Vaccine Acceptance in Two Middle Income Countries: The Impact of Attitudes on Vaccine Safety

Transcription

1 Vaccine Acceptance in Two Middle Income Countries: The Impact of Attitudes on Vaccine Safety Sarah Appeadu Mentor: Dr. Kristen Feemster MD, MPH, MSHP August 14, 2014

2 Objectives Project Background and Significance Methods Preliminary Observations Lessons Learned

3 The Decade of Vaccines Expanding availability of vaccines Attitudes towards vaccination are changing Changing attitudes influence public demand Public weighs vaccination risks against non-vaccination benefits Research shows attitudes influential in U.S context Not much known about vaccine acceptance measured in developing countries

4 Our Research Question In middle income countries, what factors influence caregivers and healthcare providers attitudes and beliefs towards childhood vaccination? How does exposure to media coverage about vaccine safety influence vaccine acceptance?

5 Why Middle Income Countries? Emerging, rapidly growing immunization programs Stable public health infrastructure Disparities in resource distribution

6 Project Design Qualitative study Exploring factors that promote or undermine vaccine acceptance Defining attitudes towards childhood vaccination Focus groups and structured interviews Interview / focus group script based upon health belief models and influential factors previously identified in literature

7 Conceptual Model Personal characteris1cs Communica1on about vaccina1on program Vaccina1on site loca1on, 1me, cost Social Norms regarding vaccina1on Knowledge and beliefs regarding vaccines / disease A"tudes towards vaccina1on Inten1on to be vaccinated Vaccine Acceptance / Vaccine Receipt Previous experience w/ vaccina1on Perceived Risk of acquiring vaccine preventable disease Perceived Risk of adverse event from vaccine

8 Study Population Recruitment from 3 urban communities & 2 semi-rural communities Caregivers & healthcare providers Caregivers show under 5 cards to document whether their children were fully or incompletely immunized Focus groups facilitated by research study nurse, conducted in Setswana

9 Analytic Plan Transcribed from audio, translated from Setswana to English Classifying quotes into 20 different categories of potential factors- parent nodes Freedom to add nodes if found motif in transcripts Raters- Sarah Appeadu, Dr. Lori Kestenbaum, Dr. Kristen Feemster Used Nvivo, qualitative data software Analyzes data from qualitative sources (i.e video, audio, interviews, surveys, etc.)

10 Codebook

11 Sources

12 Coding Highlighting and Stripes Gives Kaffa coefficient- compares our matching to chance

13 Analyzing the Transcripts: Challenges Inter-rater reliability Translation discrepancy Tedious, slow process

14 Preliminary Results 20 focus groups/interviews 33 providers and 22 caregivers Approximately 978 comments coded

15 ~300 of those 978 comments are related to communication about vaccines from healthcare workers and medical literature, community members, or the media

16 Preliminary Results Observations Batswana are a very aware and informed people Thanks to the media: And then of course radio, radio broadcasts and TV broadcasts, they are all very very important, too. However, the media can be unreliable: Sometimes the same media issues are so distorted that you may want to turn off your radios because there would be so much negative issues that would make one doubt the safety of vaccines. Luckily, they have their providers to turn to: The clinic staff will rescue you from the dilemma. Generally strong trust in government, healthcare system, and healthcare providers

17 Preliminary Results Observations Possibilities for improvement exist A caregiver complains of long lines at the clinic: Well I have observed one thing especially during campaigns and that is long queues at the service points. It is sometimes too hot for mothers to be lining up in those conditions. A provider notes the issue with lack of transparency from distributor to healthcare providers: We just receive that and accept to use that without properly [ ] without really actually getting into reason why this drug was changed. A caregiver explains the consequence of poor worker-patient interactions: They get so harsh that you may think twice before you approach them.

18 Preliminary Results Observations Interesting topics for further implications Mobile clinics help with accessibility Traditional medicine not integrated into public health sphere, though still held on to by many Cost not prohibitive due to free vaccinations

19 Moving Forward Dr. Feemster and Dr. Kestenbaum will be traveling to Botswana in September to present the most commonly observed phenomena from the focus groups to the Ministry of Health and begin planning interventions Manuscript preparation Serving as a model for vaccine acceptance research in similar settings Comparing results to other project study sites

20 Moving Forward Deeper exploration of specific topics Literature Review What is the role of religious and spiritual beliefs on vaccine acceptance in low and middle income countries? Example Journal Articles: Polio Vaccines: "No Thank You!" Barriers to Polio Eradication in Northern Nigeria The social shaping of childhood vaccination practice in rural and urban Gambia

21 Lessons Learned Despite the notion of African healthcare as hindered by lack of resources, Botswana is an example of diversity in continent manifested by its rather stable public health infrastructure and informed population Qualitative research humanizes data Nvivo skills Every member of a research team has value Curiosity truly fuels research Example: This project Example 2: Literature Review

22 Dr. Kristen Feemster Dr. Lori Kestenbaum CHOP Policy Lab Thank You!! Leonard Davis Institute of Health Economics Team Joanne Levy & Safa Browne