1
|
Jones K, Chisnall G, Crocker-Buque T, Elliman D, Horwood J, Mounier-Jack S, Campbell CN, Saliba V, Chantler T. A new neonatal BCG vaccination pathway in England: a mixed methods evaluation of its implementation. BMC Public Health 2024; 24:1175. [PMID: 38671383 DOI: 10.1186/s12889-024-18586-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/25/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION The introduction of a national evaluation of newborn screening for Severe Combined Immunodeficiency (SCID) in England triggered a change to the selective Bacillus Calmette-Guerin (BCG) vaccination programme delivery pathway, as this live attenuated vaccine is contraindicated in infants with SCID. The neonatal BCG vaccination programme is a targeted programme for infants at increased risk of tuberculosis and used to be offered shortly after birth. Since September 2021 the BCG vaccine is given to eligible infants within 28 days of birth, when the SCID screening outcome is available. We explore the experiences of those implementing the new pathway, and how they made sense of, engaged with, and appraised the change. METHODS A mixed-methods evaluation was conducted between October 2022 and February 2023. This involved national online surveys with BCG commissioners and providers and qualitative semi-structured interviews with commissioners, providers, and Child Health Information System stakeholders in two urban areas. Survey data was analysed using descriptive statistics and interview data was analysed thematically. The data was triangulated using Normalization Process Theory as a guiding framework. RESULTS Survey respondents (n = 65) and qualitative interviewees (n = 16) revealed that making sense of the new pathway was an iterative process. Some expressed a desire for more direction on how to implement the new pathway. The perceived value of the change varied from positive, ambivalent, to concerned. Some felt well-prepared and that improvements to data capture, eligibility screening, and accountably brought by the change were valuable. Others were concerned about the feasibility of the 28-day target, reductions in vaccination coverage, increased resource burden, and the outcome of the SCID evaluation. New collaborations and communities of practice were required to facilitate the change. Three main challenges in implementing the pathway and meeting the 28-day vaccination target were identified: appointment non-attendance; appointment and data systems; and staffing and resourcing. Feedback mechanisms were informal and took place in tandem with implementation. CONCLUSION The new NHS neonatal BCG service specification has created an effective structure for monitoring and managing the BCG vaccination programme, but further work is required to support delivery of the 28-day vaccination target and improve uptake rates.
Collapse
Affiliation(s)
| | - Georgia Chisnall
- London School of Hygiene and Tropical Medicine, London, England.
| | | | | | | | | | | | | | - Tracey Chantler
- London School of Hygiene and Tropical Medicine, London, England
| |
Collapse
|
2
|
Fisher H, Denford S, Audrey S, Finn A, Hajinur H, Hickman M, Mounier-Jack S, Mohamed A, Roderick M, Tucker L, Yates J, Chantler T. Information needs of ethnically diverse, vaccine-hesitant parents during decision-making about the HPV vaccine for their adolescent child: a qualitative study. BMC Public Health 2024; 24:91. [PMID: 38178083 PMCID: PMC10768213 DOI: 10.1186/s12889-023-17540-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 12/19/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND The English schools-based human papillomavirus (HPV) vaccination programme has the potential to eliminate HPV-related cancers if high uptake is achieved. However, unmet information needs among some parents may contribute to persisting lower uptake among minority ethnic groups. Through this study we aimed to understand the information needs of vaccine-hesitant, ethnically diverse parents during decision-making about the HPV vaccine for their adolescent child, to inform the future development of tailored communication materials. METHODS Recruitment was facilitated thorough healthcare and community organisations within London and the South West of England. Semi-structured interviews took place between April and August 2023. Thematic analysis was undertaken, assisted by NVivo software. RESULTS Of the 29 parents interviewed, the majority were mothers (79%), belonged to a minority ethnic group (88%), and had an adolescent child unvaccinated against HPV (72%). Five of the interviews were undertaken in the participants' primary language with translation support. Most parents interviewed had limited knowledge about the HPV vaccine and appeared conflicted as to whether vaccines could offer benefits to health. Misunderstanding around the potential of developing serious side-effects (e.g. fertility issues, developing cancer) were factors that could negatively impact decision-making by parents. Stigma associated with the sexual transmissibility of HPV did not always negatively impact decision-making. However, some parents chose not to vaccinate on the basis of perceptions of low risk and a preference to provide education about sexual behaviours to their adolescent child. CONCLUSIONS Tailoring communication materials to address misunderstandings could support informed decision-making by vaccine hesitant parents for their adolescent children to be vaccinated against HPV. Future communication materials about the HPV vaccine should highlight the benefits of protection against cancer to increase parents' motivation for protect their adolescent child; provide accurate convincing information in relation to the excellent safety profile; and emphasise the importance of providing HPV vaccine at the recommended age, all alongside communicating the universality and commonality of HPV infection. TRIAL REGISTRATION N/A.
Collapse
Affiliation(s)
- Harriet Fisher
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation (BSE), Bristol Medical School, University of Bristol, Bristol, UK.
| | - Sarah Denford
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation (BSE), Bristol Medical School, University of Bristol, Bristol, UK
| | - Suzanne Audrey
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation (BSE), Bristol Medical School, University of Bristol, Bristol, UK
| | - Adam Finn
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation (BSE), Bristol Medical School, University of Bristol, Bristol, UK
- Schools of Population Health Sciences and of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | | | - Matthew Hickman
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation (BSE), Bristol Medical School, University of Bristol, Bristol, UK
| | - Sandra Mounier-Jack
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Vaccinations and Immunisation, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, UK
- LSHTM Vaccine Centre, London, UK
| | | | - Marion Roderick
- Department of Paediatric Immunology and Infectious Diseases, University Hospitals of Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Julie Yates
- UK Health Security Agency, Wellington House, London, UK
| | - Tracey Chantler
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Vaccinations and Immunisation, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, UK
- LSHTM Vaccine Centre, London, UK
| |
Collapse
|
3
|
Fisher H, Audrey S, Chantler T, Dominey M, Evans K, Henden L, Hickman M, Letley L, Towson A, Thomas C. Towards successful implementation of public health research into practice: Experiences and lessons learned from EDUCATE. Public Health Pract (Oxf) 2023; 6:100447. [PMID: 38028256 PMCID: PMC10643450 DOI: 10.1016/j.puhip.2023.100447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/11/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background The English schools-based human papillomavirus (HPV) vaccination programme is routinely offered to all young people aged 12-13 years. The EDUCATE lesson was developed to overcome barriers to uptake related to unmet information needs by providing young people with information and answering questions they may have about the HPV vaccine. The resource comprises a PowerPoint presentation, interspersed with five short films and a guidance document for professionals delivering the lesson. Adopting public health research into practice is challenging and few papers describe the process. This paper reports the initial use of the EDUCATE resource in schools and the process involved in supporting wider implementation. Study design Implementation and knowledge mobilisation. Methods Five secondary schools supported implementation of the EDUCATE resource. Delivery took place during April and December 2022 and was observed in four schools, with feedback obtained from two school staff members and 15 young people. Alongside this, meetings were held with over 80 stakeholders with the aim of identifying possible policy levers to encourage use of the EDUCATE resource, and to enhance understanding of how wider scale and sustained impact can be achieved. Results Overall, the resource was positively received by school staff and young people engaged well during the lesson. As a result of the stakeholder networking activities, the research team worked with the Personal, Social, Health and Economic (PSHE) Association to adapt the materials to meet their Quality Assessment and incorporate elements, such as more interactive activities, requested during the implementation study. Conclusion The EDUCATE resource has the potential to change practice by enhancing information provision about the HPV vaccine in schools and supporting young people nationally to make informed decisions. Key learnings from the project include the importance of integrating input from target users at all stages of the research process, pragmatism in relation to evaluation research designs, and incentivising researchers to undertake translation activities through further funding and a greater focus on impact. Together, these can help facilitate the availability of public health resources and their adoption into 'real-world' practice.
Collapse
Affiliation(s)
- Harriet Fisher
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation (BSE), Bristol Medical School, University of Bristol, Bristol, UK
| | - Suzanne Audrey
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation (BSE), Bristol Medical School, University of Bristol, Bristol, UK
| | - Tracey Chantler
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Vaccinations and Immunisation, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | | | - Karen Evans
- School-aged Immunisation Team, Sirona Care & Health, Bristol, UK
| | - Lizzie Henden
- Communities and Public Health Team, Bristol City Council, Bristol, UK
| | - Matthew Hickman
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation (BSE), Bristol Medical School, University of Bristol, Bristol, UK
| | - Louise Letley
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Alix Towson
- School-aged Immunisation Team, Sirona Care & Health, Bristol, UK
| | - Clare Thomas
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation (BSE), Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| |
Collapse
|
4
|
Kasstan B, Mounier-Jack S, Zuriaga-Alvaro A, Weil LG, Chantler T. "We're potentially worsening health inequalities": Evaluating how delivery of the 2022 London polio booster campaign was tailored to Orthodox Jewish families to reduce transmission vulnerability. SSM Qual Res Health 2023; 4:100365. [PMID: 38169919 PMCID: PMC10759644 DOI: 10.1016/j.ssmqr.2023.100365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/01/2023] [Accepted: 11/01/2023] [Indexed: 01/05/2024]
Abstract
A polio booster campaign targeting all children aged 1-9 was implemented across London between August-December 2022 as part of a national enhanced poliovirus incident response. Orthodox Jewish (OJ) children were particularly vulnerable to transmission due to disparities in childhood vaccination coverage and the transnational spread of poliovirus affecting linked populations in New York and Israel. This study aimed to evaluate how the polio booster campaign was tailored to increase uptake and enable access for OJ families in northeast and north central London boroughs, and the impact of the campaign on local-level vaccine inequities. Semi-structured in-depth interviews (n = 36) were conducted with participants involved in the implementation and delivery of the polio booster campaign, and OJ mothers. Site visits (n = 5) were conducted at vaccine clinics, and rapid interviews (n = 26) were held to explore parental perceptions of the poliovirus incident and childhood immunisations. Enablers to vaccination during the campaign included the production of targeted printed communications and offering flexible clinic times in primary care settings or complementary delivery pathways embedded in family-friendly spaces. Barriers included digital booking systems. Mothers reported being aware of the poliovirus incident, but the majority of those interviewed did not feel their children were at risk of contracting polio. Healthcare provider participants raised concerns that the vaccine response had limited impact on reducing disparities in vaccine uptake. While OJ families were recognised as a priority for public health engagement during the poliovirus incident response, this evaluation identified limitations in reducing transmission vulnerability during the booster campaign. Lessons for future campaign delivery include effectively conveying transmission risk and the urgency to vaccinate. Priorities for mitigating vaccine inequities include public engagement to develop messaging strategies and strengthening the capacity of primary care and complementary delivery pathways to serve families with higher-than-average numbers of children.
Collapse
Affiliation(s)
- Ben Kasstan
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
- The Vaccine Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
| | - Sandra Mounier-Jack
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
- The Vaccine Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
| | - Ana Zuriaga-Alvaro
- NHS Legacy and Health Equity Partnership, Primary Care and Public Health Commissioning, National Health Service England, London Region, London, SE1 8UG, United Kingdom
| | - Leonora G. Weil
- NHS Legacy and Health Equity Partnership, Primary Care and Public Health Commissioning, National Health Service England, London Region, London, SE1 8UG, United Kingdom
- United Kingdom Health Security Agency, London Region, South Colonnade, Canary Wharf, London, E14 4PU, United Kingdom
| | - Tracey Chantler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
- The Vaccine Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
| |
Collapse
|
5
|
Han K, Hou Z, Tu S, Wang Q, Hu S, Xing Y, Du J, Zang S, Chantler T, Larson H. Caregivers' understanding of childhood influenza vaccination during the epidemic in China. A mixed-methods study. Front Public Health 2023; 11:1196019. [PMID: 37637809 PMCID: PMC10447896 DOI: 10.3389/fpubh.2023.1196019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Influenza vaccination uptake among young children has been poor in China, but it is unclear how it changed during the COVID-19. This study aimed to investigate the uptake status and reasons of childhood influenza vaccination during the pandemic in China. Methods A mixed-methods study combining a questionnaire survey and semi-structured interviews was conducted in Anhui, Shaanxi, and Guangdong provinces between September and November 2021. 2081 caregivers completed the valid questionnaire. 38 caregivers participated in interviews, and data were analyzed thematically, using deductive and inductive coding. Results A total of 2081 caregivers completed the valid questionnaire, and 38 caregivers participated in interviews. Among the caregivers, a total of 1796 were in the age group for high-risk groups in the 2019-2020 flu season, and 46.10% reported that their children received influenza vaccination in the 2019-2020 flu season; 43.63% said that they vaccinated their children against influenza in the 2020-2021 flu season. Many caregivers indicated that the adoption of nonpharmacologic interventions (NPIs) during COVID-19 reduced the risk of influenza infection for children. Most caregivers consider the severity of influenza to be low, and some confused the common cold with influenza. Meanwhile, some caregivers lack confidence in the vaccine's effectiveness and importance. They thought that vaccines are not effective in preventing the constantly mutating virus. Despite clear perceptions about the severity of influenza and the effectiveness of the vaccine, we found that most caregivers did not receive any relevant medical information, and the communication about vaccines between caregivers and professional information sources, such as healthcare workers, is inadequate. Hence, caregivers have no scientific evidence to back up their perceptions. In terms of access to vaccination service, caregivers reported conflicts between time of vaccination service and their schedule, and the need for vaccine prices to be reduced. Discussion Targeted interventions are needed to address caregivers' lack of risk perception on influenza during COVID-19 and promote communication between caregivers and professional information sources. Extending vaccination service hours and increasing the number of vaccine clinics close to residential areas and expansion of financing sources for self-paid vaccination could facilitate the access to influenza vaccination service.
Collapse
Affiliation(s)
- Kaiyi Han
- School of Public and Health, Fudan University, Shanghai, China
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Zhiyuan Hou
- School of Public and Health, Fudan University, Shanghai, China
- NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Shiyi Tu
- School of Public and Health, Fudan University, Shanghai, China
- NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Qian Wang
- School of Public and Health, Fudan University, Shanghai, China
| | - Simeng Hu
- School of Public and Health, Fudan University, Shanghai, China
| | - Yuting Xing
- School of Public and Health, Fudan University, Shanghai, China
| | - Jing Du
- School of Public and Health, Fudan University, Shanghai, China
| | - Shujie Zang
- School of Public and Health, Fudan University, Shanghai, China
| | - Tracey Chantler
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Heidi Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, United States
| |
Collapse
|
6
|
Kasstan B, Mounier-Jack S, Chantler T, Masters N, Flores SA, Stokley S, Meek H, Easton D, De Luna-Evans T, Souto M, Punjabi C, Ruppert PS, Rosenberg E, Routh J. Poliovirus outbreak in New York State, August 2022: qualitative assessment of immediate public health responses and priorities for improving vaccine coverage. Epidemiol Infect 2023; 151:e120. [PMID: 37435800 PMCID: PMC10468811 DOI: 10.1017/s0950268823001127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/01/2023] [Accepted: 07/05/2023] [Indexed: 07/13/2023] Open
Abstract
In 2022, a case of paralysis was reported in an unvaccinated adult in Rockland County (RC), New York. Genetically linked detections of vaccine-derived poliovirus type 2 (VDPV2) were reported in multiple New York counties, England, Israel, and Canada. The aims of this qualitative study were to: i) review immediate public health responses in New York to assess the challenges in addressing gaps in vaccination coverage; ii) inform a longer-term strategy to improving vaccination coverage in under-vaccinated communities, and iii) collect data to support comparative evaluations of transnational poliovirus outbreaks. Twenty-three semi-structured interviews were conducted with public health professionals, healthcare professionals, and community partners. Results indicate that i) addressing suboptimal vaccination coverage in RC remains a significant challenge after recent disease outbreaks; ii) the poliovirus outbreak was not unexpected and effort should be invested to engage mothers, the key decision-makers on childhood vaccination; iii) healthcare providers (especially paediatricians) received technical support during the outbreak, and may require resources and guidance to effectively contribute to longer-term vaccine engagement strategies; vi) data systems strengthening is required to help track under-vaccinated children. Public health departments should prioritize long-term investments in appropriate communication strategies, countering misinformation, and promoting the importance of the routine immunization schedule.
