How can human-centered design build a story-based video intervention that addresses vaccine hesitancy and bolsters vaccine confidence in the Philippines? A mixed method protocol for project SALUBONG

Abstract

IntroductionSince the onset of a dengue vaccine controversy in late 2017, vaccine confidence has plummeted in the Philippines, leading to measles and polio outbreaks in early 2019. This protocol outlines a human-centered design (HCD) approach to co-create and test an intervention that addresses vaccine hesitancy (VH) via narrative and empathy with and among families and healthcare workers.Methods and analysis‘Salubong’ is a Filipino term that means to welcome someone back into one’s life, reinforcing notions of family ties and friendships. We apply this sentiment to vaccines. Following the phases of HCD, guided by a theoretical framework, and drawing from locally held understandings of faith and acceptance, we will conduct in-depth interviews (IDIs) and focus group discussions (FGDs) in rural and urban Filipino communities that witnessed dramatic increases in measles cases in recent years. During qualitative engagements with caretakers, providers, and policymakers, we will collect narratives about family and community perceptions of childhood vaccinations, public health systems and opportunities to restore faith. IDIs and FGDs will continuously inform the development of (and delivery mechanisms for) story-based interventions. Once developed, we will test our co-created interventions among 800 caretakers and administer a VH questionnaire prior to and immediately following the intervention encounter. We will use the feedback gained through the survey and Kano-style questionnaires to further refine the intervention. Considering the data collection challenges posed by the ongoing COVID-19 pandemic, we have developed workarounds to conduct data collection primarily online. We will use systematic online debriefings to facilitate comprehensive participation of the full research team.Ethics and disseminationEthical approval has been granted by the Institutional Review Board of the Research Institute for Tropical Medicine (number 2019–44) and Ethical Commission of Heidelberg University, Faculty of Medicine (S-833/2019). Study findings will be disseminated in scientific conferences and published in peer-reviewed journals.

Understanding Factors to COVID-19 Vaccine Adoption in Gujarat, India

“…Numerous studies have found that people do not consider vaccines safe and effective, thereby doubting the vaccination program [ 10 , 11 , 12 ]. This uncertainty has resulted in lower-than-expected vaccination rates, especially in low- and middle-income countries [ 13 , 14 , 15 ].…”

Misinformation, infighting, backlash, and an ‘endless’ recovery; policymakers recount challenges and mitigating measures after a vaccine scare in the Philippines

“…This qualitative study is part of a larger mixed-methods study designed to develop and test a story-based VH intervention to revive vaccine confidence in the Philippines. Detailed information regarding overall study design and procedures are published elsewhere [ 24 ].…”

“…We initially invited respondents via email or phone call and performed a one-on-one phone call where the study was briefly introduced. After the initial call, we arranged an appointment to further explain the study, answer any questions, request consent, and proceed for a formal interview [ 24 , 34 ]. Policymakers included National Immunization Program managers, coordinators, team leaders from government agencies (DOH, Department of Education (DepEd)) and non-government organizations (World Health Organization (WHO) country and Western Pacific region offices, and UNICEF).…”

Scared, powerless, insulted and embarrassed: hesitancy towards vaccines among caregivers in Cavite Province, the Philippines

“…This study is part of a larger mixed methods study ('Project SALUBONG') aiming to develop an intervention that draws on vaccination narratives and imagery from caregivers of under-5 children and HCWs in the Philippines. 26 The Republic of the Philippines, the setting of this study, is an archipelago in Southeast Asia consisting of more than 7000 islands divided into 17 administrative regions. 27 While the Philippines was once among the countries with high vaccine confidence and uptake, vaccine confidence rapidly declined in 2018 following the large-scale, highly politicised Dengvaxia vaccine scare.…”

“…39 From 2018 to 2019, Calabarzon saw a 300% increase in measles cases. [40][41][42] Recruitment and data collection As part of the larger project SALUBONG, 26 we purposively selected vaccine hesitant caregivers (VHCs) of under-5 children who had not completed their vaccination according to the recommended schedule in the preceding years (from 2018 up to the date of collection). Eligibility in terms of vaccine uptake was determined based on vaccination records provided by HCWs in the region.…”