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Bringing the social into vaccination research: Community-led ethnography and trust-building in immunization programs in Sierra Leone

BACKGROUND: Vaccine hesitancy is a complex, contested social phenomenon and existing research highlights the multifaceted role of trust in strengthening vaccine confidence. However, understanding public engagement with vaccination through the lens of (mis)trust requires more contextual evidence on t...

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Autores principales: Enria, Luisa, Bangura, Joseph S., Kanu, Hassan M., Kalokoh, Joseph A., Timbo, Alie D., Kamara, Mohamed, Fofanah, Maligie, Kamara, Alhassan N., Kamara, Adikalie I., Kamara, Morlai M., Suma, Ibrahim Sorie, Kamara, Osman M., Kamara, Alusine M., Kamara, Alhajie O., Kamara, Abu B., Kamara, Emmah, Lees, Shelley, Marchant, Mark, Murray, Mariama
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8535180/
https://www.ncbi.nlm.nih.gov/pubmed/34679104
http://dx.doi.org/10.1371/journal.pone.0258252
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author Enria, Luisa
Bangura, Joseph S.
Kanu, Hassan M.
Kalokoh, Joseph A.
Timbo, Alie D.
Kamara, Mohamed
Fofanah, Maligie
Kamara, Alhassan N.
Kamara, Adikalie I.
Kamara, Morlai M.
Suma, Ibrahim Sorie
Kamara, Osman M.
Kamara, Alusine M.
Kamara, Alhajie O.
Kamara, Abu B.
Kamara, Emmah
Lees, Shelley
Marchant, Mark
Murray, Mariama
author_facet Enria, Luisa
Bangura, Joseph S.
Kanu, Hassan M.
Kalokoh, Joseph A.
Timbo, Alie D.
Kamara, Mohamed
Fofanah, Maligie
Kamara, Alhassan N.
Kamara, Adikalie I.
Kamara, Morlai M.
Suma, Ibrahim Sorie
Kamara, Osman M.
Kamara, Alusine M.
Kamara, Alhajie O.
Kamara, Abu B.
Kamara, Emmah
Lees, Shelley
Marchant, Mark
Murray, Mariama
author_sort Enria, Luisa
collection PubMed
description BACKGROUND: Vaccine hesitancy is a complex, contested social phenomenon and existing research highlights the multifaceted role of trust in strengthening vaccine confidence. However, understanding public engagement with vaccination through the lens of (mis)trust requires more contextual evidence on trust’s qualitative determinants. This includes expanding the geographic focus beyond current studies’ focus on High Income Countries. Furthermore, obstacles remain in effectively integrating social science findings in the design of vaccine deployment strategies, and in ensuring that those who implement interventions and are affected by them are directly involved in producing knowledge about vaccination challenges. METHODS: We piloted a community-led ethnographic approach, training Community Health Workers (CHWs) in Kambia District, Sierra Leone, in qualitative social science methods. Methods included participant observation, participatory power mapping and rumour tracking, focus group discussions and key stakeholder interviews. CHWs, with the support of public health officials and professional social scientists, conducted research on vaccination challenges, analysed data, tested new community engagement strategies based on their findings and elicited local perspectives on these approaches. RESULTS: Our findings on vaccine confidence in five border communities highlighted three key themes: the impact of prior experiences with the health system on (mis)trust; relevance of livelihood strategies and power dynamics for vaccine uptake and access; and the contextual nature of knowledge around vaccines. Across these themes, we show how expressions of trust centered on social proximity, reliability and respect and the role of structural issues affecting both vaccine access and confidence. The pilot also highlighted the value and practical challenges to meaningfully co-designed research. CONCLUSION: There is scope for broader application of a community-led ethnographic approach will help redesign programming that is responsive to local knowledge and experience. Involving communities and low-cadre service providers in generating knowledge and solutions can strengthen relationships and sustain dialogue to bolster vaccine confidence.