Collapse
Affiliation(s)
- Ben Kasstan
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- The Vaccine Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Sandra Mounier-Jack
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- The Vaccine Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Tracey Chantler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- The Vaccine Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Nina Masters
- Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, GA, USA
| | - Stephen A Flores
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shannon Stokley
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Haillie Meek
- Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, GA, USA
- New York State Department of Health, Albany, NY, USA
| | - Delia Easton
- New York State Department of Health, Albany, NY, USA
| | | | - Maria Souto
- Rockland County Department of Health, Pomona, NY, USA
| | | | | | - Eli Rosenberg
- New York State Department of Health, Albany, NY, USA
| | - Janell Routh
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
7
|
Skirrow H, Kajungu D, Le Doare K, Chantler T, Kampmann B. Considerations for post-licensure group B streptococcus vaccine effectiveness studies. Int J Gynaecol Obstet 2023; 162:183-185. [PMID: 37165788 PMCID: PMC10952615 DOI: 10.1002/ijgo.14845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 02/14/2023] [Accepted: 04/25/2023] [Indexed: 05/12/2023]
Abstract
Post‐licensure studies of a Group B streptococcal vaccines for pregnant women in low and middle‐income countries will require investment in electronic health records.
Collapse
Affiliation(s)
- Helen Skirrow
- Department of Primary Care and Public Health, School of Public HealthImperial College LondonLondonUK
| | - Dan Kajungu
- Makerere University Centre for Health and Population ResearchIgangaUganda
- Department of Global HealthStellenbosch UniversityStellenboschSouth Africa
| | - Kirsty Le Doare
- Centre for Paediatric and Neonatal InfectionSt. George's University of LondonLondonUK
- Makerere University, John's Hopkins UniversityKampalaUganda
| | - Tracey Chantler
- The Vaccine Centre, Faculty of Public Health & PolicyLondon School of Hygiene & Tropical MedicineLondonUK
| | - Beate Kampmann
- The Vaccine Centre, Faculty of Public Health & PolicyLondon School of Hygiene & Tropical MedicineLondonUK
- Charite Centre for Global HealthBerlinGermany
| |
Collapse
|
8
|
Mounier-Jack S, Paterson P, Bell S, Letley L, Kasstan B, Chantler T. Covid-19 vaccine roll-out in England: A qualitative evaluation. PLoS One 2023; 18:e0286529. [PMID: 37267295 DOI: 10.1371/journal.pone.0286529] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 05/17/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND The UK was the first country to launch a national pandemic COVID-19 vaccination programme, which was implemented swiftly despite significant vaccine supply constraints. The delivery strategy used a combination of mass vaccination sites operated by NHS secondary care providers and local sites led by Primary Care Networks, and local pharmacies. Despite nation-wide rollout, persistent gaps in coverage continued to affect particular populations, including ethnic minority and marginalised social groups. AIM The study examined sub-national immunisation commissioners and providers' perspectives on how the COVID-19 vaccine programme was operationalised, and how delivery strategies impacted inequalities in access to vaccination services and uptake. The study aimed to inform national programme implementation, sustainability and future pandemic preparedness. METHODS Qualitative research was conducted in eight local NHS areas in 4 regions of England. Semi-structured interviews were performed with 82 sub-national NHS and public health vaccine providers and commissioners. RESULTS England's COVID-19 vaccination programme was described as top down, centralised and highly political. The programme gradually morphed from a predominantly mass vaccination strategy into more locally driven and tailored approaches able to respond more effectively to inequalities in uptake. Over time more flexibility was introduced, as providers adapted services by "working around" the national systems for vaccine supply and appointment booking. The constant change faced by providers and commissioners was mitigated by high staff motivation and resilience, local collaboration and pragmatism. Opportunities for efficient implementation were missed because priority was given to achieving national performance targets at the expense of a more flexible sub-national tailored delivery. CONCLUSION Pandemic vaccination delivery models need to be adapted for underserved and hesitant groups, working in collaboration with local actors. Learnings from the initial COVID-19 vaccine roll-out in England and elsewhere is important to inform future pandemic responses, in tailoring strategies to local communities, and improve large-scale vaccination programmes.
Collapse
Affiliation(s)
- Sandra Mounier-Jack
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Pauline Paterson
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sadie Bell
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Louise Letley
- Immunisation and Vaccine Preventable Disease Division, UK Health Security Agency, London, United Kingdom
| | - Ben Kasstan
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Tracey Chantler
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| |
Collapse
|
9
|
Ismail S, Chantler T, Paterson P, Letley L, Bell S, Mounier-Jack S. Adapting SARS-CoV-2 vaccination delivery in England to population needs: a thematic analysis of providers and commissioner's perceptions. BMC Health Serv Res 2023; 23:417. [PMID: 37127638 PMCID: PMC10150662 DOI: 10.1186/s12913-023-09350-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/28/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND A national SARS-CoV-2 vaccination programme was implemented in England from 8th December 2020, adopting a series of local level service delivery models to maximise rollout. The evidence base informing service design programme at inception was limited. We examined the real-world implementation of the programme through an assessment of sub-national providers' and commissioners' perspectives on the service delivery models used, to strengthen evidence on the acceptability, effectiveness and efficiency of the service delivery approaches used for SARS-CoV-2 vaccination in England or elsewhere. METHODS Qualitative, cross-sectional analysis based on semi-structured interviews conducted with 87 stakeholders working in SARS-CoV-2 vaccination delivery across four regions in England. Localities were selected according to geography and population socio-economic status. Participants were purposively sampled from health service providers, commissioners and other relevant bodies. Interviews were conducted between February and October 2021, and transcripts were thematically analysed using inductive and deductive approaches. RESULTS Various service delivery models were implemented over the course of the programme, beginning with hospital hubs and mass vaccination sites, before expanding to incorporate primary care-led services, mobile and other outreach services. Each had advantages and drawbacks but primary care-led models, and to some extent pharmacies, were perceived to offer a better combination of efficiency and community reach for equitable delivery. Common factors for success included availability of a motivated workforce, predictability in vaccine supply chains and strong community engagement. However, interviewees noted a lack of coordination between service providers in the vaccination programme, linked to differing financial incentives and fragmentated information systems, among other factors. CONCLUSION A range of delivery models are needed to enable vaccine rollout at pace and scale, and to mitigate effects on routine care provision. However, primary care-led services offer a tried-and-trusted framework for vaccine delivery at scale and pace and should be central to planning for future pandemic responses. Mass vaccination sites can offer delivery at scale but may exacerbate inequalities in vaccination coverage and are unlikely to offer value for money. Policymakers in England should prioritise measures to improve collaboration between service providers, including better alignment of IT systems.
Collapse
Affiliation(s)
- Sharif Ismail
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Tracey Chantler
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Pauline Paterson
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Louise Letley
- UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Sadie Bell
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Sandra Mounier-Jack
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| |
Collapse
|
10
|
Du Y, Jin C, Jit M, Chantler T, Lin L, Larson HJ, Li J, Gong W, Yang F, Ren N, Cheng W, Zhou Y, Tang W, Tucker JD, Wu D. Influenza vaccine uptake among children and older adults in China: a secondary analysis of a quasi-experimental study. BMC Infect Dis 2023; 23:225. [PMID: 37055738 PMCID: PMC10098986 DOI: 10.1186/s12879-023-08145-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 03/09/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Influenza vaccination is the key to prevent influenza-related disease, especially among high-risk populations. However, influenza vaccine uptake in China is low. This secondary analysis of a quasi-experimental trial aimed to understand factors associated with influenza vaccine uptake among children and older people stratified by funding context. METHODS A total of 225 children (aged 0.5-8 years) and 225 older people (aged 60 years or above) were recruited from three clinics (rural, suburban and urban) in Guangdong Province. Participants were allocated into two groups based on funding contexts: a self-paid group (N = 150, 75 children and 75 older adults) in which participants paid full price for their vaccination; and a subsidized group (N = 300, 150 children and 150 older adults) in which varying levels of financial support was provided. Univariate and multivariable logistic regressions were conducted stratified by funding contexts. RESULTS Overall, 75.0% (225/300) of participants in the subsidized group and 36.7% (55/150) in the self-paid group got vaccinated. Older adults had lower vaccination rates than children in both funding groups, while both age groups showed much higher uptake in the subsidized group than in the self-paid group (aOR = 5.96, 95% CI: 3.77-9.42, p = 0.001). In the self-paid group, having prior influenza vaccination history of children (aOR:2.61, 95%CI: 1.06-6.42) or older people (aOR:4.76, 95%CI: 1.08-20.90) was associated with increased influenza vaccine uptake compared to those who had no prior vaccination experiences in the family. While in the subsidized group, participants who got married or lived with partners (aOR = 0.32, 0.10-0.98) had lower vaccination uptake than single ones. Trust in providers' advice (aOR = 4.95, 95%CI:1.99, 12.43), perceived effectiveness of the vaccine (aOR: 12.18, 95%CI: 5.21-28.50), and experienced influenza-like illnesses in the family in the past year (aOR = 46.52, 4.10, 533.78) were associated with higher vaccine uptake. CONCLUSIONS Older people had suboptimal vaccine uptake compared to children in both contexts and need more attention to enhance influenza vaccination. Tailoring interventions to different vaccine funding contexts may help improve influenza vaccination: In self-paid context, motivating people to accept their first ever influenza vaccination may be a promising strategy. In subsidized context, improving public confidence in vaccine effectiveness and providers' advice would be useful.
Collapse
Affiliation(s)
- Yumeng Du
- Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, Guangzhou, China
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Chenqi Jin
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- Dermatology Hospital of South Medical University, Guangzhou, China
| | - Mark Jit
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, New Territories, Hong Kong, China
| | - Tracey Chantler
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Leesa Lin
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, New Territories, Hong Kong, China
| | - Heidi J Larson
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jing Li
- Department of Occupational and Environmental Health, West China School of Public Health, Sichuan University, Chengdu, China
| | - Wenfeng Gong
- China Country Office, Bill & Melinda Gates Foundation, Beijing, China
| | - Fan Yang
- Institute of Population Research, Peking University, Beijing, China
| | - Nina Ren
- Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Weibin Cheng
- Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yi Zhou
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Weiming Tang
- Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, Guangzhou, China
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joseph D Tucker
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dan Wu
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China.
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, Room 360, Keppel St, London, WC1E 7HT, UK.
| |
Collapse
|
11
|
Kasstan B, Chantler T, Marcus B, Mounier-Jack S, Saliba V, Edelstein M. Linked poliovirus incidents in the UK, USA and Israel: Silent transmission or missed warnings of vaccine inequity? Vaccine 2023; 41:2339-2342. [PMID: 36828717 DOI: 10.1016/j.vaccine.2023.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 01/09/2023] [Accepted: 02/13/2023] [Indexed: 02/25/2023]
Affiliation(s)
- Ben Kasstan
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; Centre for Health, Law & Society, University of Bristol, Bristol BS8 1RJ, UK.
| | - Tracey Chantler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; The Vaccine Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Blima Marcus
- Hunter-Bellevue School of Nursing, City University of New York, First Avenue, NY 10065, USA
| | - Sandra Mounier-Jack
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; The Vaccine Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Vanessa Saliba
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | | |
Collapse
|
12
|
Karafillakis E, Peretti-Watel P, Verger P, Chantler T, Larson HJ. " We don't have the same bodies; we don't react the same way": mothers and adolescent girls' perceptions of the risks and benefits of HPV vaccination in France. Hum Vaccin Immunother 2022; 18:2036555. [PMID: 35240936 PMCID: PMC9009901 DOI: 10.1080/21645515.2022.2036555] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Human Papillomavirus (HPV) vaccination is one of the most publicly mistrusted vaccines in Europe, with countries such as France struggling with low vaccine uptake due to parental questioning of vaccine risks and benefits. However, limited evidence exists on adolescent girls' perceptions of the risks and benefits of HPV vaccination. The aim of this qualitative study was to provide an in-depth exploration and comparison of French mothers (n = 21) and adolescent girls' (n = 36) perceptions of the risks and benefits of HPV vaccination. A thematic analysis showed that adolescent girls and mothers perceived the risks and benefits of HPV vaccination differently, with girls reporting positive and beneficial views and emotions toward vaccination and mothers expressing concerns about possible risks. Adolescent girls also reported that both perceptions and actual risks and benefits may vary from one individual to another. Vaccine safety was also understood differently, with mothers reporting a widespread view that vaccines are unsafe and focusing on controversial side effects and girls discussing short-term consequences of vaccination (e.g. pain, fever) and administration and storage issues. Strategies to improve uptake of HPV vaccination should consider and address both the mothers' and daughters' perceptions and understandings of HPV vaccination.
Collapse
Affiliation(s)
- E Karafillakis
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - P Peretti-Watel
- UMR Vitrome, Aix-Marseille Université, IHU Méditerrannée, IRD, Marseille, France.,Southeastern Health Regional Observatory (ORS Paca),Aix-Marseille Université, Marseille, France
| | - P Verger
- Southeastern Health Regional Observatory (ORS Paca),Aix-Marseille Université, Marseille, France
| | - T Chantler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - H J Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
13
|
Han K, Hou Z, Tu S, Wang Q, Hu S, Xing Y, Du J, Zang S, Chantler T, Larson H. Childhood Influenza Vaccination and Its Determinants during 2020-2021 Flu Seasons in China: A Cross-Sectional Survey. Vaccines (Basel) 2022; 10:vaccines10121994. [PMID: 36560404 PMCID: PMC9783337 DOI: 10.3390/vaccines10121994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022] Open
Abstract
Young children aged 6−59 months are recommended as one of the priority groups for seasonal influenza vaccination in China. This study assessed influenza vaccination coverage and the factors associated with vaccination uptake among children in three Chinese provinces. In September 2021, 2081 caregivers with children <5 years completed self-administered questionnaires as part of a cross-sectional survey. Logistic regression was used to assess determinants of childhood influenza vaccination. A total of 43.63% of respondents reported vaccinating their children against influenza during the 2020−2021 flu season. Caregivers who lived in Anhui province, had a bachelor degree or above, and an annual household income <20,000 RMB were more likely to vaccinate their children against influenza. Confidence in the importance (OR: 2.50; 95%CI: 1.77−3.54), safety (OR: 1.60; 95%CI: 1.29−1.99), and effectiveness (OR: 1.54; 95%CI: 1.23−1.93) of influenza vaccine was significantly associated with childhood vaccine acceptance. Respondents who saw that other caregivers were vaccinating their children had significantly higher odds of vaccinating their own children. Caregivers’ receiving positive influence from healthcare workers (OR: 1.33; 95%CI: 1.00−1.77), family members, or friends (OR: 1.30; 95%CI: 1.14−1.49) were also significantly associated with childhood influenza vaccination. Poor access, including conflicts between caregivers’ availability and vaccination service schedules and inconvenient transportation to the vaccination site were negatively associated with childhood flu vaccination. To promote childhood influenza vaccination, public health information campaigns need to target wealthier and less educated caregivers to enhance caregivers’ confidence in influenza vaccination. Targeted interventions are also needed to optimize access to vaccination services, including extending vaccination service hours and increasing the number of vaccination sites close to residential areas. Interventions are also needed to encourage primary care providers to play a greater role in promoting vaccination. Finally, the dissemination of related information and the public response need to be monitored for the timely understanding of public perceptions.
