Understanding the main barriers to immunization in Colombia to better tailor communication strategies

BMC Public Health

M Carolina Danovaro-Holliday²  Pamela Bravo-Alcántara²  M Cristina Pedreira²  Silas Pierson Trumbo²  Martha Velandia-González²  Diego Alejandro García L¹ 

[1]Expanded Program on Immunization, Carrera 13 No. 32-76, Bogotá, Colombia

[2]Comprehensive Family Immunization Unit, Pan American Health Organization, 525 23rd St., NW Washington, DC 20037, USA

关键词: Communication strategies;    Barriers to immunization;    Immunization services;    Colombia;    Immunization programs;   

Others  :  866330
DOI  :  10.1186/1471-2458-14-669

 received in 2013-06-27, accepted in 2014-06-19,  发布年份 2014

【 摘 要 】

Background

The Expanded Program on Immunization (EPI) in Colombia has made great advances since its inception in 1979; however, by 2010 vaccination coverage rates had been declining. In 2010, the EPI commissioned a nationwide study on practices on immunization, attitudes and knowledge, perceived service quality, and barriers to childhood immunization in order to tailor EPI communication strategies.

Methods

Colombia’s 32 geographical departments were divided into 10 regions. Interviewers from an independent polling company administered a survey to 4802 parents and guardians of children aged <5 years in these regions. To better assess barriers to vaccination, the study was designed to have 70% of participants who had children with incomplete vaccination schedules. Explanatory factorial, principal component, and cluster analyses were performed to place participants into a group (segment) representing the primary category of reasons respondents offered for not vaccinating their children. Types of barriers were then compared to other variables, such as service quality, communication preferences, and parental attitudes on vaccination.

Results

Although all respondents indicated that vaccines have health benefits, and 4738 (98.7%) possessed vaccination cards for their children, attitudes and knowledge were not always favorable to immunization. Six groups of immunization barriers were identified: 1) factors related to caregivers (24.4%), 2) vaccinators (19.7%), 3) health centers (18.0%), 4) the health system (13.4%), 5) concerns about adverse events (13.1%), and 6) cultural and religious beliefs (11.4%); groups 1, 5 and 6 together represented almost half (48.9%) of users, indicating problems related to the demand for vaccines as the primary barriers to immunization. Differences in demographics, communication preferences, and reported service quality were found among participants in the six groups and among participants in the 10 regions. Additionally, differences between how participants reported receiving information on vaccination and how they believed such information should be communicated were observed.

Conclusions

Better understanding immunization barriers and the users of the EPI can help tailor communication strategies to increase demand for immunization services. Results of the study have been used by Colombia’s EPI to inform the design of new communication strategies.

【 授权许可】

   
2014 García L et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]World Health Organization: International evaluation of Colombia’s expanded programme on Immunization. Vaccine Immun News 2012, 5. http://www.who.int/immunization/GIN_October_2012.pdf webcite
• [2]World Health Organization: WHO-UNICEF estimates of coverage. http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tswucoveragedtp3.html webcite
• [3]Ministry of Health and Social Protection of Colombia: Documento Marco Jornada de Vacunación de las Américas, 2012 Abril. http://www.scribd.com/doc/104916190/Documento-Marco-Jornada-de-Vacunacion-de-las-Americas-abril2012 webcite
• [4]Acosta-Ramírez N, Durán-Arenas LG, Eslava-Rincón JI, Campuzano-Rincón JCL: Determinants of vaccination after the Colombian health system reform. Rev Saude Publica 2005, 39(3):421-429.
• [5]Ruiz-Rodríguez M, Vera-Cala LM, López-Barbosa N: Health insurance for infants and infant vaccination related to forced displacement in Colombia. Rev Salud Pública 2008, 10(1):49-61.
• [6]De la Hoz F, Perez L, Wheeler JG, de Neira M, Hall AJ: Vaccine coverage with hepatitis B and other vaccines in the Colombian Amazon: do health worker knowledge and perception influence coverage? Trop Med Int Health 2005, 10(4):322-329.
• [7]Morón-Duarte L, Espitia MT: A rapid evaluation of vaccination coverage in Bogotá, 2006. Rev Salud Publica (Bogota) 2009, 11(2):237-246.
• [8]Lewin S, Hill S, Abdullahi LH, de Castro Freire SB, Bosch-Capblanch X, Hussey GD, Jones CM, Kaufman J, Lin V, Mahomed H, Rhoda L, Robinson P, Waggie Z, Willis N, Wiysonge CS: ‘Communicate to vaccinate’ (COMMVAC), building evidence for communicating about childhood vaccinations in low- and middle-income countries: protocol for a programme of research. Implement Sci 2011, 6:125. BioMed Central Full Text
• [9]Waisbord S, Larson H: Why Invest In Communication For Immunization: Evidence and Lessons Learned. A Joint Publication Of The Health Communication Partnership at Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs (Baltimore) and the United Nations Children’s Fund (New York) 2005 June. http://www.who.int/immunization/hpv/communicate/why_invest_in_communication_for_immunization_unicef_healthcommunicationspartnership_path_usaid.pdf webcite
• [10]Shrimp L: Strengthening Immunization Programs: The Communication Component. Published by the Basic Support for Institutionalizing Child Survival Project (BASIC) II for the United States Agency for International Development; 2004. http://www.jsi.com/JSIInternet/Resources/publication/display.cfm?txtGeoArea=INTL&id=10277&thisSection=Resources webcite]
• [11]Health Secretariat of Bogotá: Decreto 2287 De 2003: Por El Cual Se Reglamenta El Uso Del Carné De Salud Infantil Como Requisito De Ingreso A Los Establecimientos Educativos Y De Bienestar. http://www.alcaldiabogota.gov.co/sisjur/normas/Norma1.jsp?i=9290 webcite
• [12]Trochim W: Research Methods Knowledge Base. http://www.socialresearchmethods.net/kb/questype.php webcite
• [13]Rainey JJ, Watkins M, Ryman TK, Sandhu TK, Bo A, Banerjee K: Reasons related to non-vaccination and under-vaccination of children in low and middle income countries: findings from a systematic review of the published literature, 1999–2009. Vaccine 2011, 29(46):8215-8221.
• [14]Hutchins SS, Jansen HAFM, Robertson SE, Evans P, Kim-Farley RJ: Studies of missed opportunities for immunization in developing and industrialized countries. Bull World Health Organ 1993, 71(5):549-560.
• [15]Acosta Ramírez N, Rodríguez García J: Inequity in infant vaccination coverage in Colombia 2000 and 2003. Rev Salud Pública 2006, 8(Suppl 1):102-115.
• [16]Leask J, Kinnersley P, Jackson C, Cheater F, Bedford H, Rowles G: Communicating with parents about vaccination: a framework for health professionals. BMC Pediatr 2012, 12:154. BioMed Central Full Text
• [17]Kaufman J, Synnot A, Ryan R, Hill S, Horey D, Willis N, Lin V, Robinson P: Face to face interventions for informing or educating parents about early childhood vaccination. Cochrane Database Syst Rev 2013, 5(Art. No.: CD010038):1-91.
• [18]Pronovost PJ, Vohr E: Safe Patients, Smart Hospitals: How One Doctor’s Checklists Can Help Us Change Health Care from the Inside Out. New York, NY: Hudson Street Press, Penguin Group Inc.; 2010.
• [19]World Health Organization: Immunization Checklists. http://www.who.int/pmnch/activities/jointactionplan/immunization_checklist_background.pdf webcite