The influence of gender on immunisation: using an ecological framework to examine intersecting inequities and pathways to change

Feletto, Marta; Sharkey, Alyssa

doi:10.1136/bmjgh-2019-001711

Cited by 31 publications

(45 citation statements)

References 49 publications

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“…Similarly, the role of gender on vaccination coverage have raised scholarly debate lately in LIMC. Disparities in immunization coverage between boys and girls have shown in some instances how gender of child determines uptake [87][88][89]. This study provides valuable insights on this debate.…”

Section: Discussionmentioning

confidence: 84%

Caregivers’ Willingness to Vaccinate Their Children against Childhood Diseases and Human Papillomavirus: A Cross-Sectional Study on Vaccine Hesitancy in Malawi

et al. 2021

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Background: Vaccines are among the most effective and cost-efficient public health interventions for promoting child health. However, uptake is considerably affected by vaccine hesitancy. An example is Malawi, with a decline in second vaccine doses and the highest cervical cancer incidence and mortality rate in Sub-Saharan Africa. Understanding vaccine hesitancy is especially important when new vaccines are introduced. This study explores factors contributing to vaccine hesitancy for routine childhood immunization and the human papillomavirus vaccine in Malawi. Methods: The study used a cross-sectional survey design targeting caregivers of children under five years old and adolescent girls. The sample population was derived using three inclusion criteria: one district with low vaccine uptake (Dowa), one district with high vaccine uptake (Salima), and one district where human papillomavirus vaccine was piloted earlier (Zomba). A convenience sample of one primary and one secondary health facility was selected within each district, and participants were systematically included (n = 600). The measures were based on 5C scale for measuring vaccine hesitancy. Multiple regression analyses were performed to explore vaccination intention predictors. Results: Confidence in vaccine safety was the strongest predictor of routine childhood immunization, followed by constraints due to everyday stress. Caregivers had lower confidence in vaccine safety and efficacy when they believed rumors and misinformation and were unemployed. Confidence was higher for those who had more trust in healthcare workers. Age, gender, religion, education, employment, belief in rumors, and trust in healthcare workers were considered predictors of vaccination intention. A husband’s positive attitude (approval) increased childhood vaccination intention. For human papillomavirus, vaccination intentions were higher for those with lower education, more trust in healthcare workers, lower complacency, and a lower tendency toward calculating the benefits and risks of vaccination. Knowledge of human papillomavirus did not increase vaccination intention, but the need to attain a husband’s approval did. Being a young adult and unemployed increased belief in rumors, while trust in healthcare workers reduced the belief. Conclusions: This study provides good insights into the drivers of vaccine hesitancy across different contexts in Malawi. However, further studies are necessary to understand low risk perception among elderly people and the declining trend in second vaccine doses.

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Section: Discussionmentioning

confidence: 84%

Caregivers’ Willingness to Vaccinate Their Children against Childhood Diseases and Human Papillomavirus: A Cross-Sectional Study on Vaccine Hesitancy in Malawi

et al. 2021

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“…Gender inequality is a well-known gap in immunization rate, especially in childhood, but these results highlight a potential life-time gap to be investigated. Holistic/systemic approaches are necessary to unravel the complexity of the interaction between gender, socioeconomic, environmental/community factors on immunization, to target specific implementation strategies that may operate differently within and across gender and other variables [ 28 ]. The important role of the healthcare organization has been highlighted by the intraclass-correlation of results showing a significant variation in VC through the regions, now quite autonomous in Italy, in the framework of a federalist reform of the Italian healthcare system and highlight the importance of the implementation strategies in achieving VC.…”

Section: Discussionmentioning

confidence: 99%

Gender, Socioeconomic, and Health Characteristics Associated with Influenza Vaccination Coverage (VC) among Italian Healthcare Workers: Secondary Analysis of a National Cross-Sectional Survey

et al. 2020

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Influenza epidemics pose a great overload over health-care facilities with an increase in the burden of disease for patients and healthcare costs. Despite a well-established amount of research in the area, vaccination rates show room for improvement and more research is needed in finding systematic interventions useful in improving healthcare workers (HCWs) vaccination coverage (VC). The purpose of this study was to describe the self-reported frequency of influenza immunization in HCWs and to identify demographic, socioeconomic, lifestyle, and health factors associated with this practice in Italy. Data about 5823 workers participating in the Italian national survey about health and healthcare services utilization are analyzed in the present study. Overall, 18.8% of HCWs reported being vaccinated against seasonal flu. In the multilevel regression, older workers had a higher likelihood of vaccine uptake (OR: 6.07; 95% CI 4.72–7.79), similar to those with chronic conditions or poor self-perceived health status (OR: 2.18 95% CI 1.17–4.09). On the other hand, the results highlighted a lower rate of VC in female HCWs (OR: 0.73 95% CI 0.61–0.86). Data confirm the low compliance towards flu immunization among Italian HCWs and highlight an important gap to be investigated in women.

