很少有研究从参与设计和实施疫苗运动的人——如政府官员和民间社会利益攸关方——的角度描述印度疫苗犹豫不决和接受的驱动因素,这是制定解决这一阻碍高免疫覆盖率和进一步改善儿童健康的方法的先决条件。
我们进行了一项定性研究,以了解政府官员和公民社会利益相关者对印度疫苗犹豫驱动因素的看法。我们使用开放式问题的结构化指南对来自国际和国家非政府组织的21名参与者进行了深入的电话采访,专业协会,和大学,以及新德里的州和国家政府-六个国家级利益相关者,北方邦的六个州级利益相关者,六个在喀拉拉邦,和三个在古吉拉特邦-从2020年7月到2020年10月。我们根据扎根理论通过多阶段过程分析数据。我们提出了个人层面的发现,上下文,以及影响疫苗犹豫的疫苗/疫苗接种计划特异性因素。
我们确定了多种驱动因素和它们影响疫苗信念的复杂方式,态度,以及政府官员和参与疫苗活动的公民社会利益相关者的行为。重要的个人层面的影响是对疫苗接种益处的认识不足,安全问题,特别是与免疫接种后的轻度不良事件有关,以及对政府和卫生服务质量的不信任。上下文层面的因素包括沟通,媒体环境,和社交媒体,这是错误信息和犹豫的主要渠道,以及社会人口因素-特定的驱动因素因收入而异,教育,城市/农村环境,跨宗教和文化群体。在疫苗/疫苗接种级别的问题中,疫苗计划的设计和交付以及医疗保健专业人员的作用成为犹豫的最重要决定因素。
印度疫苗犹豫的驱动因素,和其他地方一样,因当地情况而异;成功的干预措施应针对个人,上下文,和疫苗特异性因素。虽然以前的研究集中在个人层面的因素,我们的研究证明了上下文和疫苗特异性影响的同等重要性,特别是传播和媒体环境,有影响力的领导人,社会人口因素,和一线卫生工作者。
Few studies have described the drivers of vaccine hesitancy and acceptance in India from the perspective of those involved in the design and implementation of vaccine campaigns-such as government officials and civil society stakeholders-a prerequisite to developing approaches to address this barrier to high immunization coverage and further child health improvements.
We conducted a qualitative
study to understand government officials and civil society stakeholders\' perceptions of the drivers of vaccine hesitancy in India. We conducted in-depth phone interviews using a structured guide of open-ended questions with 21 participants from international and national non-governmental organizations, professional associations, and universities, and state and national government-six national-level stakeholders in New Delhi, six state-level stakeholders in Uttar Pradesh, six in Kerala, and three in Gujarat-from July 2020 to October 2020. We analyzed data through a multi-stage process following Grounded Theory. We present findings on individual-level, contextual, and vaccine/vaccination program-specific factors influencing vaccine hesitancy.
We identified multiple drivers and complex ways they influence vaccine beliefs, attitudes, and behaviors from the perspective of government officials and civil society stakeholders involved in vaccine campaigns. Important individual-level influences were low awareness of the benefits of vaccination, safety concerns, especially related to mild adverse events following immunization, and mistrust in government and health service quality. Contextual-level factors included communications, the media environment, and social media, which serves as a major conduit of misinformation and driver of hesitancy, as well as sociodemographic factors-specific drivers varied widely by income, education, urban/rural setting, and across religious and cultural groups. Among vaccine/vaccination-level issues, vaccine program design and delivery and the role of health care professionals emerged as the strongest determinants of hesitancy.
Drivers of vaccine hesitancy in India, as elsewhere, vary widely by local context; successful interventions should address individual, contextual, and vaccine-specific factors. While previous studies focused on individual-level factors, our
study demonstrates the equal importance of contextual and vaccine-specific influences, especially the communication and media environment, influential leaders, sociodemographic factors, and frontline health workers.