Abstract
Background
In 2016–18, a large measles outbreak occurred in Romania identified by pockets of sub-optimally vaccinated population groups in the country. The aim of the current study was to gain insight into barriers and drivers from the experience of measles vaccination from the perspectives of caregivers and their providers.
Methods
Data were collected by non-participant observation of vaccination consultations and individual interviews with health workers and caregivers in eight Romanian clinics with high or low measles vaccination uptake. Romanian stakeholders were involved in all steps of the study. The findings of this study were discussed during a workshop with key stakeholders.
Results
Over 400 h of observation and 161 interviews were conducted. A clear difference was found between clinics with high and low measles vaccination uptake which indicates that being aware of and following recommended practices for both vaccination service delivery and conveying vaccine recommendations to caregivers may have an impact on vaccine uptake. Barriers identified were related to shortcomings in following recommended practices for vaccination consultations by health workers (e.g. correctly assessing contraindications or providing enough information to allow an informed decision). These observations were largely confirmed in interviews with caregivers and revealed significant knowledge gaps.
Conclusions
The identification of key barriers provided an opportunity to design specific interventions to improve vaccination service delivery (e.g. mobile vaccination clinics, use of an electronic vaccination registry system for scheduling of appointments) and build capacity among health workers (e.g. guidance and supporting materials and training programmes).
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Details
1 Direction des risques biologiques et de la santé au travail, Institut National de Santé Publique du Québec , Québec, QC, Canada
2 Centre for Communicable Disease Surveillance and Control, National Institute of Public Health Romania , Bucharest, Romania
3 World Health Organization (WHO) Country Office in Romania , Bucharest, Romania
4 Common Thread , Bucharest, Romania
5 Department of Health Behavior, Gillings School of Global Public Health and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill , Chapel Hill, NC, USA
6 Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney , Sydney, NSW, Australia
7 Vaccine Acceptance and Demand, Sabin Vaccine Institute , Washington, DC, USA
8 Vaccine-Preventable Diseases and Immunization, World Health Organization (WHO) Behavioural and Cultural Insights unit and WHO Europe, Copenhagen , Denmark