Collapse
Affiliation(s)
- Kaiyi Han
- School of Public and Health, Fudan University, Shanghai 200032, China
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Zhiyuan Hou
- School of Public and Health, Fudan University, Shanghai 200032, China
- NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China
- Correspondence:
| | - Shiyi Tu
- School of Public and Health, Fudan University, Shanghai 200032, China
- NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China
| | - Qian Wang
- School of Public and Health, Fudan University, Shanghai 200032, China
| | - Simeng Hu
- School of Public and Health, Fudan University, Shanghai 200032, China
| | - Yuting Xing
- School of Public and Health, Fudan University, Shanghai 200032, China
| | - Jing Du
- School of Public and Health, Fudan University, Shanghai 200032, China
| | - Shujie Zang
- School of Public and Health, Fudan University, Shanghai 200032, China
| | - Tracey Chantler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Heidi Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
- Department of Health Metrics Sciences, University of Washington, Seattle, WA 98195, USA
| |
Collapse
|
14
|
Wu D, Jin C, Bessame K, Tang FFY, Ong JJ, Wang Z, Xie Y, Jit M, Larson HJ, Chantler T, Lin L, Gong W, Yang F, Jing F, Wei S, Cheng W, Zhou Y, Ren N, Qiu S, Bao J, Wen L, Yang Q, Tian J, Tang W, Tucker JD. Effectiveness of a pay-it-forward intervention compared with user-paid vaccination to improve influenza vaccine uptake and community engagement among children and older adults in China: a quasi-experimental pragmatic trial. The Lancet Infectious Diseases 2022; 22:1484-1492. [PMID: 35868342 PMCID: PMC9492551 DOI: 10.1016/s1473-3099(22)00346-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 01/04/2023]
Abstract
Background China has low seasonal influenza vaccination rates among priority populations. In this study, we aimed to evaluate a pay-it-forward strategy to increase influenza vaccine uptake in rural, suburban, and urban settings in China. Methods We performed a quasi-experimental pragmatic trial to examine the effectiveness of a pay-it-forward intervention (a free influenza vaccine and an opportunity to donate financially to support vaccination of other individuals) to increase influenza vaccine uptake compared with standard-of-care user-paid vaccination among children (aged between 6 months and 8 years) and older people (≥60 years) in China. Recruitment took place in the standard-of-care group until the expected sample size was reached and then in the pay-it-forward group in primary care clinics from a rural site (Yangshan), a suburban site (Zengcheng), and an urban site (Tianhe). Participants were introduced to the influenza vaccine by project staff using a pamphlet about influenza vaccination and were either asked to pay out-of-pocket at the standard market price (US$8·5–23·2; standard-of-care group) or to donate any amount anonymously (pay-it-forward group). Participants had to be eligible to receive an influenza vaccine and to have not received an influenza vaccine in the past year. The primary outcome was vaccine uptake. Secondary outcomes were vaccine confidence and costs (from the health-care provider perspective). Regression methods compared influenza vaccine uptake and vaccine confidence between the two groups. This trial is registered with ChiCTR, ChiCTR2000040048. Findings From Sept 21, 2020, to March 3, 2021, 300 enrolees were recruited from patients visiting three primary care clinics. 55 (37%) of 150 people in the standard-of-care group (40 [53%] of 75 children and 15 [20%] of 75 older adults) and 111 (74%) of 150 in the pay-it-forward group (66 [88%] of 75 children and 45 [60%] of 75 older adults) received an influenza vaccine. People in the pay-it-forward group were more likely to receive an influenza vaccine compared with those in the standard-of-care group (adjusted odds ratio [aOR] 6·7 [95% CI 2·7–16·6] among children and 5·0 [2·3–10·8] among older adults). People in the pay-it-forward group had greater confidence in vaccine safety (aOR 2·2 [95% CI 1·2–3·9]), importance (3·1 [1·6–5·9]), and effectiveness (3·1 [1·7–5·7]). In the pay-it-forward group, 107 (96%) of 111 participants donated money for subsequent vaccinations. The pay-it-forward group had a lower economic cost (calculated as the cost without subtraction of donations) per person vaccinated (US$45·60) than did the standard-of-care group ($64·67). Interpretation The pay-it-forward intervention seemed to be effective in improving influenza vaccine uptake and community engagement. Our data have implications for prosocial interventions to enhance influenza vaccine uptake in countries where influenza vaccines are available for a fee. Funding Bill & Melinda Gates Foundation and the UK National Institute for Health Research.
Collapse
|
15
|
Kasstan B, Mounier-Jack S, Gaskell KM, Eggo RM, Marks M, Chantler T. "We've all got the virus inside us now": Disaggregating public health relations and responsibilities for health protection in pandemic London. Soc Sci Med 2022; 309:115237. [PMID: 35964473 PMCID: PMC9357441 DOI: 10.1016/j.socscimed.2022.115237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 11/29/2022]
Abstract
The COVID-19 pandemic has disproportionately impacted ethnic minorities in the global north, evidenced by higher rates of transmission, morbidity, and mortality relative to population sizes. Orthodox Jewish neighbourhoods in London had extremely high SARS-CoV-2 seroprevalence rates, reflecting patterns in Israel and the US. The aim of this paper is to examine how responsibilities over health protection are conveyed, and to what extent responsibility is sought by, and shared between, state services, and 'community' stakeholders or representative groups, and families in public health emergencies. The study investigates how public health and statutory services stakeholders, Orthodox Jewish communal custodians and households sought to enact health protection in London during the first year of the pandemic (March 2020-March 2021). Twenty-eight semi-structured interviews were conducted across these cohorts. Findings demonstrate that institutional relations - both their formation and at times fragmentation - were directly shaped by issues surrounding COVID-19 control measures. Exchanges around protective interventions (whether control measures, contact tracing technologies, or vaccines) reveal diverse and diverging attributions of responsibility and authority. The paper develops a framework of public health relations to understand negotiations between statutory services and minority groups over responsiveness and accountability in health protection. Disaggregating public health relations can help social scientists to critique who and what characterises institutional relationships with minority groups, and what ideas of responsibility and responsiveness are projected by differently-positioned stakeholders in health protection.
Collapse
Affiliation(s)
- Ben Kasstan
- Centre for Health, Law & Society, University of Bristol, Bristol, BS8 1RJ, United Kingdom
| | - Sandra Mounier-Jack
- The Vaccine Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom
| | - Katherine M Gaskell
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
| | - Rosalind M Eggo
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom; Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom; Hospital for Tropical Diseases, University College London Hospital NHS Foundation Trust, London, WC1E 6JB, United Kingdom
| | - Tracey Chantler
- The Vaccine Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom.
| |
Collapse
|
16
|
Hou Z, Song K, Wang Q, Zang S, Tu S, Chantler T, Larson HJ. Childhood COVID-19 vaccine acceptance and preference from caregivers and healthcare workers in China: A survey experiment. Prev Med 2022; 161:107138. [PMID: 35809825 PMCID: PMC9259187 DOI: 10.1016/j.ypmed.2022.107138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 06/14/2022] [Accepted: 07/02/2022] [Indexed: 11/28/2022]
Abstract
With approval of more COVID-19 vaccines for children, vaccine attributes may influence parental acceptance and choices. We aimed to assess effects of vaccine attributes and information on herd immunity on childhood COVID-19 vaccine acceptance. A survey experiment was conducted with caregivers of children aged 6 months to 11 years old and health care workers (HCWs) in China from September 14 to November 18, 2021. Respondents were randomly assigned to receive differing information on herd immunity (> 80% of the entire population must be vaccinated; or no information). Respondents then completed eight discrete choice tasks to assess vaccine acceptance based on attributes. 2331 (90.07%) of 2588 surveyed caregivers and 1576 (92.71%) of 1700 surveyed HCWs would accept COVID-19 vaccination for children, respectively. High Odds Ratios (OR) were found for acceptance of a vaccine with 90% over 50% efficacy (OR 6.70 [95% CI 6.11-7.35] for caregivers; 11.44 [10.12-12.95] for HCWs); and risk of adverse reactions to be 1 over 10 in 10,000 (3.96 [3.72-4.22] for caregivers; 2.98 [2.76-3.22] for HCWs). To achieve herd immunity target (> 80% vaccination coverage), vaccine efficacy should reach over 70% and risk of adverse reactions lower than 1 in 10,000. Knowledge on herd immunity target increased the odds of vaccine acceptance (1.82 [1.34-2.46] for caregivers; 2.42 [1.58-3.72] for HCWs). Childhood COVID-19 vaccine acceptance was high in China, independent of child's age, and depended on vaccine attributes.
Collapse
Affiliation(s)
- Zhiyuan Hou
- School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China.
| | - Kuimeng Song
- School of Health Care Security, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Qian Wang
- School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Shujie Zang
- School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Shiyi Tu
- School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Tracey Chantler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, UK
| | - Heidi J Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, UK; Department of Health Metrics Sciences, University of Washington, Seattle, USA
| |
Collapse
|
17
|
Fisher H, Chantler T, Mounier-Jack S, Audrey S. Human papillomavirus vaccine communication materials for young people in English-speaking countries: A content analysis. Health Educ J 2022; 81:513-528. [PMID: 35910267 PMCID: PMC9326800 DOI: 10.1177/00178969221092135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To undertake a content analysis of human papillomavirus (HPV) vaccine communication materials available to young people. DESIGN Content analysis. SETTING Majority English-speaking countries. METHODS Between March and April 2020, a web engine was utilised to search for and retrieve relevant communication materials. Content analysis was used to describe how the following key issues were covered: (1) side effects, (2) safety, (3) practicalities related to receiving the HPV vaccine and (4) gender-specific information. RESULTS A total of 44 separate communication materials were retrieved, predominantly videos, webpages and leaflets. There was a focus on mild side effects of the vaccine (43.2%), with less frequent reference being made to moderate or serious side effects (22.7%). Reassurance concerning the safety profile of vaccine was communicated by referencing the widespread use of the HPV vaccine (31.8%). Information regarding formal criteria for entry into the vaccination programme emphasised country-specific eligibility criteria (59.1%), the setting in which vaccination was offered (38.6%) and the number of doses required (38.6%). Content intended to improve young people's experiences of receiving the HPV vaccine was less often provided (22.7%). Gender-specific content usually related to specific HPV-related diseases (52.3%) and/or the availability of cervical cancer screening programmes (52.3%). CONCLUSION A variety of different communication tools were retrieved encompassing a wide variety of formats and content, reflective of different vaccination programmes and the varied priorities of organisations producing the materials. Findings will inform the co-production of a tailored educational package to improve access to information by populations of young people identified as having lower HPV vaccine uptake.
Collapse
Affiliation(s)
- Harriet Fisher
- National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tracey Chantler
- National Institute for Health Research Health Protection Research Unit in Vaccinations and Immunisation, London School of Hygiene and Tropical Medicine, London, UK
| | - Sandra Mounier-Jack
- National Institute for Health Research Health Protection Research Unit in Vaccinations and Immunisation, London School of Hygiene and Tropical Medicine, London, UK
| | - Suzanne Audrey
- National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
18
|
Kasstan B, Letley L, Mounier-Jack S, Klynman N, Gaskell KM, Eggo RM, Marks M, Chantler T. Tailoring immunisation programmes in a time of SARS-CoV-2: What can be learnt by comparing the findings of childhood and COVID-19 vaccine evaluation studies in an underserved population? Public Health Pract (Oxf) 2022; 4:100287. [PMID: 35811646 PMCID: PMC9250158 DOI: 10.1016/j.puhip.2022.100287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 01/03/2023]
Abstract
Objectives A WHO Tailoring Immunization Programmes (TIP) evaluation was conducted in 2014-16 to investigate suboptimal childhood vaccination coverage in the north London Orthodox Jewish community. In 2021-22 a qualitative evaluation of the COVID-19 vaccine programme (CVP) was conducted in the same setting. This paper examines whether the issues identified by the TIP affected the CVP and what differences emerged between these two vaccine programme evaluations. Study design Qualitative study. Methods The CVP evaluation involved conducting 28 semi-structured interviews with public health professionals, Orthodox Jewish welfare and religious representatives, and household members in February-May 2021. The key considerations arising from the thematic analysis of this data was then compared systematically with the overarching findings from the TIP study. Results The issues identified in the TIP study diverged and converged with results from the CVP evaluation: i) participants did not express concerns of unmet CVP information needs; ii) the social value of COVID-19 vaccines was influenced by international travel requirements; iii) in contrast to commissioning constraints noted to have limited flexible delivery of childhood immunisations in the TIP evaluation, the CVP was characterised by a flexible commissioning and delivery model. This model was facilitated by significant government investment as part of the COVID-19 pandemic response. Conclusions The comparative analysis indicates that flexible vaccine commissioning and fit for purpose public health investment can influence how documented knowledge is translated into action. Implications are raised for how routine vaccination services are equipped to serve the needs of minority populations with historically suboptimal coverage levels.
Collapse
Affiliation(s)
- Ben Kasstan
- Centre for Health, Law & Society, University of Bristol, Bristol, BS8 1RJ, United Kingdom
- Department of Sociology & Anthropology, Hebrew University of Jerusalem, Har HaTzofim, Jerusalem, 91905, Israel
| | - Louise Letley
- Immunisation and Countermeasures, National Infection Service, UK Health Security Agency, London, United Kingdom
| | - Sandra Mounier-Jack
- The Vaccine Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom
| | - Nicole Klynman
- City and Hackney Public Health Team, Hackney Council, 1 Hillman Street, London, E8 1DY, United Kingdom
| | - Katherine M. Gaskell
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
| | - Rosalind M. Eggo
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
- Hospital for Tropical Diseases, University College London Hospital NHS Foundation Trust, London, WC1E 6JB, United Kingdom
| | - Tracey Chantler
- The Vaccine Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom
- Corresponding author. The Vaccine Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom.
| |
Collapse
|
19
|
Daly MJ, Elvidge J, Chantler T, Dawoud D. A Review of Economic Models Submitted to NICE's Technology Appraisal Programme, for Treatments of T1DM & T2DM. Front Pharmacol 2022; 13:887298. [PMID: 35645790 PMCID: PMC9130744 DOI: 10.3389/fphar.2022.887298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/12/2022] [Indexed: 11/20/2022] Open
Abstract
Background: In the UK, 4.7 million people are currently living with diabetes. This is projected to increase to 5 million by 2025. The direct and indirect costs of T1DM and T2DM are rising, and direct costs already account for approximately 10% of the National Health Service (NHS) budget. Objective: The aim of this review is to assess the economic models used in the context of NICE’s Technology Appraisals (TA) Programme of T1DM and T2DM treatments, as well as to examine their compliance with the American Diabetes Association’s (ADA) guidelines on computer modelling. Methods: A review of the economic models used in NICE’s TA programme of T1DM and T2DM treatments was undertaken. Relevant TAs were identified through searching the NICE website for published appraisals completed up to April 2021. The review also examined the associated Evidence Review Group (ERG) reports and Final Appraisal Documents (FAD), which are publicly accessible. ERG reports were scrutinised to identify major issues pertaining to the economic modelling. The FAD documents were then examined to assess how these issues reflected on NICE recommendations. Results: Overall, 10 TAs pertaining to treatments of T1DM and T2DM were identified. Two TAs were excluded as they did not use economic models. Seven of the 8 included TAs related to a novel class of oral antidiabetic drugs (OADs), gliflozins, and one to continuous subcutaneous insulin infusion (CSII) devices. There is a lack of recent, robust data informing risk equations to enable the derivation of transition probabilities. Despite uncertainty surrounding its clinical relevance, bodyweight/BMI is a key driver in many T2DM-models. HbA1c’s reliability as a predictor of hard outcomes is uncertain, chiefly for macrovascular complications. The external validity of T1DM is even less clear. There is an inevitable trade-off between the sophistication of models’ design, their transparency and practicality. Conclusion: Economic models are essential tools to support decision-making in relation to market access and ascertain diabetes technologies’ cost effectiveness. However, key structural and methodological issues exist. Models’ shortcomings should be acknowledged and contextualised within the framework of technology appraisals. Diabetes medications and other technologies should also be subject to regular and consistent re-appraisal to inform disinvestment decisions. Artificial intelligence could potentially enhance models’ transparency and practicality.