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“…As compared with SMS, audio messaging is more amenable to culture-specific contextualization and an edutainment approach. The second insight concerns how gender-related barriers shape immunization access [ 28 ] and affected the study interventions. Participation in mobile phone interventions was limited by women’s ease of access to mobile phones, and, to a lesser degree, with technological familiarity.…”

Section: Discussionmentioning

confidence: 99%

Social and Behavior Change Communication Interventions Delivered Face-to-Face and by a Mobile Phone to Strengthen Vaccination Uptake and Improve Child Health in Rural India: Randomized Pilot Study

Johri¹,

Chandra²,

Kone³

et al. 2020

JMIR Mhealth Uhealth

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Background In resource-poor settings, lack of awareness and low demand for services constitute important barriers to expanding the coverage of effective interventions. In India, childhood immunization is a priority health strategy with suboptimal uptake. Objective To assess study feasibility and key implementation outcomes for the Tika Vaani model, a new approach to educate and empower beneficiaries to improve immunization and child health. Methods A cluster-randomized pilot trial with a 1:1 allocation ratio was conducted in rural Uttar Pradesh, India, from January to September 2018. Villages were randomly assigned to either the intervention or control group. In each participating village, surveyors conducted a complete enumeration to identify eligible households and requested participation before randomization. Interventions were designed through formative research using a social marketing approach and delivered over 3 months using strategies adapted to disadvantaged populations: (1) mobile health (mHealth): entertaining educational audio capsules (edutainment) and voice immunization reminders via mobile phone and (2) face-to-face: community mobilization activities, including 3 small group meetings offered to each participant. The control group received usual services. The main outcomes were prespecified criteria for feasibility of the main study (recruitment, randomization, retention, contamination, and adoption). Secondary endpoints tested equity of coverage and changes in intermediate outcomes. Statistical methods included descriptive statistics to assess feasibility, penalized logistic regression and ordered logistic regression to assess coverage, and generalized estimating equation models to assess changes in intermediate outcomes. Results All villages consented to participate. Gaps in administrative data hampered recruitment; 14.0% (79/565) of recorded households were nonresident. Only 1.4% (8/565) of households did not consent. A total of 387 households (184 intervention and 203 control) with children aged 0 to 12 months in 26 villages (13 intervention and 13 control) were included and randomized. The end line survey occurred during the flood season; 17.6% (68/387) of the households were absent. Contamination was less than 1%. Participation in one or more interventions was 94.0% (173/184), 78.3% (144/184) for the face-to-face strategy, and 67.4% (124/184) for the mHealth strategy. Determinants including place of residence, mobile phone access, education, and female empowerment shaped intervention use; factors operated differently for face-to-face and mHealth strategies. For 11 of 13 intermediate outcomes, regression results showed significantly higher basic health knowledge among the intervention group, supporting hypothesized causal mechanisms. Conclusions A future trial of a new intervention model is feasible. The interventions could strengthen the delivery of immunization and universal primary health care. Social and behavior change communication via mobile phones proved viable and contributed to standardization and scalability. Face-to-face interactions remain necessary to achieve equity and reach, suggesting the need for ongoing health system strengthening to accompany the introduction of communication technologies. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN) 44840759; https://doi.org/10.1186/ISRCTN44840759

show abstract

The influence of gender on immunisation: using an ecological framework to examine intersecting inequities and pathways to change

Cited by 31 publications

References 49 publications

Caregivers’ Willingness to Vaccinate Their Children against Childhood Diseases and Human Papillomavirus: A Cross-Sectional Study on Vaccine Hesitancy in Malawi

Caregivers’ Willingness to Vaccinate Their Children against Childhood Diseases and Human Papillomavirus: A Cross-Sectional Study on Vaccine Hesitancy in Malawi

Gender, Socioeconomic, and Health Characteristics Associated with Influenza Vaccination Coverage (VC) among Italian Healthcare Workers: Secondary Analysis of a National Cross-Sectional Survey

Social and Behavior Change Communication Interventions Delivered Face-to-Face and by a Mobile Phone to Strengthen Vaccination Uptake and Improve Child Health in Rural India: Randomized Pilot Study

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