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Drivers of early childhood vaccination success in Nepal, Senegal, and Zambia: a multiple case study analysis using the Consolidated Framework for Implementation Research
INTRODUCTION: 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...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10478385/ https://www.ncbi.nlm.nih.gov/pubmed/37667374 http://dx.doi.org/10.1186/s43058-023-00489-1 |
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author | 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. |
author_facet | 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. |
author_sort | Escoffery, Cam |
collection | PubMed |
description | INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSION: Adequate organizational commitment, resources, communication, training, and partnerships were the most critical facilitators for these countries to improve childhood vaccination. |
format | Online Article Text |
id | pubmed-10478385 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-104783852023-09-06 Drivers of early childhood vaccination success in Nepal, Senegal, and Zambia: a multiple case study analysis using the Consolidated Framework for Implementation Research 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. Implement Sci Commun Research INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSION: Adequate organizational commitment, resources, communication, training, and partnerships were the most critical facilitators for these countries to improve childhood vaccination. BioMed Central 2023-09-04 /pmc/articles/PMC10478385/ /pubmed/37667374 http://dx.doi.org/10.1186/s43058-023-00489-1 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research 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. Drivers of early childhood vaccination success in Nepal, Senegal, and Zambia: a multiple case study analysis using the Consolidated Framework for Implementation Research |
title | Drivers of early childhood vaccination success in Nepal, Senegal, and Zambia: a multiple case study analysis using the Consolidated Framework for Implementation Research |
title_full | Drivers of early childhood vaccination success in Nepal, Senegal, and Zambia: a multiple case study analysis using the Consolidated Framework for Implementation Research |
title_fullStr | Drivers of early childhood vaccination success in Nepal, Senegal, and Zambia: a multiple case study analysis using the Consolidated Framework for Implementation Research |
title_full_unstemmed | Drivers of early childhood vaccination success in Nepal, Senegal, and Zambia: a multiple case study analysis using the Consolidated Framework for Implementation Research |
title_short | Drivers of early childhood vaccination success in Nepal, Senegal, and Zambia: a multiple case study analysis using the Consolidated Framework for Implementation Research |
title_sort | drivers of early childhood vaccination success in nepal, senegal, and zambia: a multiple case study analysis using the consolidated framework for implementation research |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10478385/ https://www.ncbi.nlm.nih.gov/pubmed/37667374 http://dx.doi.org/10.1186/s43058-023-00489-1 |
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