Collapse
Affiliation(s)
- Marie-Josée Daly
- Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Jamie Elvidge
- National Institute for Health and Care Excellence (NICE), London, United Kingdom
| | - Tracey Chantler
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Dalia Dawoud
- National Institute for Health and Care Excellence (NICE), London, United Kingdom.,Faculty of Pharmacy, Cairo University, Giza, Egypt
| |
Collapse
|
20
|
Waites W, Pearson CAB, Gaskell KM, House T, Pellis L, Johnson M, Gould V, Hunt A, Stone NRH, Kasstan B, Chantler T, Lal S, Roberts CH, Goldblatt D, Marks M, Eggo RM. Transmission dynamics of SARS-CoV-2 in a strictly-Orthodox Jewish community in the UK. Sci Rep 2022; 12:8550. [PMID: 35595824 PMCID: PMC9121858 DOI: 10.1038/s41598-022-12517-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 05/12/2022] [Indexed: 11/22/2022] Open
Abstract
Some social settings such as households and workplaces, have been identified as high risk for SARS-CoV-2 transmission. Identifying and quantifying the importance of these settings is critical for designing interventions. A tightly-knit religious community in the UK experienced a very large COVID-19 epidemic in 2020, reaching 64.3% seroprevalence within 10 months, and we surveyed this community both for serological status and individual-level attendance at particular settings. Using these data, and a network model of people and places represented as a stochastic graph rewriting system, we estimated the relative contribution of transmission in households, schools and religious institutions to the epidemic, and the relative risk of infection in each of these settings. All congregate settings were important for transmission, with some such as primary schools and places of worship having a higher share of transmission than others. We found that the model needed a higher general-community transmission rate for women (3.3-fold), and lower susceptibility to infection in children to recreate the observed serological data. The precise share of transmission in each place was related to assumptions about the internal structure of those places. Identification of key settings of transmission can allow public health interventions to be targeted at these locations.
Collapse
Affiliation(s)
- William Waites
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, Scotland, UK.
| | - Carl A B Pearson
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Katherine M Gaskell
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Thomas House
- School of Mathematics, University of Manchester, Manchester, UK
| | - Lorenzo Pellis
- School of Mathematics, University of Manchester, Manchester, UK
| | - Marina Johnson
- Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London, UK
| | - Victoria Gould
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Adam Hunt
- Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London, UK
| | - Neil R H Stone
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
- Hospital for Tropical Diseases, University College London Hospital NHS Foundation Trust, London, UK
| | - Ben Kasstan
- Centre for Health, Law and Society, University of Bristol Law School, Bristol, UK
- Department of Sociology and Anthropology, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tracey Chantler
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Sham Lal
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Chrissy H Roberts
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - David Goldblatt
- Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London, UK
| | - Michael Marks
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
- Hospital for Tropical Diseases, University College London Hospital NHS Foundation Trust, London, UK
| | - Rosalind M Eggo
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| |
Collapse
|
21
|
Fisher H, Chantler T, Finn A, Kesten J, Hickman M, Letley L, Mounier-Jack S, Thomas C, Worthington K, Yates J, Audrey S. Development of an educational package for the universal human papillomavirus (HPV) vaccination programme: a co-production study with young people and key informants. Res Involv Engagem 2022; 8:16. [PMID: 35468845 PMCID: PMC9035505 DOI: 10.1186/s40900-022-00349-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/11/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The English schools-based human papillomavirus (HPV) vaccination programme is routinely offered to all young people aged 12-13 years, to prevent cancers affecting the cervix, vulva, vagina, penis, anus and mouth. Lower uptake among some population groups has been identified, in part, because of unmet information needs among young people. To address these unmet needs we report intervention planning and development processes to co-produce an educational package about the HPV vaccine. METHODS We used co-production research methodologies and the 'person-based approach' involving the following iterative stages: (i) collating and analysing primary and secondary evidence, including HPV vaccine communication materials, interviews and workshops; (ii) developing guiding principles; (iii) undertaking a behavioural analysis informed by the Behaviour Change Wheel and the Behaviour Change Technique taxonomy; (iv) development of a preliminary logic model; (v) co-production of resources, and; (vi) refinement of resources informed by feedback from young people and key informants. RESULTS We co-produced EDUCATE, a theory-based educational package, that is designed to be delivered to young people prior to being offered the HPV vaccine to support uptake. Young people and key informants identified the following key issues to include as content: (i) HPV-related information; (ii) how vaccines work; (iii) safety and side-effects of the HPV vaccine; (iii) eligibility for the HPV vaccination programme, and; (iv) preparation of young people to receive the HPV vaccine. A manual for professionals (e.g. immunisation nurses, school staff) delivering the intervention and a PowerPoint presentation, interspersed with five short films, were co-produced with young people and key informants. Following feedback, the content of the EDUCATE package was refined to increase acceptability, engagement, and persuasiveness to the target users. CONCLUSION Engagement with young people and key informants was integral to the development of our rigorously developed, theory-based intervention to address young people's information needs about the HPV vaccination programme. The acceptability and persuasiveness of the package has been maximised by working closely with young people and key informants to develop the content. An implementation study to examine how the EDUCATE package is implemented in practice and the impact on uptake of the HPV vaccination programme is underway.
Collapse
Affiliation(s)
- Harriet Fisher
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK.
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, London, UK.
| | - Tracey Chantler
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Adam Finn
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Joanna Kesten
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew Hickman
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Louise Letley
- Immunisation and Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Sandra Mounier-Jack
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Clare Thomas
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Julie Yates
- Screening and Immunisation, NHS England and Improvement South West, Bristol, UK
| | - Suzanne Audrey
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
22
|
Fisher H, Chantler T, Denford S, Finn A, Hickman M, Mounier-Jack S, Roderick M, Tucker L, Yates J, Audrey S. Development of a multicomponent intervention to increase parental vaccine confidence and young people's access to the universal HPV vaccination programme in England: protocol for a co-design study. BMJ Open 2022; 12:e062050. [PMID: 35387837 PMCID: PMC8987754 DOI: 10.1136/bmjopen-2022-062050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Persistent infection with HPV can result in cancers affecting men and, especially, women. Lower uptake exists by area and different population groups. Increasing parental confidence about, and adolescent access to, the universal HPV vaccination programme may help reduce inequalities in uptake. However, the evidence-base for interventions to address uptake for schools-based HPV vaccination programmes is currently lacking. This study protocol outlines how a multicomponent intervention to address this evidence gap will be codesigned with parents. METHODS AND ANALYSIS The proposed research will be undertaken in localities covered by two immunisation teams in London and the south-west of England. The 'person-based approach' to intervention development will be followed. In the first phase, an exploratory qualitative study will be undertaken with key stakeholders (n=8) and parents (n=40) who did not provide consent for their adolescent child to be vaccinated. During the interviews, parents' views on ways to improve parental confidence about, and adolescents' access to, HPV vaccination will be sought. The findings will be used to inform the co-design of a preliminary plan for a targeted, multicomponent intervention. In the second phase, at least two parent working groups (n=8) will be convened and will work with creative designers to co-design communication materials aimed at increasing parents' confidence in vaccination. At least two workshops with each parent group will be organised to obtain feedback on the intervention plan and communication materials to ensure they are fit for purpose. These findings will inform a protocol for a future study to test the effectiveness of the intervention at increasing HPV vaccination uptake. ETHICS AND DISSEMINATION The National Health Services Research Ethics Service and London School of Hygiene & Tropical Medicine Observational / Interventions Research Ethics Committee provided approvals for the study (reference 22/SW/0003 & 26902, respectively). We will work with parent advisory groups to inform our dissemination strategy and co-present our findings (eg, at community events or through social media). We will disseminate our findings with academics and healthcare professionals through webinars and academic conferences, as well as peer-reviewed publications.
Collapse
Affiliation(s)
- Harriet Fisher
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation (BSE), University of Bristol, Bristol, Bristol, UK
| | - Tracey Chantler
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Vaccinations and Immunisation, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah Denford
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation (BSE), University of Bristol, Bristol, Bristol, UK
| | - Adam Finn
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Matthew Hickman
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation (BSE), University of Bristol, Bristol, Bristol, UK
| | - Sandra Mounier-Jack
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Vaccinations and Immunisation, London School of Hygiene and Tropical Medicine, London, UK
| | - Marion Roderick
- Department of Paediatric Immunology and Infectious Diseases, University Hospitals of Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Julie Yates
- Screening and Immunisation, South West, NHS England South, Taunton, UK
| | - Suzanne Audrey
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation (BSE), University of Bristol, Bristol, Bristol, UK
| |
Collapse
|
23
|
Kasstan B, Mounier-Jack S, Letley L, Gaskell KM, Roberts CH, Stone NRH, Lal S, Eggo RM, Marks M, Chantler T. Localising vaccination services: Qualitative insights on public health and minority group collaborations to co-deliver coronavirus vaccines. Vaccine 2022; 40:2226-2232. [PMID: 35216844 PMCID: PMC8849863 DOI: 10.1016/j.vaccine.2022.02.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 01/15/2023]
Abstract
Ethnic and religious minorities have been disproportionately affected by the SARS-CoV-2 pandemic and are less likely to accept coronavirus vaccinations. Orthodox (Haredi) Jewish neighbourhoods in England experienced high incidences of SARS-CoV-2 in 2020-21 and measles outbreaks (2018-19) due to suboptimal childhood vaccination coverage. The objective of our study was to explore how the coronavirus vaccination programme (CVP) was co-delivered between public health services and an Orthodox Jewish health organisation. Methods included 28 semi-structured interviews conducted virtually with public health professionals, community welfare and religious representatives, and household members. We examined CVP delivery from the perspectives of those involved in organising services and vaccine beneficiaries. Interview data was contextualised within debates of the CVP in Orthodox (Haredi) Jewish print and social media. Thematic analysis generated five considerations: i) Prior immunisation-related collaboration with public health services carved a role for Jewish health organisations to host and promote coronavirus vaccination sessions, distribute appointments, and administer vaccines ii) Public health services maintained responsibility for training, logistics, and maintaining vaccination records; iii) The localised approach to service delivery promoted vaccination in a minority with historically suboptimal levels of coverage; iv) Co-delivery promoted trust in the CVP, though a minority of participants maintained concerns around safety; v) Provision of CVP information and stakeholders' response to situated (context-specific) challenges and concerns. Drawing on this example of CVP co-delivery, we propose that a localised approach to delivering immunisation programmes could address service provision gaps in ways that involve trusted community organisations. Localisation of vaccination services can include communication or implementation strategies, but both approaches involve consideration of investment, engagement and coordination, which are not cost-neutral. Localising vaccination services in collaboration with welfare groups raises opportunities for the on-going CVP and other immunisation programmes, and constitutes an opportunity for ethnic and religious minorities to collaborate in safeguarding community health.
Collapse
Affiliation(s)
- Ben Kasstan
- Centre for Health, Law & Society, University of Bristol Law School, Bristol BS8 1RJ, UK; Department of Sociology & Anthropology, Hebrew University of Jerusalem, Har HaTzofim, Jerusalem 91905, Israel
| | - Sandra Mounier-Jack
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Louise Letley
- Immunisation and Countermeasures, National Infection Service, Public Health England, London, UK
| | - Katherine M Gaskell
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Chrissy H Roberts
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Neil R H Stone
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; Hospital for Tropical Diseases, University College London Hospital NHS Foundation Trust, London, UK
| | - Sham Lal
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Rosalind M Eggo
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT UK
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; Hospital for Tropical Diseases, University College London Hospital NHS Foundation Trust, London, UK; Division of Infection and Immunity, University College London, London, WC1E 6BT, UK
| | - Tracey Chantler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| |
Collapse
|
24
|
Lin SY, Zhang SY, Chantler T, Sun FY, Zou JT, Cheng JJ, Chen YQ, Sun M, Howard N. Vaccination coverage determinants in low uptake areas of China: a qualitative study of provider perspectives in Sichuan, Guangdong, and Henan Provinces. Hum Vaccin Immunother 2022; 18:2030623. [PMID: 35176962 PMCID: PMC8993075 DOI: 10.1080/21645515.2022.2030623] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
China’s immunization programme is relatively strong, with latest WHO-UNICEF monitoring rates for 2019 showing national vaccination coverage over 90%. However, vaccination coverage is heterogeneous, varying across geographic regions, rural–urban communities, and sub-populations. We conducted a qualitative study from a critical realist perspective, analyzing semi-structured interviews with 26 vaccination providers in three provinces, selected to represent regional socioeconomic disparities across Eastern, Central, and Western China. We analyzed data thematically, using deductive and inductive coding. Providers reported vaccination coverage in their areas had increased significantly, but remained lower among migrant and left-behind children. Main coverage determinants were child-related (i.e. gender, number, health status), caregiver-related (i.e. socioeconomic status, role, education level, ethnicity), institution-related (i.e. vaccinator numbers, information system, appointment process), and system-related (i.e. vaccine supply, intersectoral cooperation, vaccine ‘hesitancy’). Potentially effective measures to promote vaccination coverage included using routine maternal and child health-care visits for catch-up vaccination, providing additional health education, conducting follow-up family visits by village doctors, and requiring vaccination verification at school enrollment. This is the first qualitative study to examine potential determinants of low vaccination coverage in these areas of China. Findings can inform policies to strengthen the role of schools, develop the national immunization information system, and promote appointment apps. More consideration is needed to improve service quality and eliminating inequities, such as strengthening health education and service provision for migrant and left-behind children.
Collapse
Affiliation(s)
- Shi-Yu Lin
- Department of Health Policy and Management, School of Public Health, Fudan University, Shanghai, China.,NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Shi-Ya Zhang
- Department of Health Policy and Management, School of Public Health, Fudan University, Shanghai, China.,NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Tracey Chantler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Fiona Yueqian Sun
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, University of London, London, UK
| | - Jia-Tong Zou
- Department of Organization and Personnel, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Jie-Jie Cheng
- Department of Health Policy and Management, School of Public Health, Fudan University, Shanghai, China.,NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Yu-Qian Chen
- Department of Health Policy and Management, School of Public Health, Fudan University, Shanghai, China.,NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Mei Sun
- Department of Health Policy and Management, School of Public Health, Fudan University, Shanghai, China.,NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Natasha Howard
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| |
Collapse
|
25
|
Karafillakis E, Peretti-Watel P, Verger P, Chantler T, Larson H. ‘I trust them because my mum trusts them’: Exploring the role of trust in HPV vaccination decision-making among adolescent girls and their mothers in France. Vaccine 2022; 40:1090-1097. [DOI: 10.1016/j.vaccine.2022.01.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 11/28/2022]
|
26
|
Karafillakis E, Peretti-Watel P, Verger P, Chantler T, Larson HJ. The role of maturity in adolescent decision-making around HPV vaccination in France. Vaccine 2021; 39:5741-5747. [PMID: 34483023 DOI: 10.1016/j.vaccine.2021.08.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
Mothers are often responsible for vaccination decisions in the household. However, their confidence in certain vaccines such as Human Papillomavirus (HPV) vaccines is eroding in some countries. France is one of the countries with the lowest HPV vaccine uptake in Europe, with parents delaying or refusing the vaccine for their adolescent daughters due to safety- and effectiveness-related concerns. Although parental consent is required for vaccination, adolescents' involvement in HPV vaccination decision-making could improve vaccine uptake, with self-consent procedures already introduced in some countries. Adolescents' capacity to engage in decision-making is influenced by their maturity and autonomy in health. This study explored the role of maturity in decision-making around HPV vaccination in France through qualitative interviews with adolescent girls (n = 24) and their mothers (n = 21) and two focus groups with adolescent girls (n = 12). A codebook approach to thematic analysis revealed that adolescent girls' involvement in HPV decision-making is a process that evolved with maturity. As adolescents progressed towards maturity at different speeds, some expressed childlike traits such as impulsive decisions and others described more rational, reflective decision-making. Despite these differences, most adolescents in this study described a passive role in HPV vaccination decision-making, following their parents' lead. However, their expressed desire for information and involvement in discussions indicates that their lack of engagement may not only be due to a lack of maturity but also a result of mothers and doctors excluding them from getting involved. Furthermore, as health behaviours are shaped during adolescence, the influence of vaccine hesitant mothers on their daughters' own views and beliefs could be significant, together with exposure to regular controversies in the mainstream media. Individualised approaches to engage adolescents in decision-making around their own health are needed, for example through strengthening discussions and information around HPV vaccination with parents and doctors.
