Perceived enablers and barriers of community engagement for vaccination in India: Using socioecological analysis.
Perceived enablers and barriers of community engagement for vaccination in India: Using socioecological analysis.
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DOI：
10.1371/journal.pone.0253318
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Nicholson-Crotty J
中科院分区：
文献类型：
--
作者：
Dutta T;Agley J;Meyerson BE;Barnes PA;Sherwood-Laughlin C;Nicholson-Crotty J
在印度，有一个高级别的政策共识，即社区参与（CE）可以提高疫苗接种率，减少疫苗可预防疾病的负担。然而，迄今为止，该国的疫苗接种研究尚未明确将CE作为其本身的结果。因此，本研究旨在研究印度社区参与疫苗接种的障碍和推动因素。采用定性方法，对25名疫苗决策者的半结构化精英访谈与24份国家级疫苗政策文件和研究人员现场记录（2017年12月至2018年2月）进行了三角分析。本研究收集的数据包括对CE疫苗接种促进因素和障碍的看法和实例。在文件审查期间确认了一些概念，如缺乏与CE相关的正式程序或数据收集方法，并于2018年12月和2019年1月与研究受访者进行了最终召集，以审查研究结果，以确认本研究的一般结果。社会生态模型（SEM）被用来组织和解释研究结果。尽管决策者和政策文件普遍支持CE，但在疫苗接种方面，CE障碍多于促进因素，这在所有社会生态层面都得到了确认。对印度疫苗决策者的访谈揭示了影响疫苗接种CE的复杂系统性和结构性因素，这些因素存在于从个人到政策的每个SEM层面。政策层面的推动因素包括决策者对社区教育的政治意愿以及强调社会动员的政策文件和访谈，而障碍则是缺乏社区教育战略文件和决策者对社区教育的广泛理解。在社区一级，传播社会行为变化交流（SBCC）材料从国家一级的国家被认为是CE的促进者，而阶级，种姓为基础的权力关系在社区，缺乏以家庭为中心的CE战略，家长式的态度，决策者对社区（后者报告了一些非政府组织负责人）被认为是CE的障碍。在组织一级，与地方组织的伙伴关系被认为是促进环境和教育的因素，而几位决策者强调，缺乏制度化的支持来使这些伙伴关系正规化和激励这些伙伴关系是障碍。在人际层面，对医护人员的SBCC培训、向疫苗信心低的社区传递敏感信息以及社交媒体信息被认为是CE促进因素。一些决策者认为，在引入和推出新疫苗期间，缺乏管理疫苗相关谣言或复制成功CE干预措施的策略是CE障碍。本研究获得的数据突出了国家层面的复杂性和挑战的CE在整个SEM的看法，从个人到系统的水平。未来的研究应尝试将这些促进因素和障碍与实际的CE结果联系起来，例如参与或社区支持疫苗政策制定，针对特定疫苗和情况（如疾病爆发）的CE实施，或基于亚人群的社区抵抗事件的频率和社区促进疫苗接种。制定一个基于人口的CE操作定义可能是有价值的，并有一个关于“如何做CE”的分步手册。这项研究的数据还表明，在国家数据集中纳入环境保护指标和编制一份记录环境保护最佳做法的简编十分重要。这样做可以更严格地分析印度和其他具有类似免疫计划的国家的CE疫苗接种的证据基础。
There is high level policy consensus in India that community engagement (CE) improves vaccination uptake and reduces burden of vaccine preventable diseases. However, to date, vaccination studies in the country have not explicitly focused on CE as an outcome in and of itself. Therefore, this study sought to examine the barriers and enablers of community engagement for vaccination in India. Employing qualitative methods, twenty-five semi-structured elite interviews among vaccine decisionmakers’ were triangulated with twenty-four national-level vaccine policy documents and researcher field notes (December 2017 to February 2018). Data collected for this study included perceptions and examples of enablers of and barriers to CE for vaccination uptake. Concepts, such as the absence of formal procedures or data collection approaches related to CE, were confirmed during document review, and a final convening to review study results was conducted with study respondents in December 2018 and January 2019 to affirm the general set of findings from this study. The Social Ecological Model (SEM) was used to organize and interpret the study findings. Although decisionmakers and policy documents generally supported CE, there were more CE barriers than facilitators in the context of vaccination, which were identified at all social-ecological levels. Interviews with vaccine decisionmakers in India revealed complex systemic and structural factors which affect CE for vaccination and are present across each of the SEM levels, from individual to policy. Policy-level enablers included decisionmakers’ political will for CE and policy documents and interviews highlighted social mobilization, whereas barriers were lack of a CE strategy document and a broad understanding of CE by decisionmakers. At the community level, dissemination of Social-behavioral Change Communication (SBCC) materials from the national-level to the states was considered a CE facilitator, while class, and caste-based power relations in the community, lack of family-centric CE strategies, and paternalistic attitude of decisionmakers toward communities (the latter reported by some NGO heads) were considered CE barriers. At the organizational level, partnerships with local organizations were considered CE enablers, while lack of institutionalized support to formalize and incentivize these partnerships highlighted by several decisionmakers, were barriers. At the interpersonal level, SBCC training for healthcare workers, sensitive messaging to communities with low vaccine confidence, and social media messaging were considered CE facilitators. The lack of strategies to manage vaccine related rumors or replicate successful CE interventions during the during the introduction and rollout of new vaccines were perceived as CE barriers by several decisionmakers. Data obtained for this study highlighted national-level perceptions of the complexities and challenges of CE across the entire SEM, from individual to systemic levels. Future studies should attempt to associate these enablers and barriers with actual CE outcomes, such as participation or community support in vaccine policy-making, CE implementation for specific vaccines and situations (such as disease outbreaks), or frequency of sub-population-based incidents of community resistance and community facilitation to vaccination uptake. There would likely be value in developing a population-based operational definition of CE, with a step-by-step manual on ‘how to do CE.’ The data from this study also indicate the importance of including CE indicators in national datasets and developing a compendium documenting CE best-practices. Doing so would allow more rigorous analysis of the evidence-base for CE for vaccination in India and other countries with similar immunization programs.
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影响因子：
4.8
作者：
Dutta T;Meyerson BE;Agley J;Barnes PA;Sherwood-Laughlin C;Nicholson-Crotty J
通讯作者：
Nicholson-Crotty J
DOI：
10.1016/s0140-6736(20)32642-8
发表时间：
2021-01-02
期刊：
Lancet (London, England)
影响因子：
--
作者：
Burgess RA;Osborne RH;Yongabi KA;Greenhalgh T;Gurdasani D;Kang G;Falade AG;Odone A;Busse R;Martin-Moreno JM;Reicher S;McKee M
通讯作者：
McKee M
影响因子：
3.8
作者：
Blankenship, Kim A.;West, Brooke S.;Biradavolu, Monica R.
通讯作者：
Biradavolu, Monica R.
影响因子：
3.3
作者：
Aberbach, JD;Rockman, BA
通讯作者：
Rockman, BA
影响因子：
3.3
作者：
de Timoteo Mavimbe, Joao Carlos;Muquingue, Humberto Nelson;Bjune, Gunnar
通讯作者：
Bjune, Gunnar