Strategies for expanding childhood vaccination in the Americas following the COVID-19 pandemic

Objective

To provide an overview of the status of the childhood vaccination schedule in the Americas, outline program structures, and identify updated implementation strategies to improve vaccination coverage following the COVID-19 pandemic.

Methods

A group of experts in pediatrics, epidemiology, vaccines, and global and public health discussed the current status of the childhood vaccination schedule in the Americas, describing the program structure and identifying new implementation strategies that have the potential to improve vaccination coverage in the post-pandemic context, after the challenges COVID-19 presented for more than two years.

Results

The Americas currently face a high risk of resurgence of diseases that were previously controlled or eliminated. Therefore, it is important to find new strategies to educate citizens on the risks associated with lower vaccination rates, especially in children.

Conclusions

New strategies along with strong mobilization of the population and advocacy by citizens are necessary to prevent antivaccination groups from gaining a stronger presence in the region and jeopardizing the credibility of the Expanded Program on Immunization.

Adapting a transdiagnostic digital mental health intervention for use among immigrant and refugee youth in Seattle: a human-centered design approach

Digital mental health interventions show promise in addressing mental health needs, especially among youth and marginalized communities. This study adapted the World Health Organization -developed STARS (Sustainable Technology for Adolescents to Reduce Stress) digital mental health intervention for use among youth and young adults aged 14-25 from immigrant and refugee communities in Seattle, Washington. Human-centered design methods centered around qualitative semi-structured interviews were used to contextually and culturally adapt the intervention and prioritize the needs and preferences of the intended end user. Intervention prototypes were modified and then presented to the target groups in iterative cycles until saturation was achieved. Qualitative interviews occurred in three iterations of five participants each. Modifications were documented according to the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) implementation science framework. Modifications aligned with the FRAME process elements: (a) tailoring/refining, which included adapting language to less resemble digital phishing scams; (b) changes in packaging or materials, which included naming the chatbot and adopting a corresponding avatar; (c) adding/removing, which included changing existing emojis and adding additional media types including graphics interchange format images, pictures, and voice memos; (d) shortening/condensing, which included shortening the length of individual text sections as well as deleting redundant language; (e) lengthening/extending, which included allowing the user to choose to receive content catered to teenagers or to adults; and (f) loosening structure, including giving users options to skip parts of modules or to engage with additional material. The modified STARS intervention shows promise for engagement with immigrant and refugee youth in Seattle and can be examined for clinical effectiveness. Adaptations increased the relevance of content to the intended end user, expanded options for personalization and customization of the user experience, and utilized language that was age appropriate, engaging, and did not invoke feelings of stigma or distrust. Adaptations of digital mental health interventions should focus on modifications that maximize acceptability and appropriateness to intended audiences.