Designing tailored interventions to address barriers to vaccination
Katrine Habersaat, Noni MacDonald, Eve Dubé
Katrine Habersaat, WHO EURO
Noni MacDonald, Dalhousie University
Eve Dubé, INSPQ
Despite efforts to promote vaccination and make vaccination services easily accessible, vaccination coverage rates remain below the target rate for many vaccines in various jurisdictions. How can we develop effective interventions to increase vaccine acceptance and uptake? This CANVax in Brief presents some insights based on the Tailoring Immunization Programmes approach.1
The WHO Tailoring Immunization Programmes (TIP) approach1 offers a method to diagnose the barriers to, and drivers of, vaccination in specific subgroups and to design appropriate interventions to address these populations. TIP uses social and behavioural insight methods (i.e., people-centred research and social sciences methods) to design and evaluate interventions for behaviour change. For more information on TIP, see TIP Tailoring Immunization Programmes (2019).1
TIP is a comprehensive and phased approach that requires the investment of time and resources. Even if your organization does not conduct a full TIP project, two key insights provided below from TIP will help you to design an effective intervention to enhance vaccine acceptance and uptake.
1. Diagnose the problem ‒ don’t just guess
Often, the causes of low vaccination coverage rates are not understood, and the interventions are designed based on expert intuition rather than actual data.
“We have tried that in the past and it worked.”
“If only they knew how safe and effective vaccines are, they would vaccinate.”
In contrast, the TIP approach emphasizes that the very first step to find a solution is to have a good understanding of the root cause of the problem.
You can do this by:
- looking at the relevant studies conducted in your jurisdiction, and
- questioning front-line health providers, the students / parents / potential recipients themselves, members of the local community, or other key stakeholders.
The aim is to identify the main barriers to, and drivers of, the intended immunization behaviour in the target group:
Is the problem related to vaccination services? To a lack of awareness? To misinformation in social media? Only by having a good understanding of the causes of the problem will you be able to develop an effective intervention.
2. Design the tailored intervention
Once you have a good understanding of the root cause of the problem, the next step is to design an intervention based on this understanding and the resources available. If the issues are about access to vaccination services, then interventions aimed to inform people about the risk and benefits of vaccines will not be effective. If lack of awareness is the main cause of under-vaccination, you need to address this first.
Generally, interventions that have multiple components are more effective than single-component interventions. For example, even a simple intervention such as a change in clinic hours requires communication to the community – not just announcing the hours of change on the clinic door. The Behaviour Change Wheel model – see Figure 1 – can help inform the design of the intervention to address health behaviours by highlighting the relevant types of interventions, depending on the barriers and drivers identified.2 The TIP approach has adapted this model for vaccination-related concerns.1 Note there are multiple components for consideration.
Figure 1. The Behaviour Change Wheel2
If you need additional information on effective interventions to increase vaccine acceptance and uptake, please consult the CANVax fact sheets.
3. Implementation and Evaluation
Finally, too often, the work stops after the interventions have been implemented. When possible, a good practice is to evaluate the implementation process and the impact of the interventions. Even if you are not conducting a large study, try to document how the interventions were implemented and check whether there was an increase in vaccine uptake.
This could be done using regular vaccination program monitoring activities (e.g., coverage assessment before and after the implementation of the intervention). Examples include formal surveys or interviews, or simply by speaking with the people involved in the process to discuss the implementation so far and the successes and shortcomings experienced.
In conclusion, TIP is a valuable and effective approach to designing interventions to address barriers to vaccination. It is based on the understanding of needs and realities of individuals and communities. Even if you are not doing a formal TIP project, you can apply the key principles guiding TIP (Figure 2) to design your intervention.1
Figure 2. Values and Principles guiding TIP1
1. World Health Organization Regional Office for Europe. TIP Tailoring Immunization Programmes (2019) [Internet]. 2019 [cited 2019 Oct 29]. Available from: http://www.euro.who.int/en/publications/abstracts/tip-tailoring-immunization-programmes-2019.
2. Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation science. 2011 Apr 23;6:42.