Cargando…

Insights into vaccine hesitancy from systems thinking, Rwanda

OBJECTIVE: To investigate vaccine hesitancy leading to underimmunization and a measles outbreak in Rwanda and to develop a conceptual, community-level model of behavioural factors. METHODS: Local immunization systems in two Rwandan communities (one recently experienced a measles outbreak) were explo...

Descripción completa

Detalles Bibliográficos
Autores principales: Decouttere, Catherine, Banzimana, Stany, Davidsen, Pål, Van Riet, Carla, Vandermeulen, Corinne, Mason, Elizabeth, Jalali, Mohammad S, Vandaele, Nico
Formato: Online Artículo Texto
Lenguaje:English
Publicado: World Health Organization 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8542260/
https://www.ncbi.nlm.nih.gov/pubmed/34737471
http://dx.doi.org/10.2471/BLT.20.285258
_version_ 1784589394083053568
author Decouttere, Catherine
Banzimana, Stany
Davidsen, Pål
Van Riet, Carla
Vandermeulen, Corinne
Mason, Elizabeth
Jalali, Mohammad S
Vandaele, Nico
author_facet Decouttere, Catherine
Banzimana, Stany
Davidsen, Pål
Van Riet, Carla
Vandermeulen, Corinne
Mason, Elizabeth
Jalali, Mohammad S
Vandaele, Nico
author_sort Decouttere, Catherine
collection PubMed
description OBJECTIVE: To investigate vaccine hesitancy leading to underimmunization and a measles outbreak in Rwanda and to develop a conceptual, community-level model of behavioural factors. METHODS: Local immunization systems in two Rwandan communities (one recently experienced a measles outbreak) were explored using systems thinking, human-centred design and behavioural frameworks. Data were collected between 2018 and 2020 from: discussions with 11 vaccination service providers (i.e. hospital and health centre staff); interviews with 161 children’s caregivers at health centres; and nine validation interviews with health centre staff. Factors influencing vaccine hesitancy were categorized using the 3Cs framework: confidence, complacency and convenience. A conceptual model of vaccine hesitancy mechanisms with feedback loops was developed. FINDINGS: A comparison of service providers’ and caregivers’ perspectives in both rural and peri-urban settings showed that similar factors strengthened vaccine uptake: (i) high trust in vaccines and service providers based on personal relationships with health centre staff; (ii) the connecting role of community health workers; and (iii) a strong sense of community. Factors identified as increasing vaccine hesitancy (e.g. service accessibility and inadequate follow-up) differed between service providers and caregivers and between settings. The conceptual model could be used to explain drivers of the recent measles outbreak and to guide interventions designed to increase vaccine uptake. CONCLUSION: The application of behavioural frameworks and systems thinking revealed vaccine hesitancy mechanisms in Rwandan communities that demonstrate the interrelationship between immunization services and caregivers’ vaccination behaviour. Confidence-building social structures and context-dependent challenges that affect vaccine uptake were also identified.
format Online
Article
Text
id pubmed-8542260
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher World Health Organization
record_format MEDLINE/PubMed
spelling pubmed-85422602021-11-03 Insights into vaccine hesitancy from systems thinking, Rwanda Decouttere, Catherine Banzimana, Stany Davidsen, Pål Van Riet, Carla Vandermeulen, Corinne Mason, Elizabeth Jalali, Mohammad S Vandaele, Nico Bull World Health Organ Research OBJECTIVE: To investigate vaccine hesitancy leading to underimmunization and a measles outbreak in Rwanda and to develop a conceptual, community-level model of behavioural factors. METHODS: Local immunization systems in two Rwandan communities (one recently experienced a measles outbreak) were explored using systems thinking, human-centred design and behavioural frameworks. Data were collected between 2018 and 2020 from: discussions with 11 vaccination service providers (i.e. hospital and health centre staff); interviews with 161 children’s caregivers at health centres; and nine validation interviews with health centre staff. Factors influencing vaccine hesitancy were categorized using the 3Cs framework: confidence, complacency and convenience. A conceptual model of vaccine hesitancy mechanisms with feedback loops was developed. FINDINGS: A comparison of service providers’ and caregivers’ perspectives in both rural and peri-urban settings showed that similar factors strengthened vaccine uptake: (i) high trust in vaccines and service providers based on personal relationships with health centre staff; (ii) the connecting role of community health workers; and (iii) a strong sense of community. Factors identified as increasing vaccine hesitancy (e.g. service accessibility and inadequate follow-up) differed between service providers and caregivers and between settings. The conceptual model could be used to explain drivers of the recent measles outbreak and to guide interventions designed to increase vaccine uptake. CONCLUSION: The application of behavioural frameworks and systems thinking revealed vaccine hesitancy mechanisms in Rwandan communities that demonstrate the interrelationship between immunization services and caregivers’ vaccination behaviour. Confidence-building social structures and context-dependent challenges that affect vaccine uptake were also identified. World Health Organization 2021-11-01 2021-09-28 /pmc/articles/PMC8542260/ /pubmed/34737471 http://dx.doi.org/10.2471/BLT.20.285258 Text en (c) 2021 The authors; licensee World Health Organization. https://creativecommons.org/licenses/by/3.0/igo/This is an open access article distributed under the terms of the Creative Commons Attribution IGO License (http://creativecommons.org/licenses/by/3.0/igo/legalcode (https://creativecommons.org/licenses/by/3.0/igo/) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any reproduction of this article there should not be any suggestion that WHO or this article endorse any specific organization or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.
spellingShingle Research
Decouttere, Catherine
Banzimana, Stany
Davidsen, Pål
Van Riet, Carla
Vandermeulen, Corinne
Mason, Elizabeth
Jalali, Mohammad S
Vandaele, Nico
Insights into vaccine hesitancy from systems thinking, Rwanda
title Insights into vaccine hesitancy from systems thinking, Rwanda
title_full Insights into vaccine hesitancy from systems thinking, Rwanda
title_fullStr Insights into vaccine hesitancy from systems thinking, Rwanda
title_full_unstemmed Insights into vaccine hesitancy from systems thinking, Rwanda
title_short Insights into vaccine hesitancy from systems thinking, Rwanda
title_sort insights into vaccine hesitancy from systems thinking, rwanda
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8542260/
https://www.ncbi.nlm.nih.gov/pubmed/34737471
http://dx.doi.org/10.2471/BLT.20.285258
work_keys_str_mv AT decoutterecatherine insightsintovaccinehesitancyfromsystemsthinkingrwanda
AT banzimanastany insightsintovaccinehesitancyfromsystemsthinkingrwanda
AT davidsenpal insightsintovaccinehesitancyfromsystemsthinkingrwanda
AT vanrietcarla insightsintovaccinehesitancyfromsystemsthinkingrwanda
AT vandermeulencorinne insightsintovaccinehesitancyfromsystemsthinkingrwanda
AT masonelizabeth insightsintovaccinehesitancyfromsystemsthinkingrwanda
AT jalalimohammads insightsintovaccinehesitancyfromsystemsthinkingrwanda
AT vandaelenico insightsintovaccinehesitancyfromsystemsthinkingrwanda