Collapse
Affiliation(s)
- E Karafillakis
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
| | - P Peretti-Watel
- UMR Vitrome, AMU, IHU Méditerrannée, IRD, Marseille, France; Southeastern Health Regional Observatory (ORS Paca), Marseille, France
| | - P Verger
- UMR Vitrome, AMU, IHU Méditerrannée, IRD, Marseille, France; Southeastern Health Regional Observatory (ORS Paca), Marseille, France
| | - T Chantler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - H J Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA; Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
27
|
Lin S, Jing Z, Howard N, Chantler T, Cheng J, Zhang S, Zhou C, Sun M. Associations of Elements of Parental Social Integration with Migrant Children's Vaccination: An Epidemiological Analysis of National Survey Data in China. Vaccines (Basel) 2021; 9:vaccines9080884. [PMID: 34452009 PMCID: PMC8402568 DOI: 10.3390/vaccines9080884] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022] Open
Abstract
Our study explored the effects of parental social integration on migrant children's vaccination status in China. Using data obtained from the 2014 China Migrants Dynamic Survey, a total of 4915 participants were included in this study. Social integration was measured by economic, social, cultural, and internal identity. Univariate chi-square testing was used to calculate associations between all variables and migrant children's vaccination status. Binary logistic regression was employed to calculate the impacts of social integration on migrant children's vaccination status. In total, 94.7% of migrant children had complete vaccinations for their age. Migrants who had medical insurance, spoke the native language when communicating with locals, lived mainly with locals, and did not perceive discrimination were more likely to have their children completely vaccinated. Social integration was positively associated with migrant children's vaccination status. Our study indicated that to improve vaccination coverage of migrant children, more policy support for migrant employment and housing, promotion of health services for migrants, and language support in health institutions is needed.
Collapse
Affiliation(s)
- Shiyu Lin
- Department of Health Policy and Management, School of Public Health, Fudan University, 130 Dong’an Road, Shanghai 200032, China; (S.L.); (J.C.); (S.Z.)
- NHC Key Laboratory of Health Technology Assessment, Fudan University, 130 Dong’an Road, Shanghai 200032, China
| | - Zhengyue Jing
- School of Health Policy and Management, Nanjing Medical University, Nanjing 211166, China;
- Centre for Health Management and Policy, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Natasha Howard
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15–17 Tavistock Place, London WC1H 9SH, UK; (N.H.); (T.C.)
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore 117549, Singapore
| | - Tracey Chantler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15–17 Tavistock Place, London WC1H 9SH, UK; (N.H.); (T.C.)
| | - Jiejie Cheng
- Department of Health Policy and Management, School of Public Health, Fudan University, 130 Dong’an Road, Shanghai 200032, China; (S.L.); (J.C.); (S.Z.)
- NHC Key Laboratory of Health Technology Assessment, Fudan University, 130 Dong’an Road, Shanghai 200032, China
| | - Shiya Zhang
- Department of Health Policy and Management, School of Public Health, Fudan University, 130 Dong’an Road, Shanghai 200032, China; (S.L.); (J.C.); (S.Z.)
- NHC Key Laboratory of Health Technology Assessment, Fudan University, 130 Dong’an Road, Shanghai 200032, China
| | - Chengchao Zhou
- Centre for Health Management and Policy, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, 44 Wen-hua-xi Road, Jinan 250012, China
- Correspondence: (C.Z.); (M.S.); Tel.: +86-0531-8838-1567 (C.Z.); +86-21-3356-3956 (M.S.)
| | - Mei Sun
- Department of Health Policy and Management, School of Public Health, Fudan University, 130 Dong’an Road, Shanghai 200032, China; (S.L.); (J.C.); (S.Z.)
- NHC Key Laboratory of Health Technology Assessment, Fudan University, 130 Dong’an Road, Shanghai 200032, China
- Correspondence: (C.Z.); (M.S.); Tel.: +86-0531-8838-1567 (C.Z.); +86-21-3356-3956 (M.S.)
| |
Collapse
|
28
|
Gaskell KM, Johnson M, Gould V, Hunt A, Stone NRH, Waites W, Kasstan B, Chantler T, Lal S, Roberts CH, Goldblatt D, Eggo RM, Marks M. SARS-CoV-2 seroprevalence in a strictly-Orthodox Jewish community in the UK: A retrospective cohort study. Lancet Reg Health Eur 2021; 6:100127. [PMID: 34308409 PMCID: PMC8291041 DOI: 10.1016/j.lanepe.2021.100127] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Ethnic and religious minorities have been disproportionately affected by SARS-CoV-2 worldwide. The UK strictly-Orthodox Jewish community has been severely affected by the pandemic. This group shares characteristics with other ethnic minorities including larger family sizes, higher rates of household crowding and relative socioeconomic deprivation. We studied a UK strictly-Orthodox Jewish population to understand transmission of COVID-19 within this community. METHODS We performed a household-focused cross-sectional SARS-CoV-2 serosurvey between late-October and early December 2020 prior to the third national lockdown. Randomly-selected households completed a standardised questionnaire and underwent serological testing with a multiplex assay for SARS-CoV-2 IgG antibodies. We report clinical illness and testing before the serosurvey, seroprevalence stratified by age and sex. We used random-effects models to identify factors associated with infection and antibody titres. FINDINGS A total of 343 households, consisting of 1,759 individuals, were recruited. Serum was available for 1,242 participants. The overall seroprevalence for SARS-CoV-2 was 64.3% (95% CI 61.6-67.0%). The lowest seroprevalence was 27.6% in children under 5 years and rose to 73.8% in secondary school children and 74% in adults. Antibody titres were higher in symptomatic individuals and declined over time since reported COVID-19 symptoms, with the decline more marked for nucleocapsid titres. INTERPRETATION In this tight-knit religious minority population in the UK, we report one of the highest SARS-CoV-2 seroprevalence levels in the world to date, which was markedly higher than the reported 10% seroprevalence in London at the time of the study. In the context of this high force of infection, all age groups experienced a high burden of infection. Actions to reduce the burden of disease in this and other minority populations are urgently required. FUNDING This work was jointly funded by UKRI and NIHR [COV0335; MR/V027956/1], a donation from the LSHTM Alumni COVID-19 response fund, HDR UK, the MRC and the Wellcome Trust.
Collapse
Affiliation(s)
- Katherine M Gaskell
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Marina Johnson
- Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, UK
| | - Victoria Gould
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Adam Hunt
- Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, UK
| | - Neil RH Stone
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Hospital for Tropical Diseases, University College London Hospital NHS Foundation Trust, London, UK
| | - William Waites
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT UK
- School of Informatics, University of Edinburgh, Edinburgh, Scotland, EH8 9AB
| | - Ben Kasstan
- Centre for Health, Law and Society, University of Bristol Law School, Bristol BS1 1RJ, UK
- Department of Sociology and Anthropology, Hebrew University of Jerusalem, Jerusalem 9190501, UK
| | - Tracey Chantler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Sham Lal
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Chrissy H. Roberts
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - David Goldblatt
- Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, UK
| | - Rosalind M Eggo
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT UK
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Hospital for Tropical Diseases, University College London Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
29
|
Paterson P, Mounier-Jack S, Saliba V, Yarwood J, White J, Ramsay M, Chantler T. Strengthening HPV vaccination delivery: findings from a qualitative service evaluation of the adolescent girls' HPV vaccination programme in England. J Public Health (Oxf) 2021; 43:189-196. [PMID: 31219155 PMCID: PMC8042364 DOI: 10.1093/pubmed/fdz061] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 04/30/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In 2014, the number of HPV vaccine doses given to adolescent girls as part of the English school-based immunization programme was reduced from three to two. This was based on evidence that a two-dose schedule provides long-lasting protection against HPV infection. In 2015/16 a small decline in HPV vaccination coverage in adolescent girls was noted; from 86.7% for the three-dose schedule in 2013/14 to 85.1% for the two-dose schedule. This evaluation examined whether service-related factors contributed to this decline. METHODS In May-August 2017, we conducted semi-structured qualitative interviews with 39 participants responsible for commissioning or delivering immunization programmes in six local authorities in the South West, North Central Midlands and South Central Midlands, England. RESULTS Effective planning and data management were key for successful service provision of HPV vaccination, as well as close collaboration between commissioners, service providers and data system managers, a team skill mix with experienced staff, pro-active engagement with schools and service providers equipped to respond to parental concerns. CONCLUSIONS To maintain and improve the high HPV adolescent girls' vaccine coverage rates achieved in England, in the context of an expanding school-based immunization programme, it is essential to strengthen the organizational capacity of the delivery system.
Collapse
Affiliation(s)
- P Paterson
- The Vaccine Confidence Project, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - S Mounier-Jack
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - V Saliba
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK
| | - J Yarwood
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK
| | - J White
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - M Ramsay
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK
| | - T Chantler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
30
|
Thizy D, Pare Toe L, Mbogo C, Matoke-Muhia D, Alibu VP, Barnhill-Dilling SK, Chantler T, Chongwe G, Delborne J, Kapiriri L, Nassonko Kavuma E, Koloi-Keaikitse S, Kormos A, Littler K, Lwetoijera D, Vargas de Moraes R, Mumba N, Mutengu L, Mwichuli S, Nabukenya SE, Nakigudde J, Ndebele P, Ngara C, Ochomo E, Odiwuor Ondiek S, Rivera S, Roberts AJ, Robinson B, Sambakunsi R, Saxena A, Sykes N, Tarimo BB, Tiffin N, Tountas KH. Proceedings of an expert workshop on community agreement for gene drive research in Africa - Co-organised by KEMRI, PAMCA and Target Malaria. Gates Open Res 2021; 5:19. [PMID: 33884362 PMCID: PMC8042295 DOI: 10.12688/gatesopenres.13221.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 01/02/2023] Open
Abstract
Gene drive research is progressing towards future field evaluation of modified mosquitoes for malaria control in sub-Saharan Africa. While many literature sources and guidance point to the inadequacy of individual informed consent for any genetically modified mosquito release, including gene drive ones, (outside of epidemiological studies that might require blood samples) and at the need for a community-level decision, researchers often find themselves with no specific guidance on how that decision should be made, expressed and by whom. Target Malaria, the Kenya Medical Research Institute and the Pan African Mosquito Control Association co-organised a workshop with researchers and practitioners on this topic to question the model proposed by Target Malaria in its research so far that involved the release of genetically modified sterile male mosquitoes and how this could be adapted to future studies involving gene drive mosquito releases for them to offer reflections about potential best practices. This paper shares the outcomes of that workshop and highlights the remaining topics for discussion before a comprehensive model can be designed.
Collapse
Affiliation(s)
| | - Lea Pare Toe
- Institut de Recherche en Science de la Santé, Ouagadougou, Burkina Faso
| | - Charles Mbogo
- Kenyan Institute of Medical Research, Kilifi, Kenya.,Pan African Mosquito Control Association, Nairobi, Kenya
| | - Damaris Matoke-Muhia
- Pan African Mosquito Control Association, Nairobi, Kenya.,Kenyan Institute of Medical Research, Nairobi, Kenya
| | | | | | | | | | | | - Lydia Kapiriri
- Department of Health, Ageing and Society, McMaster University, Hamilton, Canada
| | | | | | - Ana Kormos
- University of California Irvine Malaria Initiative, Irvine, USA
| | - Katherine Littler
- Global Health Ethics Unit, World Health Organization, Geneva, Switzerland
| | | | - Roberta Vargas de Moraes
- Institute on Ethics and Policy for Innovation, Faculty of Humanities, McMaster University, Hamilton, Canada
| | - Noni Mumba
- Kenyan Institute of Medical Research, Kilifi, Kenya
| | | | - Sylvia Mwichuli
- International Center for Evaluation and Development, nairobi, Kenya
| | | | - Janet Nakigudde
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Paul Ndebele
- Milken Institute School of Public Health, George Washington University, Washington DC, USA
| | | | - Eric Ochomo
- Kenyan Institute of Medical Research, Kisumu, Kenya
| | | | - Stephany Rivera
- Institute on Ethics and Policy for Innovation, Faculty of Humanities, McMaster University, Hamilton, Canada
| | - Aaron J Roberts
- Institute on Ethics and Policy for Innovation, Faculty of Humanities, McMaster University, Hamilton, Canada
| | | | - Rodrick Sambakunsi
- Malawi Liverpool Wellcome Trust Clinical Research Program, Blantyre, Malawi
| | - Abha Saxena
- The INCLEN Trust International, Delhi, India.,Institut Ethique Histoire Humanités, University of Geneva, Geneva, Switzerland
| | | | - Brian B Tarimo
- Vector Immunity and Transmission Biology Unit, Department of Environmental Health and Ecological Sciences,, ifakara Health Institute, Bagamoyo, Tanzania
| | - Nicki Tiffin
- Division of Computational Biology, and Wellcome Centre for Infectious Disease Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Karen H Tountas
- Foundation for the National Institutes of Health, Bethesda, USA
| |
Collapse
|
31
|
Hoyt J, Krishnaratne S, Hamon JK, Boudarene L, Chantler T, Demissie SD, Landegger J, Moseti E, Marcus S, Kambanje M, Pryor S, Spilotros N, Gnintoungbe M, Curry D, Webster J. "As a woman who watches how my family is… I take the difficult decisions": a qualitative study on integrated family planning and childhood immunisation services in five African countries. Reprod Health 2021; 18:41. [PMID: 33588879 PMCID: PMC7885443 DOI: 10.1186/s12978-021-01091-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 01/27/2021] [Indexed: 11/10/2022] Open
Abstract
Background Family planning (FP) has the potential to improve maternal and child health outcomes and to reduce poverty in sub-Saharan Africa. However, substantial unmet need for modern contraceptive methods (MCMs) persists in this region. Current literature highlights multi-level barriers, including socio-cultural norms that discourage the use of MCMs. This paper explores women’s choices and decision-making around MCM use and examines whether integrating FP services with childhood immunisations influenced women’s perceptions of, and decision to use, an MCM. Methods 94 semi-structured interviews and 21 focus group discussions with women, health providers, and community members (N = 253) were conducted in health facilities and outreach clinics where an intervention was delivering integrated FP and childhood immunisation services in Benin, Ethiopia, Kenya, Malawi and Uganda. Data were coded using Nvivo software and an analytical framework was developed to support interpretative and thematic analyses on women’s decision-making about MCM use. Results Most women shared the reproductive desire to space or limit births because of the perceived benefits of improved health and welfare for themselves and for their children, including the economic advantages. For some, choices about MCM use were restricted because of wider societal influences. Women’s decision to use MCMs was driven by their reproductive desires, but for some that was stymied by fears of side effects, community stigma, and disapproving husbands, which led to clandestine MCM use. Health providers acknowledged that women understood the benefits of using MCMs, but highlighted that the wider socio-cultural norms of their community often contributed to a reluctance to use them. Integration of FP and childhood immunisation services provided repeat opportunities for health providers to counter misinformation and it improved access to MCMs, including for women who needed to use them covertly. Conclusions Some women chose to use MCMs without the approval of their husbands, and/or despite cultural norms, because of the perceived health and economic benefits for themselves and for their families, and because they lived with the consequences of short birth intervals and large families. Integrated FP and childhood immunisation services expanded women’s choices about MCM use and created opportunities for women to make decisions autonomously.