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spelling pubmed-85351802021-10-23 Bringing the social into vaccination research: Community-led ethnography and trust-building in immunization programs in Sierra Leone Enria, Luisa Bangura, Joseph S. Kanu, Hassan M. Kalokoh, Joseph A. Timbo, Alie D. Kamara, Mohamed Fofanah, Maligie Kamara, Alhassan N. Kamara, Adikalie I. Kamara, Morlai M. Suma, Ibrahim Sorie Kamara, Osman M. Kamara, Alusine M. Kamara, Alhajie O. Kamara, Abu B. Kamara, Emmah Lees, Shelley Marchant, Mark Murray, Mariama PLoS One Research Article BACKGROUND: Vaccine hesitancy is a complex, contested social phenomenon and existing research highlights the multifaceted role of trust in strengthening vaccine confidence. However, understanding public engagement with vaccination through the lens of (mis)trust requires more contextual evidence on trust’s qualitative determinants. This includes expanding the geographic focus beyond current studies’ focus on High Income Countries. Furthermore, obstacles remain in effectively integrating social science findings in the design of vaccine deployment strategies, and in ensuring that those who implement interventions and are affected by them are directly involved in producing knowledge about vaccination challenges. METHODS: We piloted a community-led ethnographic approach, training Community Health Workers (CHWs) in Kambia District, Sierra Leone, in qualitative social science methods. Methods included participant observation, participatory power mapping and rumour tracking, focus group discussions and key stakeholder interviews. CHWs, with the support of public health officials and professional social scientists, conducted research on vaccination challenges, analysed data, tested new community engagement strategies based on their findings and elicited local perspectives on these approaches. RESULTS: Our findings on vaccine confidence in five border communities highlighted three key themes: the impact of prior experiences with the health system on (mis)trust; relevance of livelihood strategies and power dynamics for vaccine uptake and access; and the contextual nature of knowledge around vaccines. Across these themes, we show how expressions of trust centered on social proximity, reliability and respect and the role of structural issues affecting both vaccine access and confidence. The pilot also highlighted the value and practical challenges to meaningfully co-designed research. CONCLUSION: There is scope for broader application of a community-led ethnographic approach will help redesign programming that is responsive to local knowledge and experience. Involving communities and low-cadre service providers in generating knowledge and solutions can strengthen relationships and sustain dialogue to bolster vaccine confidence. Public Library of Science 2021-10-22 /pmc/articles/PMC8535180/ /pubmed/34679104 http://dx.doi.org/10.1371/journal.pone.0258252 Text en © 2021 Enria et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Enria, Luisa
Bangura, Joseph S.
Kanu, Hassan M.
Kalokoh, Joseph A.
Timbo, Alie D.
Kamara, Mohamed
Fofanah, Maligie
Kamara, Alhassan N.
Kamara, Adikalie I.
Kamara, Morlai M.
Suma, Ibrahim Sorie
Kamara, Osman M.
Kamara, Alusine M.
Kamara, Alhajie O.
Kamara, Abu B.
Kamara, Emmah
Lees, Shelley
Marchant, Mark
Murray, Mariama
Bringing the social into vaccination research: Community-led ethnography and trust-building in immunization programs in Sierra Leone
title Bringing the social into vaccination research: Community-led ethnography and trust-building in immunization programs in Sierra Leone
title_full Bringing the social into vaccination research: Community-led ethnography and trust-building in immunization programs in Sierra Leone
title_fullStr Bringing the social into vaccination research: Community-led ethnography and trust-building in immunization programs in Sierra Leone
title_full_unstemmed Bringing the social into vaccination research: Community-led ethnography and trust-building in immunization programs in Sierra Leone
title_short Bringing the social into vaccination research: Community-led ethnography and trust-building in immunization programs in Sierra Leone
title_sort bringing the social into vaccination research: community-led ethnography and trust-building in immunization programs in sierra leone
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8535180/
https://www.ncbi.nlm.nih.gov/pubmed/34679104
http://dx.doi.org/10.1371/journal.pone.0258252
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