Communicate to vaccinate (COMMVAC) 2: Implementing communication interventions to improve childhood vaccination uptake in LICs

Background Effective communication between the health services and caregivers of children can improve childhood vaccination uptake and strengthen immunization services in low-income countries (LICs) and settings. A key challenge, though, is how best to integrate evidence-based communication strategies into vaccination programme delivery at scale. Aim The Communicate to Vaccinate 2 (COMMVAC) project aims to develop guidance for policy makers and programme managers on how to strengthen vaccine delivery and increase vaccination uptake in LICs through the integration of evidence-based communication strategies that are adapted for local conditions. Objectives 1. To map the range of communication activities used in vaccination campaigns 2. To develop an outcomes framework for communication interventions to improve childhood vaccination uptake 3. To analyse how vaccination programmes are implementing communication interventions 4. To review systematically evidence on health system barriers and facilitators to the scaling up of vaccination communication interventions 5. To review systematically qualitative data on parents? perceptions of vaccination information and how this information influences their intention to vaccinate 6. To develop and disseminate best practice guidance on effective vaccination communication interventions for LICs Methods First, we have built on methods used in the COMMVAC 1 project (www.commvac.com) to develop a taxonomy (a classification system which groups items based on conceptual similarities) of communication interventions used in both routine and campaign-based childhood vaccination. The taxonomy was developed based on examples from the literature, informant interviews and field observations of communication interventions used within vaccination delivery. Second, we have used literature review and expert consultations to develop an outcomes framework for provider-parent vaccination communication interventions. Third, we have used qualitative methods to explore how vaccination communication interventions are being delivered in Cameroon, Mozambique and Nigeria. Fourth, we have undertaken interviews with key stakeholders and document review to explore the health systems factors affecting communication intervention scale up in LICs. Fifth, we have reviewed qualitative studies of vaccination communication to better understand parental perceptions of how vaccination information is communicated. Finally, we are working with partners to develop evidence-informed guidance on how to select and implement vaccination communication interventions in LICs. Outcomes The key outcomes for the COMMVAC 2 project are: (1) an approach to standardising outcomes for future vaccination communication intervention trials; (2) a deeper understanding of the range of vaccination communication interventions being delivered in LICs and the factors associated with their implementation at scale; and (3) improved childhood vaccination uptake in LICs. Findings: We used the COMMVAC communication intervention taxonomy to map vaccination communication strategies used in Cameroon, Mozambique and Nigeria. We then used these country level intervention maps to create a cross-country comparative map. This map was discussed at a stakeholder workshop, with participants from GAVI, WHO and relevant health departments from Cameroon, Mozambique and Nigeria, that explored childhood vaccination communication strategies in the three settings. The comparative map and discussions helped develop the comprehensive 'Communicate to Vaccinate' taxonomy of communication interventions for childhood vaccination in routine and campaign contexts. We have collected a wide range of qualitative data on how vaccination communication interventions are delivered in Cameroon, Mozambique and Nigeria. These data suggest that communication is often neglected in routine vaccination; that there are key gaps in the information available; and that resource and health worker training constraints limit the effective use of available strategies. Our Cochrane qualitative evidence synthesis on parental perceptions of childhood vaccination communication found that, in general, parents wanted more information than they were getting, available in a variety of settings, and from a source they trusted and perceived as balanced and neutral. We have completed a map of outcomes measured in trials of childhood vaccination communication interventions and developed an evidence-based outcomes taxonomy. The taxonomy includes three core areas: psychosocial impact, health impact, and community, social or structural impact, each of which encompasses several domains and sets of outcomes. We are supporting WHO AFRO to develop evidence-informed guidance on childhood vaccination communication, in collaboration with UNICEF, WHO Geneva and other stakeholders. This guidance, to be published in 2018, will draw together evidence from this project and others.

Background Effective communication between the health services and the parents and caregivers of children can improve childhood vaccination uptake and strengthen immunization services in low income countries (LICs). A key challenge, however, is how best t o integrate evidence-based communication strategies into vaccination programme delivery at scale. Aim To develop guidance for policy makers and programme managers on how to strengthen vaccine delivery and increase vaccination uptake in LICs through the integration of evidence-based communication strategies that are adapted for local conditions. Objectives -To map the range of communication activities used in vaccination campaigns -To develop an outcomes framework for communication interventions to im prove childhood vaccination uptake -To analyse how vaccination programmes are implementing communication interventions -To review systematically evidence on health system barriers and facilitators to the scaling up of vaccination communication interventi ons -To develop and disseminate best practice guidance on effective vaccination communication interventions for LICs Methods -Creating a taxonomy of communication interventions used in vaccination campaigns -Developing an outcomes framework for provider -parent vaccination communication interventions - Micro-analysis of how vaccination communication interventions are delivered - Exploring the health systems factors affecting communication intervention scale up in LICs - Translating the best available evi dence into guidance for successful application of key communication interventions in LICs Outcomes -An approach to standardising outcomes for future vaccination communication intervention trials -Deeper understanding of the range of vaccination communica tion interventions being delivered in LICs and the factors associated with their implementation at scale -Improved childhood vaccination uptake in LICs -Knowledge resources tailored for LICs