Collapse
Affiliation(s)
- Jenna Hoyt
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
| | - Shari Krishnaratne
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Jessie K Hamon
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Lydia Boudarene
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Tracey Chantler
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | | | | | | | | | | | - Jayne Webster
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
32
|
Thizy D, Pare Toe L, Mbogo C, Matoke-Muhia D, Alibu VP, Barnhill-Dilling SK, Chantler T, Chongwe G, Delborne J, Kapiriri L, Nassonko Kavuma E, Koloi-Keaikitse S, Kormos A, Littler K, Lwetoijera D, Vargas de Moraes R, Mumba N, Mutengu L, Mwichuli S, Nabukenya SE, Nakigudde J, Ndebele P, Ngara C, Ochomo E, Odiwuor Ondiek S, Rivera S, Roberts AJ, Sambakunsi R, Saxena A, Sykes N, Tarimo BB, Tiffin N, Tountas KH. Proceedings of an expert workshop on community agreement for gene drive research in Africa - Co-organised by KEMRI, PAMCA and Target Malaria. Gates Open Res 2021; 5:19. [DOI: 10.12688/gatesopenres.13221.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 11/20/2022] Open
Abstract
Gene drive research is progressing towards future field evaluation of modified mosquitoes for malaria control in sub-Saharan Africa. While many literature sources and guidance point to the inadequacy of individual informed consent for any genetically modified mosquito release, including gene drive ones, (outside of epidemiological studies that might require blood samples) and at the need for a community-level decision, researchers often find themselves with no specific guidance on how that decision should be made, expressed and by whom. Target Malaria, the Kenya Medical Research Institute and the Pan African Mosquito Control Association co-organised a workshop with researchers and practitioners on this topic to question the model proposed by Target Malaria in its research so far that involved the release of genetically modified sterile male mosquitoes and how this could be adapted to future studies involving gene drive mosquito releases for them to offer reflections about potential best practices. This paper shares the outcomes of that workshop and highlights the remaining topics for discussion before a comprehensive model can be designed.
Collapse
|
33
|
Krishnaratne S, Hamon JK, Hoyt J, Chantler T, Landegger J, Spilotros N, Demissie SD, Mohammed S, Webster J. What mechanisms drive uptake of family planning when integrated with childhood immunisation in Ethiopia? A realist evaluation. BMC Public Health 2021; 21:99. [PMID: 33413269 PMCID: PMC7791767 DOI: 10.1186/s12889-020-10114-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 12/22/2020] [Indexed: 02/06/2023] Open
Abstract
Background Maternal and child health are key priorities among the Sustainable Development Goals, which include a particular focus on reducing morbidity and mortality among women of reproductive age, newborns, and children under the age of five. Two components of maternal and child health are family planning (FP) and immunisation. Providing these services through an integrated delivery system could increase the uptake of vaccines and modern contraceptive methods (MCMs) particularly during the post-partum period. Methods A realist evaluation was conducted in two woredas in Ethiopia to determine the key mechanisms and their triggers that drive successful implementation and service uptake of an intervention of integrated delivery of immunisations and FP. The methodological approach included the development of an initial programme theory and the selection of relevant, published implementation related theoretical frameworks to aid organisation and cumulation of findings. Data from 23 semi-structured interviews were then analysed to determine key empirical mechanisms and drivers and to test the initial programme theory. These mechanisms were mapped against published theoretical frameworks and a revised programme theory comprised of context-mechanism-outcome configurations was developed. A critique of theoretical frameworks for abstracting empirical mechanisms was also conducted. Results Key contextual factors identified were: the use of trained Health Extension Workers (HEWs) to deliver FP services; a strong belief in values that challenged FP among religious leaders and community members; and a lack of support for FP from male partners based on religious values. Within these contexts, empirical mechanisms of acceptability, access, and adoption of innovations that drove decision making and intervention outcomes among health workers, religious leaders, and community members were identified to describe intervention implementation. Conclusions Linking context and intervention components to the mechanisms they triggered helped explain the intervention outcomes, and more broadly how and for whom the intervention worked. Linking empirical mechanisms to constructs of implementation related theoretical frameworks provided a level of abstraction through which findings could be cumulated across time, space, and conditions by theorising middle-range mechanisms. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-10114-8.
Collapse
Affiliation(s)
- Shari Krishnaratne
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
| | - Jessie K Hamon
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Jenna Hoyt
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Tracey Chantler
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | - Jayne Webster
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
34
|
Fisher H, Audrey S, Chantler T, Finn A, Letley L, Mounier-Jack S, Thomas C, Yates J, Hickman M. Co-production of an educational package for the universal human papillomavirus (HPV) vaccination programme tailored for schools with low uptake: a participatory study protocol. BMJ Open 2020; 10:e039029. [PMID: 33148744 PMCID: PMC7643513 DOI: 10.1136/bmjopen-2020-039029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/01/2020] [Accepted: 10/11/2020] [Indexed: 11/24/2022] Open
Abstract
AIM To co-produce with young people an educational package about the human papillomavirus (HPV) vaccine that is tailored to increase vaccine uptake in schools and populations with lower uptake. INTRODUCTION Persistent infection with HPV can result in cancers affecting men and especially women. From September 2019, the English-schools-based HPV vaccination programme was expanded to include young men (in addition to young women) aged 12-13 years. Some young people attending schools with lower uptake of the vaccine have unmet information needs. We hypothesise that mechanisms to address information needs and increase young people's autonomy in consent procedures will result in higher uptake. METHODS AND ANALYSIS The Medical Research Council's framework for development and evaluation of complex interventions will inform intervention development. Recruitment of young people aged 12-15 years and key stakeholders (National Health Service commissioners, school staff, immunisation nurses and youth workers/practitioners) will be facilitated through existing links with healthcare organisations, schools and youth organisations in areas with lower uptake of the HPV vaccination programme. The proposed research will comprise three phases: (1) a rapid review of adolescent immunisation materials and preliminary qualitative interviews with young people and key stakeholders, (2) theory development and co-production of HPV vaccine communication materials through an iterative process with young people and (iii) testing delivery mechanisms and acceptability of the educational package in four schools with lower uptake. ETHICS AND DISSEMINATION The University of Bristol's Faculty of Health Sciences and London School of Hygiene and Tropical Medicine's Research Ethics Committees provided approvals for the study. A dissemination event for young people and key stakeholders and webinar with the National Immunisation Network will be organised. The study findings will be published in peer-reviewed journals and presented at conferences. Recommendations for a future larger scale study will be made.
Collapse
Affiliation(s)
- Harriet Fisher
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Suzanne Audrey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tracey Chantler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Adam Finn
- Division of Clinical Sciences, University of Bristol, Bristol, UK
| | - Louise Letley
- National Infection Service, Public Health England, London, UK
| | - Sandra Mounier-Jack
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Clare Thomas
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
35
|
Chantler T, Pringle E, Bell S, Cooper R, Edmundson E, Nielsen H, Roberts S, Edelstein M, Mounier-Jack S. Does electronic consent improve the logistics and uptake of HPV vaccination in adolescent girls? A mixed-methods theory informed evaluation of a pilot intervention. BMJ Open 2020; 10:e038963. [PMID: 33148741 PMCID: PMC7640514 DOI: 10.1136/bmjopen-2020-038963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To evaluate the usability and acceptability of an electronic consent pilot intervention for school-based immunisations and assess its impact on consent form returns and human papilloma virus (HPV) vaccine uptake. DESIGN Mixed-methods theory-informed study applying qualitative methods to examine the usability and acceptability of the intervention and quantitative methods to assess its impact. SETTING AND PARTICIPANTS The intervention was piloted in 14 secondary schools in seven London boroughs in 2018. Intervention schools were matched with schools using paper consent based on the proportion of students with English as a second language and students receiving free school meals. Participants included nurses, data managers, school-link staff, parents and adolescents. INTERVENTIONS An electronic consent portal where parents could record whether they agreed to or declined vaccination, and nurses could access data to help them manage the immunisation programme. PRIMARY AND SECONDARY OUTCOME MEASURES Comparison of consent form return rates and HPV vaccine uptake between intervention and matched schools. RESULTS HPV vaccination uptake did not differ between intervention and matched schools, but timely consent form return was significantly lower in intervention schools (73.3% vs 91.6%, p=0.008). The transition to using electronic consent was not straightforward, while schools and staff understood the potential benefits, they found it difficult to adapt to new ways of working which removed some level of control from schools. Reasons for lower consent form return in e-consent schools included difficulties encountered by some parents in accessing and using the intervention. Adolescents highlighted the potential for electronic consent to by-pass their information needs. CONCLUSIONS The pilot intervention did not improve consent form return or vaccine uptake due to challenges encountered in transitioning to new working practice. New technologies require embedding before they become incorporated in everyday practice. A re-evaluation once stakeholders are accustomed with electronic consent may be required to understand its impact.
Collapse
Affiliation(s)
- Tracey Chantler
- Department of Global Health and Development, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ellen Pringle
- Department of Immunisation, Hepatitis and Blood Safety, Public Health England, London, UK
| | - Sadie Bell
- Department of Global Health and Development, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rosie Cooper
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Emily Edmundson
- Hounslow and Richmond Community Healthcare NHS Trust, Teddington, Greater London, UK
| | - Heidi Nielsen
- Hounslow and Richmond Community Healthcare NHS Trust, Teddington, Greater London, UK
| | - Sheila Roberts
- Hounslow and Richmond Community Healthcare NHS Trust, Teddington, Greater London, UK
| | - Michael Edelstein
- Department of Immunisation, Hepatitis and Blood Safety, Public Health England, London, UK
| | - Sandra Mounier-Jack
- Department of Global Health and Development, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
36
|
Du F, Chantler T, Francis MR, Sun FY, Zhang X, Han K, Rodewald L, Yu H, Tu S, Larson H, Hou Z. The determinants of vaccine hesitancy in China: A cross-sectional study following the Changchun Changsheng vaccine incident. Vaccine 2020; 38:7464-7471. [DOI: 10.1016/j.vaccine.2020.09.075] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/16/2020] [Accepted: 09/25/2020] [Indexed: 01/01/2023]
|
37
|
Demissie SD, Kozuki N, Olorunsaiye CZ, Gebrekirstos P, Mohammed S, Kiapi L, Chantler T, Karafillakis E, Landegger J. Community engagement strategy for increased uptake of routine immunization and select perinatal services in north-west Ethiopia: A descriptive analysis. PLoS One 2020; 15:e0237319. [PMID: 33119604 PMCID: PMC7595373 DOI: 10.1371/journal.pone.0237319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 07/26/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Routine immunization coverage has stagnated over the past decade and fallen short of WHO targets in Ethiopia. Community engagement strategies that reach beyond traditional health systems may reduce dropout and increase coverage. This evaluation assesses changes in immunization, postpartum family planning, and antenatal care coverage after implementation of an enhanced community engagement and defaulter tracing strategy, entitled "Fifth Child" project, across two districts in Benishangul-Gumuz Regional State (BGRS), Ethiopia. METHODS AND FINDINGS A formative evaluation was conducted to examine the contribution of the strategy on immunization, postpartum family planning and antenatal care utilization in Assosa and Bambasi districts of BGRS. The quantitative findings are presented here. Routine and project-specific data were analyzed to assess changes in uptake of childhood vaccinations, postpartum family planning and antenatal care. Between January 2013 and December 2016, pentavalent-3 coverage increased from 63% to 84% in Assosa, and from 78% to 93% in Bambasi. Similarly, measles vaccine coverage increased from 77% to 81% in Assosa, and from 59% to 86% in Bambasi. Approximately 54% of all eligible infants across both woredas defaulted on scheduled vaccinations at least once during the period. Among defaulting children, 84% were identified and subsequently caught up on the vaccinations missed. Secondary outcomes of postpartum family planning and antenatal care also increased in both woredas. CONCLUSION The "Fifth Child" project likely contributed to enhanced immunization performance and increased utilization of immunization and select perinatal health services in two woredas of BGRS. Further research is required in order to determine the impact of this community engagement strategy.
Collapse
Affiliation(s)
| | - Naoko Kozuki
- International Rescue Committee, New York City, NY, United States of America
| | | | | | | | - Lilian Kiapi
- International Rescue Committee, London, United Kingdom
| | - Tracey Chantler
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Justine Landegger
- International Rescue Committee, New York City, NY, United States of America
| |
Collapse
|
38
|
Tu S, Sun FY, Chantler T, Zhang X, Jit M, Han K, Rodewald L, Du F, Yu H, Hou Z, Larson H. Caregiver and service provider vaccine confidence following the Changchun Changsheng vaccine incident in China: A cross-sectional mixed methods study. Vaccine 2020; 38:6882-6888. [PMID: 32912643 PMCID: PMC7476908 DOI: 10.1016/j.vaccine.2020.08.063] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/23/2020] [Accepted: 08/25/2020] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The Changchun Changsheng Vaccine Incident (CCVI) occurred mid-2018 and involved irregularities in the manufacture and quality control of diphtheria-tetanus-acellular-pertussis and rabies vaccines. This study investigates vaccine confidence amongst Chinese caregivers and vaccination-service providers (VSPs) six months after the CCVI. METHODS Quantitative surveys were conducted in January 2019 with 2124 caregivers of children and 555 VSPs in three areas in China. The proportions of respondents who agreed to the four statements from the Vaccine Confidence Index™ were used to measure vaccine confidence. Descriptive and univariate analyses were performed to study the level of vaccine confidence. Semi-structured interviews were conducted with 48 caregivers, 43 VSPs and 9 immunization program managers. Interviews were analyzed thematically using a combination of deductive and inductive coding. Media surveillance was conducted to monitor public responses to the CCVI. RESULTS Media surveillance indicated that public attention to vaccine-related issues increased sharply immediately post-CCVI but declined rapidly thereafter. Six months post-CCVI, 96.0% of caregivers and the same proportion of VSPs reported that vaccination was important and compatible with their religious beliefs. 82.7% and 88.2% of caregivers agreed that vaccines were safe and effective. 92.8% and 94.6% of VSPs agreed that vaccines were safe and effective. Both caregivers and VSPs reported an immediate decline in vaccine confidence post-CCVI. In most cases this trust was regained over time following government and public health responses, however some people remained hesitant about vaccinating their children. Many VSPs were overwhelmed by consultations, workload and psychological pressure after the CCVI. CONCLUSION After an initial decline, vaccine confidence recovered to pre-incident levels six months after the CCVI. However, some caregivers moved from the higher to the lower end of the vaccine confidence spectrum, pointing to the need to promote the acceptance of vaccination especially given the need for new vaccines to control the coronavirus epidemic.
