Search

Delayed acceptance or refusal of COVID-19 vaccines may increase and prolong the threat to global public health and the economy. Identifying behavioural determinants is considered a critical step in explaining and addressing the barriers of vaccine refusal. This study aimed to identify the behavioural determinants of COVID-19-vaccine acceptance and provide recommendations to design actionable interventions to increase uptake of the COVID-19 vaccine in six lower- and middle-income countries. Taking into consideration the health belief model and the theory of reasoned action, a barrier analysis approach was employed to examine twelve potential behavioural determinants of vaccine acceptance in Bangladesh, India, Myanmar, Kenya, the Democratic Republic of the Congo (DRC), and Tanzania. In all six countries, at least 45 interviews with those who intended to get the vaccine ("Acceptors") and another 45 or more interviews with those who did not ("Non-acceptors") were conducted, totalling 542 interviews. Data analysis was performed to find statistically significant (p < 0.05) differences between Acceptors and Non-acceptors of COVID-19 vaccines and to identify which beliefs were most highly associated with acceptance and non-acceptance of vaccination based on the estimated relative risk. The analysis showed that perceived social norms, perceived positive and negative consequences, perceived risk, perceived severity, trust, perceived safety, and expected access to COVID-19 vaccines had the highest associations with COVID-19-vaccine acceptance in Bangladesh, Kenya, Tanzania, and the DRC. Additional behavioural determinants found to be significant in Myanmar and India were perceived self-efficacy, trust in COVID-19 information provided by leaders, perceived divine will, and perceived action efficacy of the COVID-19 vaccines. Many of the determinants were found to be significant, and their level of significance varied from country to country. National and local plans should include messages and activities that address the behavioural determinants found in this study to significantly increase the uptake of COVID-19 vaccines across these countries. ispartof: VACCINES vol:10 issue:2 ispartof: location:Switzerland status: published

Background While vaccines ensure individual protection against COVID-19 infection, delay in receipt or refusal of vaccines will have both individual and community impacts. The behavioral factors of vaccine hesitancy or refusal are a crucial dimension that need to be understood in order to design appropriate interventions. The aim of this study was to explore the behavioral determinants of COVID-19 vaccine acceptance and to provide recommendations to increase the acceptance and uptake of COVID-19 vaccines in Bangladesh. Methods We employed a Barrier Analysis (BA) approach to examine twelve potential behavioral determinants (drawn from the Health Belief Model [HBM] and Theory of Reasoned Action [TRA]) of intended vaccine acceptance. We conducted 45 interviews with those who intended to take the vaccine (Acceptors) and another 45 interviews with those who did not have that intention (Non-acceptors). We performed data analysis to find statistically significant differences and to identify which beliefs were most highly associated with acceptance and non-acceptance with COVID-19 vaccines. Results The behavioral determinants associated with COVID-19 vaccine acceptance in Dhaka included perceived social norms, perceived safety of COVID-19 vaccines and trust in them, perceived risk/susceptibility, perceived self-efficacy, perceived positive and negative consequences, perceived action efficacy, perceived severity of COVID-19, access, and perceived divine will. In line with the HBM, beliefs about the disease itself were highly predictive of vaccine acceptance, and some of the strongest statistically-significant (p Conclusion An effective behavior change strategy for COVID-19 vaccines uptake will need to address multiple beliefs and behavioral determinants, reducing barriers and leveraging enablers identified in this study. National plans for promoting COVID-19 vaccination should address the barriers, enablers, and behavioral determinants found in this study in order to maximize the impact on COVID-19 vaccination acceptance.

BackgroundWhile vaccines ensure individual protection against COVID-19 infection, delay in receipt or refusal of vaccines will have both individual and community impacts. The behavioral factors of vaccine hesitancy or refusal are a crucial dimension that need understanding to implicate appropriate interventions. The aim of this study was to assess the behavioral determinants of COVID-19 vaccine acceptance and to provide recommendations to increase the uptake of COVID-19 vaccines in Bangladesh.MethodsWe employed a Barrier Analysis (BA) approach to examine twelve potential behavioral determinants (drawn from the Health Belief Model and Theory of Reasoned Action [TRA]) of intended vaccine acceptance. We conducted 45 interviews with those who intended to take the vaccine (Acceptors) and another 45 interviews with those who did not have that intention (Non-acceptors). We performed data analysis to find statistically significant differences and to identify which beliefs were most highly associated with acceptance and non-acceptance with COVID-19 vaccines.ResultsCOVID-19 vaccine Acceptors in Dhaka were different from Non-acceptors in terms of many of their beliefs and responses. The behavioral determinants associated with the behavior included perceived social norms, perceived safety of COVID-19 vaccines and trust in them, perceived risk/susceptibility, perceived self-efficacy, perceived positive and negative consequences, perceived action efficacy, perceived severity of COVID-19, access, and perceived divine will. In line with the Health Belief Model, beliefs about the disease itself were highly correlated with vaccine acceptance, although not the only determinant. Other responses of Acceptors provide clues such as providing vaccination through government health facilities, schools, and kiosks, and having vaccinators maintain proper COVID-19 health and safety protocols as to ways to make it easier to boost acceptance.ConclusionAn effective behavior change strategy for COVID-19 vaccines uptake will need to address multiple beliefs and behavioral determinants, reducing barriers and leveraging enablers identified in this study. The national plans on COVID-19 vaccination should adopt culturally and community label acceptable and appropriate evidence-based behavior change interventions strategies to promote high vaccination coverage and acceptance in all societal structures across the country.

