各国实施规划的共同促进因素是CFIR内部环境构建中的（1）网络与沟通、（2）目标与反馈、（3）相对优先级、（4）实施准备情况，以及外部环境构建中的（5）国际主义和（6）外部政策与指令。共同障碍包括激励与奖励、可用资源、知识和信息获取，以及患者需求和资源。这些国家免疫规划成功的关键在于将健康作为一项人权进行优先排序和编纂法典、明确免疫接种的指挥链和共同所有权、传达规划目标和反馈、在多个层面提供激励、培训疫苗接种教育的核心工作人员、提供支持规划的资源、关键伙伴关系以及关于疫苗接种政策实施和采用的指导。
充足的组织承诺、资源、沟通、培训和伙伴关系是这些国家提高儿童疫苗接种率的最关键促进因素。