Collapse
Affiliation(s)
- Shiyi Tu
- School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Fiona Yueqian Sun
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Tracey Chantler
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Xuan Zhang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Kaiyi Han
- School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Lance Rodewald
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fanxing Du
- School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Hongjie Yu
- School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China; Key Laboratory of Public Health Safety (Ministry of Education), Fudan University, Shanghai, China
| | - Zhiyuan Hou
- School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China.
| | - Heidi Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| |
Collapse
|
39
|
Bell S, Chantler T, Paterson P, Mounier-Jack S. Is flu vaccination opt-out feasible? Evidence from vaccination programme implementers and managers in the English National Health Service. Vaccine 2020; 38:4183-4190. [PMID: 32381480 PMCID: PMC7254052 DOI: 10.1016/j.vaccine.2020.04.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/03/2020] [Accepted: 04/10/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND In 2018/19, English NHS trusts (NHSTs) implemented an 'opt-out' policy for seasonal flu vaccination in frontline healthcare workers (HCWs). HCWs declining the vaccination were asked to sign an opt-out form and provide a reason for their decision. In addition, HCWs working in higher risk hospital environments (e.g. oncology) were asked to inform their manager about their declination decision. The policy aimed to provide greater insight into reasons for vaccination decline and information from HCWs in higher risk areas was intended for use in considering HCW redeployment. This study investigated the feasibility, acceptability, and perceived value of the policy during the 2018/19 flu vaccination season. METHODS We conducted semi-structured interviews across 9 NHSTs in England with different levels of HCW flu vaccination uptake in 2017/18. We interviewed 30 vaccination programme implementers and 27 managers. FINDINGS The purpose of the policy was poorly understood, and interviewees did not know how data on decliners was being used. Most NHSTs tried to collect the personal details of decliners and, in some instances, these were recorded in Electronic Staff Records and reported to line-managers for action. This created strain on employer-employee relationships, leading to decliners refusing to complete opt-out forms and some vaccinators not implementing the policy. None of the NHSTs had a redeployment policy for decliners, arguing that this was impractical due to strain on staffing levels. CONCLUSION A flu-vaccination opt-out approach for HCWs did not appear acceptable in our sampled NHSTs, due to a lack of clear messaging about its purpose and complicated implementation. To promote an opt-out approach effectively, there needs to be clear communication of its purpose, which should be to explore reasons for decline rather than identify and 'push' decliners to vaccinate, so as not to damage staff relationships. NHSTs should involve their workforce in developing flu vaccination approaches.
Collapse
Affiliation(s)
- Sadie Bell
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, United Kingdom.
| | - Tracey Chantler
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, United Kingdom
| | - Pauline Paterson
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Sandra Mounier-Jack
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, United Kingdom
| |
Collapse
|
40
|
Mounier-Jack S, Bell S, Chantler T, Edwards A, Yarwood J, Gilbert D, Paterson P. Organisational factors affecting performance in delivering influenza vaccination to staff in NHS Acute Hospital Trusts in England: A qualitative study. Vaccine 2020; 38:3079-3085. [PMID: 32147294 PMCID: PMC7090903 DOI: 10.1016/j.vaccine.2020.02.077] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/21/2020] [Accepted: 02/26/2020] [Indexed: 12/19/2022]
Abstract
Wide variation in uptake of flu vaccine persists in English NHS hospitals. Many factors of high uptake are linked to leadership and organisational culture. Embedding the flu programme in well-being policy helps acceptability and adherence. A supportive culture is likely to achieve higher uptake than a coercive one. Middle managers’ facilitating role in delivering the programme is key to uptake.
Health care workers are a priority group for seasonal influenza vaccination, which is recommended by the World Health Organisation. There is a wide variation in uptake between and within countries. England has achieved 69.5% of health care workers vaccinated overall in 2017/18 across NHS acute and community health care settings, but it varies between Trusts from 50% to over 92.3%. While attitudinal factors have been well researched, there is limited evidence on organisational factors associated with high uptake. In England, most NHS Trusts are now implementing a similar range of interventions as part of their flu programme, and it remains unclear why performance remains so variable. This qualitative study is the first to explore reasons for this variation and provide recommendations for lower performing Trusts on how to improve. Fifty-seven interviews of managers and vaccinators were conducted in nine hospitals with flu vaccination uptake ranging from just over 55% to above 90%. Our study found that while Trusts deployed a wide range of both demand generating and supply interventions to increase uptake, there were marked differences in the organisational and delivery models utilised. Our study suggests that organisational culture was possibly the most important ingredient when trying to differentiate between high and low performing Trusts. We found that a positive culture aimed at fostering continuous improvement and favouring non-coercion on balance yielded more adherence from staff. Where influenza vaccination was embedded in the organisation wellbeing strategy, rather than executed as a siloed seasonal programme, this tended to foster good performance. Improving performance of influenza vaccination in health care workers will involve not only deploying the right interventions, and following “best practices”. It will require the adaptation of flu progamme delivery strategies to the organisation context, and embedding vaccination into the organisational culture, thus supporting the normalisation of yearly vaccination.
Collapse
Affiliation(s)
- Sandra Mounier-Jack
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK.
| | - Sadie Bell
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
| | - Tracey Chantler
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
| | - Angela Edwards
- Department of Immunisation and Countermeasures, Public Health England, UK
| | - Jo Yarwood
- Department of Immunisation and Countermeasures, Public Health England, UK
| | | | - Pauline Paterson
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| |
Collapse
|
41
|
Chantler T, Letley L, Paterson P, Yarwood J, Saliba V, Mounier-Jack S. Optimising informed consent in school-based adolescent vaccination programmes in England: A multiple methods analysis. Vaccine 2019; 37:5218-5224. [PMID: 31351797 DOI: 10.1016/j.vaccine.2019.07.061] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/29/2019] [Accepted: 07/18/2019] [Indexed: 10/26/2022]
Abstract
The process of obtaining informed consent for school-based adolescent immunisation provides an opportunity to engage families. However, the fact that parental consent needs to be obtained remotely adds complexity to the process and can have a detrimental effect on vaccine uptake. We conducted a multiple methods analysis to examine the practice of obtaining informed consent in adolescent immunisation programmes. This involved a thematic analysis of consent related data from 39 interviews with immunisation managers and providers collected as part of a 2017 service evaluation of the English adolescent girls' HPV vaccine programme and a descriptive statistical analysis of data from questions related to consent included in a 2017 survey of parents' and adolescents' attitudes to adolescent vaccination. The findings indicated that the non-return of consent forms was a significant logistical challenge for immunisation teams, and some were piloting opt-out consent mechanisms, increasing the proportion of adolescents consenting for their own immunisations, and introducing electronic consent. Communicating vaccine related information to parents and schools and managing uncertainties about obtaining adolescent self-consent for vaccination were the main practical challenges encountered. Survey data showed that parents and adolescents generally agreed on vaccine decisions although only 32% of parents discussed vaccination with their teenager. Parental awareness about the option for adolescents to self-consent for vaccination was limited and adolescents favoured leaving the decision-making to parents. From the interviews and variability of consent forms it was evident that health professionals were not always clear about the best way to manage the consent process. Some were also unfamiliar with self-consent processes and lacked confidence in assessing for 'Gillick competency'. Developing pathways and related interventions to improve the logistics and practice of consent in school-based adolescent immunisation programmes could help improve uptake.
Collapse
Affiliation(s)
- Tracey Chantler
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, UK.
| | - Louise Letley
- Department of Immunisation, Hepatitis and Blood Safety, Public Health England, UK
| | - Pauline Paterson
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, UK
| | - Joanne Yarwood
- Department of Immunisation, Hepatitis and Blood Safety, Public Health England, UK
| | - Vanessa Saliba
- Department of Immunisation, Hepatitis and Blood Safety, Public Health England, UK
| | - Sandra Mounier-Jack
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, UK
| |
Collapse
|
42
|
Abstract
The introduction of punitive measures to control outbreaks of measles in Europe has sparked debate and public protest about the ethical justification of penalties and exclusionary processes for non-immunisation. This article advances an ethics framework related to compulsory vaccination policies, which we use to analyse three case studies: of mandatory policies that are enforced by fines; of policies that require vaccination for the provision of social goods; and of community-led policies in which communities themselves decide how to enforce vaccination compliance. We report on contemporary, ongoing and past measures that have been used to increase vaccine uptake, consider their rationale and the related public responses, elaborate on socio-cultural and contextual influences, and discuss the ethical justification for mandatory vaccination. We argue for a measured approach that protects fundamental human rights to evidence-based information and medical counsel to support health decision making and that simultaneously raises awareness about the role of immunisation in protecting the wider community. We think more emphasis needs to be placed on immunisation as a means of promoting social good, reducing harm and protecting vulnerable groups.
Collapse
Affiliation(s)
- Tracey Chantler
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1E 9SH, UK.
| | - Emilie Karafillakis
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1E 9SH, UK
| | - James Wilson
- Department of Philosophy, University College London, London, UK
| |
Collapse
|
43
|
Chantler T, Bell S, Saliba V, Heffernan C, Raj T, Ramsay M, Mounier-Jack S. Is partnership the answer? Delivering the national immunisation programme in the new English health system: a mixed methods study. BMC Public Health 2019; 19:83. [PMID: 30654788 PMCID: PMC6337826 DOI: 10.1186/s12889-019-6400-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 01/07/2019] [Indexed: 11/22/2022] Open
Abstract
Background The English national health system experienced a major reorganisation in April 2013. This mixed methods study examined how staff managed to deliver the national immunisation programme within a new health infrastructure and explored the role and contribution of ‘partnership working’ to programme implementation. Methods A cross-sectional online questionnaire survey and a qualitative evaluation of an urban immunisation board were conducted in 2016. The questionnaire included 38 questions about immunisation responsibilities, collaboration, service evaluation and programme support. It was completed by 199 immunisation providers and 70 people involved in the management of the immunisation programme. The evaluation involved 12 semi-structured interviews, 3 observations of forum meetings and the review of forum meeting minutes. Descriptive statistical analysis of the survey data was performed using SPSS version 23 and qualitative data from both study components were uploaded to NVivo 11 and analysed thematically. Results Screening and Immunisation Teams were cited as responsible for programme leadership by 56% of survey respondents, but concerns were raised about their capacity to oversee larger geographies and a case made for decentralised accountability mechanisms. Only 44% of immunisation managers stated that poor performance was addressed adequately, and half of respondents thought that support given to providers was inadequate. Managers reported that partnership working improved the organisation (83%) and performance (78%) of immunisation, but stated it was more beneficial for information-sharing than implementation. A preference for a “locality working approach” with committees covering smaller health economies rather than larger commissioning areas was voiced. The immunisation board examined in the qualitative evaluation sought to achieve this by forging links with locally based steering committees, but also had to address internal challenges related to the role of the board and contribution of members to programmatic decision-making. Conclusions Key challenges in delivering the immunisation programme were rooted in the new health infrastructure, which had created greater distance between commissioners and providers and resulted in the fragmentation of programme responsibilities. Partnership working bridged gaps but more needs to be done to strengthen accountability mechanisms and ensure that collaborative activities are outcome oriented and sustainable in the shifting environment of reorganisation. Electronic supplementary material The online version of this article (10.1186/s12889-019-6400-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Tracey Chantler
- London School of Hygiene & Tropical Medicine, Faculty of Public Health & Policy, 15-17 Tavistock Place, London, WC1H 9SH, England.
| | - Sadie Bell
- London School of Hygiene & Tropical Medicine, Faculty of Public Health & Policy, 15-17 Tavistock Place, London, WC1H 9SH, England
| | - Vanessa Saliba
- Immunisation, Hepatitis & Blood Safety Department, National Infection Service, Public Health England, 61 Colindale Avenue, London, England
| | - Catherine Heffernan
- London School of Hygiene & Tropical Medicine, Faculty of Public Health & Policy, 15-17 Tavistock Place, London, WC1H 9SH, England.,NHS England (London Region), 5th Floor, Skipton House, 80 London Road, London, SE1 6LH, England
| | - Thara Raj
- Bristol City Council, Public Health, Bristol City Council, City Hall (formerly The Council House), College Green, Bristol, BS1 5TR, England
| | - Mary Ramsay
- Immunisation, Hepatitis & Blood Safety Department, National Infection Service, Public Health England, 61 Colindale Avenue, London, England
| | - Sandra Mounier-Jack
- London School of Hygiene & Tropical Medicine, Faculty of Public Health & Policy, 15-17 Tavistock Place, London, WC1H 9SH, England
| |
Collapse
|
44
|
Letley L, Rew V, Ahmed R, Habersaat KB, Paterson P, Chantler T, Saavedra-Campos M, Butler R. Tailoring immunisation programmes: Using behavioural insights to identify barriers and enablers to childhood immunisations in a Jewish community in London, UK. Vaccine 2018; 36:4687-4692. [PMID: 29945834 DOI: 10.1016/j.vaccine.2018.06.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/23/2018] [Accepted: 06/12/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Due to regular vaccine preventable disease outbreaks and sub-optimal immunisation uptake in the London borough of Hackney, home to the largest Charedi Orthodox Jewish community in Europe, it was decided, in consultation with the community, to implement the WHO Tailoring Immunization Programmes approach (TIP). DESIGN The WHO Tailoring Immunization Programmes (TIP) approach was used. TIP provides a framework based on behavioural insights methodology to identify populations susceptible to vaccine preventable diseases, diagnose supply and demand side barriers and enablers to vaccination and recommend evidence-informed responses to improve vaccination coverage. RESULTS The results of the formative research and behavioural analysis challenged the assumption that a cultural or religious anti-vaccination sentiment existed within the community. Critical issues related to access to and convenience of immunisation services. Service providers in the area have challenges due to having to deliver immunisation services to the large numbers of children without additional resource. Where mothers were choosing to delay or refuse vaccinations their reasons were broadly similar to the wider population. The behavioural analysis identified potential categorisation of subgroups within the community enabling a more tailored approach to addressing concerns and meeting parents' needs. CONCLUSION The TIP approach was an effective way of investigating factors linked to sub-optimal immunisation within the Charedi community. The use of behavioural insights enabled the categorisation of subgroups so that more targeted interventions could be developed. The comprehensive stakeholder engagement which is a key pillar of the TIP approach ensured a deeper understanding of the barriers and enablers to vaccination as well as increasing the level of ownership in the community. TIP should be considered as a useful approach to identify main facilitators and barriers to vaccination in communities with suboptimal immunisation uptake.
Collapse
Affiliation(s)
- Louise Letley
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK.
| | - Vanessa Rew
- North London Health Protection Team, Public Health England, UK
| | - Rehana Ahmed
- NHS England London Region Public Health Department, UK
| | - Katrine Bach Habersaat
- World Health Organization (WHO) Regional Office for Europe, Marmorvej 51, DK-2100 Copenhagen, OE, Denmark
| | - Pauline Paterson
- NIHR Health Protection Research Unit in Immunisation, London School of Hygiene and Tropical Medicine, London, UK
| | - Tracey Chantler
- NIHR Health Protection Research Unit in Immunisation, London School of Hygiene and Tropical Medicine, London, UK
| | - Maria Saavedra-Campos
- Field Epidemiology Service, National Infections Service, Public Health England, London, UK
| | - Robb Butler
- World Health Organization (WHO) Regional Office for Europe, Marmorvej 51, DK-2100 Copenhagen, OE, Denmark
| |
Collapse
|
45
|
Chantler T, Karafillakis E, Wodajo S, Dechasa Demissie S, Sile B, Mohammed S, Olorunsaiye C, Landegger J, Larson HJ. 'We All Work Together to Vaccinate the Child': A Formative Evaluation of a Community-Engagement Strategy Aimed at Closing the Immunization Gap in North-West Ethiopia. Int J Environ Res Public Health 2018; 15:E667. [PMID: 29614056 PMCID: PMC5923709 DOI: 10.3390/ijerph15040667] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 11/16/2022]
Abstract
The role of community engagement (CE) in improving demand for immunization merits investigation. The International Rescue Committee developed a CE strategy to implement a vaccine defaulter-tracing tool and a color-coded health calendar aimed at increasing uptake of immunization services in north-west Ethiopia ('The Fifth Child Project'). We report findings from a formative evaluation of this project. In May/June 2016 we conducted 18 participant observations of project activities, 46 semi-structured interviews and 6 focus groups with caregivers, health workers, community members/leaders. Audio-recordings and fieldnotes were transcribed, anonymized, translated and analyzed thematically using inductive and deductive coding. Additional data was collected in November 2016 to verify findings. The project was suitably integrated within the health extension program and established a practical system for defaulter-tracing. The calendar facilitated personalized interactions between health workers and caregivers and was a catalyst for health discussions within homes. At the community level, a regulation exercise of sanctions was observed, which served as a deterrent against vaccine default. Pre-existing community accountability mechanisms supported the CE, although varying levels of engagement between leaders and health workers were observed. The benefits of shared responsibility for immunization were evident; however, more transparency was required about community self-regulatory measures to ensure health-related discussions remain positive.
