Normalizing inconvenience to promote childhood vaccination: a qualitative implementation evaluation of a novel Michigan program
Normalizing inconvenience to promote childhood vaccination: a qualitative implementation evaluation of a novel Michigan program
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DOI：
10.1186/s12913-020-05550-6
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发表时间：
2020-07-23
影响因子：
2.8
通讯作者：
Noyes, Katia
中科院分区：
文献类型：
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作者：
Lillvis, Denise F.;Willison, Charley;Noyes, Katia
背景 2015 年，密歇根州实施了一项规定，要求家长在放弃强制儿童疫苗接种之前参加当地卫生部门 (LHD) 的教育课程。本研究利用标准化过程理论 (NPT) 来评估项目实施情况，识别对保真度和可持续性的潜在威胁。方法我们对 16 个 LHD 中参与这些教育项目的个人进行了 32 次半结构化访谈。参与的 LHD 是从分层的、具有代表性的样本中选出的。一名面试官使用半结构化面试指南进行所有面试；两位作者根据 NPT 框架（即意义建构、参与、集体行动和反射性监控）对访谈笔录进行编码和分析。 结果 对于这一新规则及其由此产生的计划的利益相关者是谁（意义建构）缺乏共识。也许正因如此，大多数 LHD 在其规划（参与）中没有征求关键利益相关群体（即学校、医疗保健提供者、社区利益相关者）的建议。虽然大多数受访者认为提供教育和信息是目标，但一些受访者认为更具挑战性的目标是说服对疫苗犹豫不决的父母为孩子接种疫苗。对于谁让健康教育者负责实现豁免教育计划（集体行动）的目标，人们的看法也存在一些差异。尽管 LHD 举行了非正式的员工汇报会，但很少进行正式的项目评估。此外，进行得特别好或特别差的课程是最重要的（反射性监测）。 结论 免疫豁免教育计划可能面临无法完全融入常规 LHD 实践的风险，可能会损害其长期有效性和可持续性。地方和州一级的管理人员应保持监督，以确保计划如实交付。由于该计划依靠持续的不便来鼓励父母为孩子接种疫苗，任何走捷径的行为都会损害其成功。
BackgroundIn 2015, Michigan implemented a rule requiring parents to attend an education session at a local health department (LHD) prior to waiving mandatory child vaccinations. This study utilizes Normalization Process Theory (NPT) to assess program implementation, identifying potential threats to fidelity and sustainability.MethodsWe conducted 32 semi-structured interviews with individuals involved in these education programs across 16 LHDs. Participating LHDs were selected from a stratified, representative sample. One interviewer conducted all interviews using a semi-structured interview guide; two authors coded and analyzed the interview transcripts according to the NPT framework (i.e, sense-making, engagement, collective action, and reflexive monitoring).ResultsThere was a lack of consensus about who the stakeholders of this new rule and its resulting program were (sense-making). Perhaps as a result, most LHDs did not solicit advice from key stakeholder groups (i.e., schools, health care providers, community stakeholders) in their planning (engagement). While most interviewees identified providing education and information as the goal, some identified the more challenging goal of persuading vaccine hesitant parents to immunize their children. There was also some variation in perception of who held health educators accountable for meeting the goals of the waiver education program (collective action). Formal program evaluation by LHDs was rare, although some held informal staff debriefings. Additionally, sessions that went particularly well or poorly were top-of-mind (reflexive monitoring).ConclusionsThe immunization waiver education program may be at risk of not becoming fully embedded into routine LHD practice, potentially compromising its long-term effectiveness and sustainability. Managers at the local and state level should maintain oversight to ensure that the program is delivered with fidelity. As the program relies on sustaining inconvenience to encourage parents to immunize their children, any shortcuts taken will undermine its success.