Vaccination coverage determinants in low uptake areas of China: a qualitative study of provider perspectives in Sichuan, Guangdong, and Henan Provinces.
Vaccination coverage determinants in low uptake areas of China: a qualitative study of provider perspectives in Sichuan, Guangdong, and Henan Provinces.
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DOI：
10.1080/21645515.2022.2030623
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发表时间：
2022-12-31
影响因子：
4.8
通讯作者：
Howard N
中科院分区：
文献类型：
--
作者：
Lin SY;Zhang SY;Chantler T;Sun FY;Zou JT;Cheng JJ;Chen YQ;Sun M;Howard N
中国的免疫规划相对强大，世卫组织-联合国儿童基金会2019年最新监测率显示，全国疫苗接种覆盖率超过90%。然而，疫苗接种覆盖率是异质性的，在地理区域、城乡社区和亚人群中各不相同。我们从批判现实主义的角度进行了一项定性研究，分析了对三个省份26名疫苗接种提供者的半结构化访谈，这些受访者代表了中国东部、中部和西部的区域社会经济差异。我们使用演绎和归纳编码按主题分析数据。提供者报告说，他们所在地区的疫苗接种覆盖率显著提高，但在流动儿童和留守儿童中仍然较低。覆盖率的主要决定因素是与儿童有关的（即性别、人数、健康状况）、与儿童有关的（即社会经济地位、作用、教育水平、种族）、与机构有关的（即接种人数、信息系统、任命程序）和与系统有关的（即疫苗供应、部门间合作、疫苗“犹豫”）。提高疫苗接种覆盖率的潜在有效措施包括利用常规妇幼保健门诊进行补种疫苗，提供额外的健康教育，由乡村医生进行后续家访，以及要求在入学时进行疫苗接种核查。这是第一个定性研究，以探讨在中国这些地区低疫苗接种覆盖率的潜在决定因素。研究结果可以为加强学校作用、开发国家免疫信息系统和推广预约应用程序的政策提供信息。需要更多地考虑提高服务质量和消除不公平，例如加强对流动儿童和留守儿童的健康教育和服务提供。
China’s immunization programme is relatively strong, with latest WHO-UNICEF monitoring rates for 2019 showing national vaccination coverage over 90%. However, vaccination coverage is heterogeneous, varying across geographic regions, rural–urban communities, and sub-populations. We conducted a qualitative study from a critical realist perspective, analyzing semi-structured interviews with 26 vaccination providers in three provinces, selected to represent regional socioeconomic disparities across Eastern, Central, and Western China. We analyzed data thematically, using deductive and inductive coding. Providers reported vaccination coverage in their areas had increased significantly, but remained lower among migrant and left-behind children. Main coverage determinants were child-related (i.e. gender, number, health status), caregiver-related (i.e. socioeconomic status, role, education level, ethnicity), institution-related (i.e. vaccinator numbers, information system, appointment process), and system-related (i.e. vaccine supply, intersectoral cooperation, vaccine ‘hesitancy’). Potentially effective measures to promote vaccination coverage included using routine maternal and child health-care visits for catch-up vaccination, providing additional health education, conducting follow-up family visits by village doctors, and requiring vaccination verification at school enrollment. This is the first qualitative study to examine potential determinants of low vaccination coverage in these areas of China. Findings can inform policies to strengthen the role of schools, develop the national immunization information system, and promote appointment apps. More consideration is needed to improve service quality and eliminating inequities, such as strengthening health education and service provision for migrant and left-behind children.
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