Background: While a vaccine is the only clinical preventive measure to control the infection and mortality caused by SARS-CoV-2 (COVID-19), delayed acceptance or refusal of COVID-19 vaccines may increase and prolong the threat to global public health and the economy. Identifying behavioural determinants is considered a critical step in explaining and addressing the barriers of vaccine refusal, but there is a lack of evidence around COVID-19 vaccine refusal and delay from a behavioural perspective. This study aims to identify the behavioural determinants of COVID-19 vaccine acceptance and provide recommendations to design actionable interventions to increase the uptake of the COVID-19 vaccine in six lower-and-middle income countries.Methods: Taking into consideration the Health Belief Model (HBM), Theory of Reasoned Action (TRA), and other behavioural models, a Barrier Analysis (BA) approach was employed to examine twelve potential behavioural determinants of vaccine acceptance in Bangladesh, India, Myanmar, Kenya, the Democratic Republic of Congo, and Tanzania. In all six countries, at least 45 interviews with those who intended to take the vaccine (“Acceptors”) and another 45 or more interviews with those who did not (“Non-Acceptors”) were conducted, totalling 542 interviews. Data analysis was performed to find statistically significant (a p-value of less than 0.05) differences between Acceptors and Non-acceptors and to identify which beliefs were most highly associated with acceptance and non-acceptance of the behaviour based on estimated relative risk (ERR). Results: The analysis showed that perceived social norms, perceived positive and negative consequences, perceived risk of getting COVID-19, perceived severity of COVID-19, trust in COVID-19 vaccines, perceived safety of COVID-19 vaccines, and expected access to COVID-19 vaccines had the highest association with COVID-19 vaccine acceptance in Bangladesh, Kenya, Tanzania, and DRC. Additional behavioural determinants found to be significant in both Myanmar and India were perceived self-efficacy, trust in COVID-19 information provided by leaders, perceived divine will, and perceived action efficacy of the COVID-19 vaccines. The study also identified important perceptions and beliefs around COVID-19 and its severity, advantages and disadvantages of being vaccinated, and action efficacy of the vaccine to control the spread of the virus.Conclusion: Many of the determinants found to be significant and their level of significance varied from country to country. National and local plans should include messages and activities that address the behavioural determinants found in this study in order to significantly increase the uptake of COVID-19 vaccine across these countries.

Introduction: The Ebola vaccine Deployment, Acceptance, and Compliance (EBODAC) project was established to develop a communication and community engagement strategy, including the development of appropriate technology, to maximize Ebola vaccination impact in the targeted population both in support of clinical trials and in the broader vaccination program beyond the clinical trial. EBODAC supported the EBOVAC-Salone trial in Kambia district in Sierra Leone to ensure that the novel prime-boost vaccine regimen is well accepted and successfully used in the context of clinical trials; while also preparing to maximize the impact of the potential deployment of a future Ebola vaccination program. The Mobile Technology for Community Health (MOTECH) platform was utilized and customized to help ensure compliance with the prime-boost vaccination regimen. Its main role was to support the communications and reminders surrounding the Ebola vaccine trial through an automated message service to participants’ mobile phones as Interactive Voice Responses (IVR) and SMS (Short Message Service) messages. Methods: The study was cross-sectional and adopted qualitative and quantitative research methods. The design was constructed to provide a representation of different user segments. The sample size was not constructed to provide statistical differences or detect differences in impact among groups but was simply designed to provide insights into how study participants interacted with the technology. Eligibility criteria involved randomly selecting participants from those that: a) received IVR and SMS and didn’t miss an appointment (booster compliant), b) received IVR and SMS and missed an appointment (booster non-compliant), c) received no IVR and SMS and didn’t miss or missed an appointment (MOTECH non-user). Quantitative information was entered in well-designed data entry templates. All participants’ names were anonymized for data analysis. Results: All the respondents, (n=81) revealed liking both the IVRS and SMS messages and majority of these, 80.2% (n=65) reported that IVR was very easy to understand. Respondents 47.5% (n=45) were comfortable receiving IVR, as opposed to 35.8% (n=29) preferred both text and voice messages. It was also found that 74.1% (n=60) of the respondents who were sent visit reminder messages never missed clinic appointment and 81.5% of those that received information preferred to know how to protect themselves from the disease. Conclusion: The EBOVAC-Salone automated voice messages contributed to valuable learning about areas of improvement for the MOTECH that will be of great importance for future outbreaks and medical interventions.

