Using immunisation caregiver journey interviews to understand and optimise vaccination uptake: lessons from Sierra Leone

Abstract

Quantitative and qualitative assessments have revealed diverse factors that influence the uptake of childhood immunisation services and shed light on reasons for vaccination delays and refusals. UNICEF and partner organisations developed the Immunisation Caregiver Journey Framework as a novel way to understand caregiver experiences in accessing and receiving immunisation services for children. This framework aims to help immunisation programmes identify vaccination barriers and opportunities to improve vaccination uptake by enhancing the overall caregiver journey in a systems-focused manner, using human-centred design principles. In this paper, we adapt the framework into a flexible qualitative inquiry approach with theoretical guidance from interpretative phenomenology. We draw from the implementation experiences in Sierra Leone to inform methodological guidance on how to design and implement the Immunisation Caregiver Journey Interviews (ICJI) to understand the lived experiences of caregivers as they navigate immunisation services for their children. Practical guidance is provided on sampling techniques, conducting interviews, data management, data analysis and the use of data to inform programmatic actions. When properly implemented, the ICJI approach generates a rich qualitative understanding of how caregivers navigate household and community dynamics, as well as primary healthcare delivery systems. We argue that understanding and improving the caregiver journey will enhance essential immunisation outcomes, such as the completion of the recommended vaccination schedule, timeliness of vaccination visits and reduction in dropouts between vaccine doses.

Using the Journey to Health and Immunization (JTHI) Framework to Engage Stakeholders in Identifying Behavioral and Social Drivers of Routine Immunization in Nepal

“…The team decided to use the Journey to Health and Immunization (JTHI) framework, a model and journey mapping tool developed by UNICEF and its partners in 2017 [20,21]. UNICEF and partners developed the JTHI in response to the limitations of applying other behavior change theories such as the Health Belief Model to caregiver vaccination and health behaviors [22]. The JTHI enables practitioners to understand both caregiver and health worker journeys, providing valuable insights into their experiences and challenges across six essential domains (Figure 1) that affect caregivers and health workers before, during, and after vaccination services are delivered [20,23].…”

“…First, the JTHI draws from the socio-ecological model, a theoretical framework with which the team had experience [20]. Second, the JTHI was developed within the contexts of immunization and low-and middle-income settings [22,23]. For example, the JTHI has been adapted as a qualitative inquiry approach and applied as an analytical framework in multiple studies focused on low-and middle-income settings, including Sierra Leone, Nigeria, Democratic Republic of the Congo, and Mozambique, as well as several other Gavisupported countries [23][24][25].…”

“…It has also been included in COVID-19 vaccination guidance developed by the United States Centers for Disease Control and Prevention [26]. Third, the JTHI is practice oriented, uses human-centered design (HCD) principles, supports problem prioritization, and can be used to design tailored solutions to improve outcomes for individuals and communities [20,22]. The team selected the JTHI framework over other models for a number of reasons.…”