Collapse
Affiliation(s)
- Tracey Chantler
- London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| | - Emilie Karafillakis
- London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| | - Samuel Wodajo
- Assosa Referral Hospital, Benishangul Gumuz Regional State, Assosa, Ethiopia.
| | | | - Bersabeh Sile
- London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| | - Siraj Mohammed
- International Rescue Committee, Bole Sub-City, 813 Addis Ababa, Ethiopia.
| | | | | | - Heidi J Larson
- London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| |
Collapse
|
46
|
Rath S, Yadav L, Tewari A, Chantler T, Woodward M, Kotwal P, Jain A, Dey A, Garg B, Malhotra R, Goel A, Farooque K, Sharma V, Webster P, Norton R. Management of older adults with hip fractures in India: a mixed methods study of current practice, barriers and facilitators, with recommendations to improve care pathways. Arch Osteoporos 2017; 12:55. [PMID: 28577286 PMCID: PMC5486685 DOI: 10.1007/s11657-017-0344-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 05/03/2017] [Indexed: 02/03/2023]
Abstract
Evidence-based management can reduce deaths and suffering of older adults with hip fractures. This study investigates the evidence-practice gaps in hip fracture care in three major hospitals in Delhi, potential barriers and facilitators to improving care, and consequently, identifies contextually appropriate interventions for implementing best practice for management of older adults with hip fractures in India. PURPOSE Hip fracture in older adults is a significant public health issue in India. The current study sought to document current practices, identify barriers and facilitators to adopting best practice guidelines and recommend improvements in the management of older adults with hip fractures in Delhi, India. METHODS This mixed methods observational study collected data from healthcare providers, patients, carers and medical records from three major public tertiary care hospitals in Delhi, India. All patients aged ≥50 years with an X-ray confirmed hip fracture that were admitted to these hospitals over a 10-week period were recruited. Patients' data were collected at admission, discharge and 30 days post-injury. Eleven key informant interviews and four focus group discussions were conducted with healthcare providers. Descriptive data for key quantitative variables were computed. The qualitative data were analysed and interpreted using a behaviour change wheel framework. RESULTS A total of 136 patients, 74 (54%) men and 62 women, with hip fracture were identified in the three participating hospitals during the recruitment period and only 85 (63%) were admitted for treatment with a mean age of 66.5 years (SD 11.9). Of these, 30% received surgery within 48 h of hospital admission, 95% received surgery within 39 days of hospital admission and two (3%) had died by 30 days of injury. According to the healthcare providers, inadequate resources and overcrowding prevent adequate caring of the hip fracture patients. They unanimously felt the need for protocol-based management of hip fracture in India. CONCLUSION The development and implementation of national guidelines and standardized protocols of care for older people with hip fractures in India has the potential to improve both care and patient-related outcomes.
Collapse
Affiliation(s)
- Santosh Rath
- The George Institute for Global Health, University of Oxford, Oxford, UK
- IGHI, Imperial College, Kensington, London, SW7 2AZ UK
| | - Lalit Yadav
- The George Institute for Global Health, New Delhi, India
| | - Abha Tewari
- The George Institute for Global Health, New Delhi, India
| | | | - Mark Woodward
- The George Institute for Global Health, University of Oxford, Oxford, UK
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Prakash Kotwal
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Anil Jain
- Department of Orthopaedics, University College of Medical Sciences, Delhi, India
| | - Aparajit Dey
- Department of Geriatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Rajesh Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ashish Goel
- Department of Medicine, University College of Medical Sciences, Delhi, India
| | - Kamran Farooque
- JPN Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Sharma
- JPN Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Premila Webster
- School of Public Health, Nuffield Department of Population Sciences, University of Oxford, Oxford, UK
| | - Robyn Norton
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| |
Collapse
|
47
|
Paterson P, Chantler T, Larson HJ. Reasons for non-vaccination: Parental vaccine hesitancy and the childhood influenza vaccination school pilot programme in England. Vaccine 2017; 36:5397-5401. [PMID: 28818568 DOI: 10.1016/j.vaccine.2017.08.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/19/2017] [Accepted: 08/07/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In 2013, the annual influenza immunisation programme in England was extended to children to reduce the burden of influenza, but uptake was sub-optimal at 53.2%. AIM To explore the reasons some parents decided not to vaccinate their child against influenza as part of the pilot programme offered in schools. METHODS Cross-sectional qualitative study conducted between February and July 2015. 913 parents whose children were not vaccinated against influenza in the school pilots in West Yorkshire and Greater Manchester, England, were asked to comment on their reasons for non-vaccination and invited to take part in a semi-structured interview. 138 parents returned response forms, of which 38 were eligible and interested in participating and 25 were interviewed. Interview transcripts were coded by theme in NVivo. RESULTS A third of parents who returned response forms had either vaccinated their child elsewhere, intended to have them vaccinated, or had not vaccinated them due to medical reasons (valid or perceived). Most interviewees were not convinced of the need to vaccinate their child against influenza. Parents expressed concerns about influenza vaccine effectiveness and vaccine side effects. Several parents interviewed declined the vaccine for faith reasons due to the presence of porcine gelatine in the vaccine. CONCLUSIONS To significantly decrease the burden of influenza in England, influenza vaccination coverage in children needs to be >60%. Hence, it is important to understand the reasons why parents are not vaccinating their children, and to tailor the communication and immunisation programme accordingly. Our finding that a third of parents, who did not consent to their child being vaccinated as part of the school programme, had actually vaccinated their child elsewhere, intended to have their child vaccinated, or had not vaccinated them due to medical reasons, illustrates the importance of including additional questions or data sources when investigating under-vaccination.
Collapse
Affiliation(s)
- Pauline Paterson
- NIHR Health Protection Research Unit in Immunisation, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
| | - Tracey Chantler
- NIHR Health Protection Research Unit in Immunisation, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
| | - Heidi J Larson
- NIHR Health Protection Research Unit in Immunisation, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom; Department of Global Health, University of Washington, Seattle, USA.
| |
Collapse
|
48
|
Chantler T, Paton C, Velardo C, Triantafyllidis A, Shah SA, Stoppani E, Conrad N, Fitzpatrick R, Tarassenko L, Rahimi K. Creating connections - the development of a mobile-health monitoring system for heart failure: Qualitative findings from a usability cohort study. Digit Health 2016; 2:2055207616671461. [PMID: 29942568 PMCID: PMC6001232 DOI: 10.1177/2055207616671461] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 09/02/2016] [Indexed: 11/17/2022] Open
Abstract
Objective There is significant interest in the role of digital health technology in enabling optimal monitoring of heart failure patients. To harness this potential, it is vital to account for users' capacity and preferences in the development of technological solutions. We adopted an iterative approach focussed on learning from users' interactions with a mobile-health monitoring system. Methods We used a participatory mixed methods research approach to develop and evaluate a mobile-health monitoring system. Fifty-eight heart failure patients were recruited from three health care settings in the UK and provided with Internet-enabled tablet computers that were wirelessly linked to sensor devices for blood pressure, heart rate and weight monitoring. One to two home visits were conducted with a subgroup of 29 participants to evaluate the usability of the system over a median follow-up period of six months. The thematic analysis of observational data and 45 interviews was informed by the domestication of technology theory. Results Our findings indicate that digital health technologies need to create and extend connections with health professionals, be incorporated into users' daily routines, and be personalised according to users' technological competencies and interest in assuming a proactive or more passive role in monitoring their condition. Conclusions Users' patterns of engagement with health technology changes over time and varies according to their need and capacity to use the technology. Incorporating diverse user experiences in the development and maintenance of mobile-health systems is likely to increase the extent of successful uptake and impacts on outcomes for patients and providers.
Collapse
Affiliation(s)
- Tracey Chantler
- George Institute for Global Health, University of Oxford, UK.,London School of Hygiene and Tropical Medicine, UK
| | - Chris Paton
- George Institute for Global Health, University of Oxford, UK
| | - Carmelo Velardo
- Institute of Biomedical Engineering, University of Oxford, UK
| | | | - Syed A Shah
- Institute of Biomedical Engineering, University of Oxford, UK
| | - Emma Stoppani
- George Institute for Global Health, University of Oxford, UK
| | - Nathalie Conrad
- George Institute for Global Health, University of Oxford, UK
| | | | | | - Kazem Rahimi
- George Institute for Global Health, University of Oxford, UK.,Division of Cardiovascular Medicine, University of Oxford, UK
| |
Collapse
|
49
|
Chantler T, Lwembe S, Saliba V, Raj T, Mays N, Ramsay M, Mounier-Jack S. "It's a complex mesh"- how large-scale health system reorganisation affected the delivery of the immunisation programme in England: a qualitative study. BMC Health Serv Res 2016; 16:489. [PMID: 27633653 PMCID: PMC5025625 DOI: 10.1186/s12913-016-1711-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 08/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The English health system experienced a large-scale reorganisation in April 2013. A national tri-partite delivery framework involving the Department of Health, NHS England and Public Health England was agreed and a new local operational model applied. Evidence about how health system re-organisations affect constituent public health programmes is sparse and focused on low and middle income countries. We conducted an in-depth analysis of how the English immunisation programme adapted to the April 2013 health system reorganisation, and what facilitated or hindered the delivery of immunisation services in this context. METHODS A qualitative case study methodology involving interviews and observations at national and local level was applied. Three sites were selected to represent different localities, varying levels of immunisation coverage and a range of changes in governance. Study participants included 19 national decision-makers and 56 local implementers. Two rounds of interviews and observations (immunisation board/committee meetings) occurred between December 2014 and June 2015, and September and December 2015. Interviews were audio recorded and transcribed verbatim and written accounts of observed events compiled. Data was imported into NVIVO 10 and analysed thematically. RESULTS The new immunisation programme in the new health system was described as fragmented, and significant effort was expended to regroup. National tripartite arrangements required joint working and accountability; a shift from the simpler hierarchical pre-reform structure, typical of many public health programmes. New local inter-organisational arrangements resulted in ambiguity about organisational responsibilities and hindered data-sharing. Whilst making immunisation managers responsible for larger areas supported equitable resource distribution and strengthened service commissioning, it also reduced their ability to apply clinical expertise, support and evaluate immunisation providers' performance. Partnership working helped staff adapt, but the complexity of the health system hindered the development of consistent approaches for training and service evaluation. CONCLUSION The April 2013 health system reorganisation in England resulted in significant fragmentation in the way the immunisation programme was delivered. Some of this was a temporary by-product of organisational change, other more persistent challenges were intrinsic to the complex architecture of the new health system. Partnership working helped immunisation leaders and implementers reconnect and now the challenge is to assess how inter-agency collaboration can be strengthened.
Collapse
Affiliation(s)
- Tracey Chantler
- London School of Hygiene & Tropical Medicine, Faculty of Public Health & Policy, London, UK.
| | - Saumu Lwembe
- London School of Hygiene & Tropical Medicine, Faculty of Public Health & Policy, London, UK
| | - Vanessa Saliba
- Immunisation, Hepatitis & Blood Safety Department, National Infection Service, Public Health England, 61 Colindale Avenue, London, UK
| | - Thara Raj
- Bristol City Council, Public Health, Bristol City Council, City Hall (formerly The Council House), College Green, Bristol, BS1 5TR, UK
| | - Nicholas Mays
- London School of Hygiene & Tropical Medicine, Faculty of Public Health & Policy, London, UK
| | - Mary Ramsay
- Immunisation, Hepatitis & Blood Safety Department, National Infection Service, Public Health England, 61 Colindale Avenue, London, UK
| | - Sandra Mounier-Jack
- London School of Hygiene & Tropical Medicine, Faculty of Public Health & Policy, London, UK
| |
Collapse
|
50
|
Yadav L, Tewari A, Jain A, Essue B, Peiris D, Woodward M, Kotwal P, Lindley R, Jan S, Chantler T, Webster P, Norton R, Rath S. Protocol-based management of older adults with hip fractures in Delhi, India: a feasibility study. Pilot Feasibility Stud 2016; 2:15. [PMID: 27965835 PMCID: PMC5154050 DOI: 10.1186/s40814-016-0056-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 03/02/2016] [Indexed: 11/10/2022] Open
Abstract
Background Worldwide hip fractures are projected to increase from 1.7 million in 1990 to 6.3 million in 2050. In India, conservative estimates suggest an annual incidence of 600,000 osteoporotic hip fractures and this is expected to increase significantly due to ageing and increase life expectancy. Protocol-based ‘care pathways’ for the management of adults, over 60 years of age, with hip fractures in high-income countries has resulted in decreased mortality rates, early hospital discharge, improved quality of life and reduction in healthcare costs. The study objectives are to determine appropriateness, acceptability and feasibility of adopting best-practice guideline or protocol-based care for the management of hip fractures among older adults in India. The study will also identify barriers and facilitators in recruiting patients and retention till the agreed follow-up period. Methods This will be a mixed-methods prospective cohort study. The quantitative data collection will involve recruitment of consecutive patients aged >50 years with an X-ray-confirmed hip fracture admitted in four tertiary care hospitals in Delhi, India, over a 2-month period. The quantitative data will be collected at three points: from patients at admission to hospital, from medical records at discharge and by telephone interviews with patients at 30 days post hip fracture. Qualitative data collection will involve key informant interviews, conducted with clinical leads and focus group discussions, conducted with groups of healthcare providers and patients and/or their carers. COM-B theoretical framework (capability, opportunity, motivation and behaviour) will be used to explore healthcare providers’ behaviour in order to facilitate development and implementation of appropriate integrated care pathway for management of older adults with hip fractures in India. Discussion The proposed study will identify gaps in best practice in the management of older people with hip fractures in tertiary care hospitals in Delhi and document barriers and facilitators to the implementation of protocol-based care through recording the contextual realities of the health systems and care-seeking behaviours. Insights into these factors will be used to facilitate the development of protocol-based management of older people with hip fractures that is appropriate, context specific and acceptable by stakeholders in a low- and middle-income country setting, such as India. Electronic supplementary material The online version of this article (doi:10.1186/s40814-016-0056-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Lalit Yadav
- The George Institute for Global Health, 219-221, Splendor Forum, Plot No. 3, Jasola District Centre, New Delhi, 110025 India
| | - Abha Tewari
- The George Institute for Global Health, 219-221, Splendor Forum, Plot No. 3, Jasola District Centre, New Delhi, 110025 India
| | - Anil Jain
- Department of Orthopaedics, University College of Medical Sciences, New Delhi, India
| | - Beverley Essue
- The George Institute for Global Health, Sydney, Australia
| | - David Peiris
- Primary Health Care Research, The George Institute for Global Health & Sydney Medical School, University of Sydney, Sydney, Australia
| | - Mark Woodward
- Epidemiology & Biostatistics, The George Institute for Global Health & Statistics & Epidemiology, University of Oxford, Oxford, UK
| | - Prakash Kotwal
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Richard Lindley
- The George Institute for Global Health & Geriatric Medicine, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Stephen Jan
- Health Economics, The George Institute for Global Health & Sydney Medical School, University of Sydney, Sydney, Australia
| | | | - Premila Webster
- Nuffield Department of Population Sciences, School of Public Health, University of Oxford, Oxford, UK
| | - Robyn Norton
- The George Institute for Global Health, University of Oxford, Oxford, UK.,The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Santosh Rath
- Global Surgery, The George Institute for Global Health, University of Oxford, Oxford, OX1 3BD UK
| |
Collapse
|