Tabassum Farhana, Delawalla Zayaan, Mirani Mushtaq, Khan Zahid Ali, Muhammad Aadarsh Fateh, Asim Muhammad, Das Jai K
Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan.
Department of Society and Technology, AGH University of Krakow, Kraków, Poland.
Front Public Health. 2025 Jun 3;13:1575319. doi: 10.3389/fpubh.2025.1575319. eCollection 2025.
Immunization remains a critical public health strategy, particularly in countries like Pakistan where vaccine-preventable diseases are prevalent despite global efforts to eradicate poliomyelitis. This study investigates the role of community engagement (CE) and conditional incentives in increasing polio vaccine uptake in High-Risk Union Councils (HRUCs) of Pakistan. Utilizing an exploratory qualitative research design, the study was conducted to assess the impact of an intervention which involved participatory CE, including the formation of Community Health Committees (CHCs) that conducted community sessions, made home visits, and implemented the Conditional-Collective-Community-Based Incentives (C3Is) in HRUCs in Bannu and Karachi, Pakistan to reduce the rate of refusals for the oral polio vaccine (OPV). These conditional incentives were based on the reduction of polio vaccine refusals by 30 and 50% in specific clusters during the first and second phase of the trial. The findings indicate that leveraging community influencers to change the social norms of the community through CE and C3Is lead to collective behavioral changes. CE served as an effective tool for dispelling myths while also providing a springboard to build community connections and cohesion. Furthermore, this change was accelerated by the provision of conditional communal non-cash incentives, leading to a significant improvement in polio immunization coverage and a reduction in the rate of vaccine refusals. The study underscores the importance of integrating context specific innovative community-specific strategies to overcome vaccine hesitancy and achieve immunization goals in challenging environments and when the target of polio eradication cannot be realized with business as usual.
免疫接种仍然是一项关键的公共卫生战略，尤其是在巴基斯坦这样的国家，尽管全球致力于根除脊髓灰质炎，但疫苗可预防疾病仍然普遍存在。本研究调查了社区参与（CE）和有条件激励措施在提高巴基斯坦高危联合委员会（HRUCs）脊髓灰质炎疫苗接种率方面的作用。该研究采用探索性定性研究设计，旨在评估一项干预措施的影响，该干预措施包括参与性社区参与，即成立社区卫生委员会（CHCs），这些委员会举办社区会议、进行家访，并在巴基斯坦巴努和卡拉奇的高危联合委员会实施基于社区的有条件集体激励措施（C3Is），以降低口服脊髓灰质炎疫苗（OPV）的拒绝率。这些有条件激励措施基于在试验的第一阶段和第二阶段特定群组中脊髓灰质炎疫苗拒绝率降低30%和50%。研究结果表明，通过社区参与和有条件集体激励措施利用社区有影响力的人来改变社区的社会规范会导致集体行为改变。社区参与是消除误解的有效工具，同时也为建立社区联系和凝聚力提供了一个跳板。此外，提供有条件的社区非现金激励措施加速了这种变化，导致脊髓灰质炎免疫接种覆盖率显著提高，疫苗拒绝率降低。该研究强调了整合因地制宜的创新社区特定策略的重要性，以克服疫苗犹豫，并在具有挑战性的环境中以及按常规方式无法实现根除脊髓灰质炎目标时实现免疫目标。