Background: The Ministry of Health in Sierra Leone has developed and operationalized the national Digital Health Strategy to guide integrated roll out of e-health/mobile health solutions. The goal is that “by 2023 an effective and efficient ICT enabled system supports delivery of quality, accessible, affordable, equitable, and timely healthcare services and moves Sierra Leone closer to achieving universal health coverage”. Investing in digital platforms for the education of community health workers (CHWs) in Sierra Leone is a critical strategic approach to strengthening the country’s readiness for future Ebola outbreaks. A new national curriculum for this target group is being implemented that is based upon classroom training approaches. In a country where many CHWs are remotely located, the use of technology can be an enabler to reach such individuals with key training content to repeat the most important messages. Here we describe the piloting of a mobile training and support (MOTS) service for CHWs using interactive voice response (IVR) technology in Bo district of Sierra Leone. This training platform delivers voice recorded training content in local languages on the topics of Vaccines and (Ebola) Disease Surveillance & Outbreak Response. Methods: MOTS was developed in collaboration with the Sierra Leone Ministry of Health & Sanitation. Training content was customized in line with the national training curriculum and case reporting requirements. Local ethical approval was achieved and a test protocol involving recruitment of 125 consenting CHWs was implemented in Bo district of Sierra Leone. Two training modules—one covering vaccination and one covering outbreak response and disease surveillance were delivered to the mobile phones of participants as audio messages in the preferred local language. Knowledge change was assessed largely through pre- and post-quiz assessments also implemented through IVR. Results: Knowledge acquisition was observed in the 123 CHWs completing this pilot assessment. The extent of knowledge acquired was higher with the Vaccine training module when compared to the (Ebola) Disease Surveillance & Outbreak Response module. The technology was readily accepted by this population and their engagement was such that they also provided important elements to be improved prior to further implementation. The order in which training modules are delivered as well as general fatigue of the IVR methodology for participating in the quiz assessments may be of importance and requires further investigation. Conclusions: Technology should be considered when planning delivery of training to CHWs and can be positioned as a vehicle by which repetitive aspects of important training content can be reinforced without the need for additional classroom presence of the CHW community. Sustainability of such solutions requires cost containment and subsequent software accessibility for authorities in resource limited settings. Transparent partnership and alignment with the Ministry of Health & Sanitation in Sierra Leone from the outset of this project is considered an important element to ensure successful implementation.

Background: Mobile Training and Support (MOTS) service is the vehicle for delivery of refresher training on healthcare related topics. This service will provide mobile training to Community Health Workers (CHWs) via their mobile phones with feature phones as the basic requirement. The MOTS service will provide training modules via Interactive Voice Response (IVR) or voice messages that include units and quizzes and allow monitoring by management. The purpose of the study was to assess the functionality of CHWs and their readiness to receive the MOTS service package. Method and Material: The study was a cross-sectional assessment utilizing both quantitative and qualitative data collection methods in Bo district, southern Sierra Leone found in West Africa. The tools had mixed method questions to capture both quantitative and qualitative data. Results: The CHWs’ willingness to participate in the MOTS service was 99.2% with 79.2% mobile phone functionality. This therefore meant that 79.2% of all CHWs surveyed met the inclusion criteria for the MOTS program. With 90.6% of the Peripheral Health Unit (PHU) in-charges proving to be supervising CHWs, only 40.63% of the PHU in-charges could actually provide supervision to CHWs for the MOTS program due to the need to own a smartphone. Conclusions: Utilization of the modular IVRs through the MOTS service to facilitate the refresher training to CHWs is possible. This is because from the assessment 79.2% CHWs met the inclusion criteria for MOTS. At the CHW level, the willingness to participate was rated at 99%. This coupled with a 90.6% of PHU-Incharges readiness will contribute to the success of the program.