Vaccination coverage determinants in low uptake areas of China: a qualitative study of provider perspectives in Sichuan, Guangdong, and Henan Provinces
China’s immunization programme is relatively strong, with latest WHO-UNICEF monitoring rates for 2019 showing national vaccination coverage over 90%. However, vaccination coverage is heterogeneous, varying across geographic regions, rural–urban communities, and sub-populations. We conducted a qualit...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2022-01-01
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| Series: | Human Vaccines & Immunotherapeutics |
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| Online Access: | http://dx.doi.org/10.1080/21645515.2022.2030623 |
| _version_ | 1797673245319626752 |
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| author | Shi-Yu Lin Shi-Ya Zhang Tracey Chantler Fiona Yueqian Sun Jia-Tong Zou Jie-Jie Cheng Yu-Qian Chen Mei Sun Natasha Howard |
| author_facet | Shi-Yu Lin Shi-Ya Zhang Tracey Chantler Fiona Yueqian Sun Jia-Tong Zou Jie-Jie Cheng Yu-Qian Chen Mei Sun Natasha Howard |
| author_sort | Shi-Yu Lin |
| collection | DOAJ |
| description | China’s immunization programme is relatively strong, with latest WHO-UNICEF monitoring rates for 2019 showing national vaccination coverage over 90%. However, vaccination coverage is heterogeneous, varying across geographic regions, rural–urban communities, and sub-populations. We conducted a qualitative study from a critical realist perspective, analyzing semi-structured interviews with 26 vaccination providers in three provinces, selected to represent regional socioeconomic disparities across Eastern, Central, and Western China. We analyzed data thematically, using deductive and inductive coding. Providers reported vaccination coverage in their areas had increased significantly, but remained lower among migrant and left-behind children. Main coverage determinants were child-related (i.e. gender, number, health status), caregiver-related (i.e. socioeconomic status, role, education level, ethnicity), institution-related (i.e. vaccinator numbers, information system, appointment process), and system-related (i.e. vaccine supply, intersectoral cooperation, vaccine ‘hesitancy’). Potentially effective measures to promote vaccination coverage included using routine maternal and child health-care visits for catch-up vaccination, providing additional health education, conducting follow-up family visits by village doctors, and requiring vaccination verification at school enrollment. This is the first qualitative study to examine potential determinants of low vaccination coverage in these areas of China. Findings can inform policies to strengthen the role of schools, develop the national immunization information system, and promote appointment apps. More consideration is needed to improve service quality and eliminating inequities, such as strengthening health education and service provision for migrant and left-behind children. |
| first_indexed | 2024-03-11T21:41:42Z |
| format | Article |
| id | doaj.art-6a7464ac852c4630b50b332f9679b3c5 |
| institution | Directory Open Access Journal |
| issn | 2164-5515 2164-554X |
| language | English |
| last_indexed | 2024-03-11T21:41:42Z |
| publishDate | 2022-01-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Human Vaccines & Immunotherapeutics |
| spelling | doaj.art-6a7464ac852c4630b50b332f9679b3c52023-09-26T12:57:38ZengTaylor & Francis GroupHuman Vaccines & Immunotherapeutics2164-55152164-554X2022-01-0118110.1080/21645515.2022.20306232030623Vaccination coverage determinants in low uptake areas of China: a qualitative study of provider perspectives in Sichuan, Guangdong, and Henan ProvincesShi-Yu Lin0Shi-Ya Zhang1Tracey Chantler2Fiona Yueqian Sun3Jia-Tong Zou4Jie-Jie Cheng5Yu-Qian Chen6Mei Sun7Natasha Howard8Fudan UniversityFudan UniversityLondon School of Hygiene & Tropical MedicineUniversity of LondonShanghai Municipal Center for Disease Control and PreventionFudan UniversityFudan UniversityFudan UniversityLondon School of Hygiene & Tropical MedicineChina’s immunization programme is relatively strong, with latest WHO-UNICEF monitoring rates for 2019 showing national vaccination coverage over 90%. However, vaccination coverage is heterogeneous, varying across geographic regions, rural–urban communities, and sub-populations. We conducted a qualitative study from a critical realist perspective, analyzing semi-structured interviews with 26 vaccination providers in three provinces, selected to represent regional socioeconomic disparities across Eastern, Central, and Western China. We analyzed data thematically, using deductive and inductive coding. Providers reported vaccination coverage in their areas had increased significantly, but remained lower among migrant and left-behind children. Main coverage determinants were child-related (i.e. gender, number, health status), caregiver-related (i.e. socioeconomic status, role, education level, ethnicity), institution-related (i.e. vaccinator numbers, information system, appointment process), and system-related (i.e. vaccine supply, intersectoral cooperation, vaccine ‘hesitancy’). Potentially effective measures to promote vaccination coverage included using routine maternal and child health-care visits for catch-up vaccination, providing additional health education, conducting follow-up family visits by village doctors, and requiring vaccination verification at school enrollment. This is the first qualitative study to examine potential determinants of low vaccination coverage in these areas of China. Findings can inform policies to strengthen the role of schools, develop the national immunization information system, and promote appointment apps. More consideration is needed to improve service quality and eliminating inequities, such as strengthening health education and service provision for migrant and left-behind children.http://dx.doi.org/10.1080/21645515.2022.2030623vaccinationmigrant childrenleft-behind childrencoverage determinantschina |
| spellingShingle | Shi-Yu Lin Shi-Ya Zhang Tracey Chantler Fiona Yueqian Sun Jia-Tong Zou Jie-Jie Cheng Yu-Qian Chen Mei Sun Natasha Howard Vaccination coverage determinants in low uptake areas of China: a qualitative study of provider perspectives in Sichuan, Guangdong, and Henan Provinces Human Vaccines & Immunotherapeutics vaccination migrant children left-behind children coverage determinants china |
| title | Vaccination coverage determinants in low uptake areas of China: a qualitative study of provider perspectives in Sichuan, Guangdong, and Henan Provinces |
| title_full | Vaccination coverage determinants in low uptake areas of China: a qualitative study of provider perspectives in Sichuan, Guangdong, and Henan Provinces |
| title_fullStr | Vaccination coverage determinants in low uptake areas of China: a qualitative study of provider perspectives in Sichuan, Guangdong, and Henan Provinces |
| title_full_unstemmed | Vaccination coverage determinants in low uptake areas of China: a qualitative study of provider perspectives in Sichuan, Guangdong, and Henan Provinces |
| title_short | Vaccination coverage determinants in low uptake areas of China: a qualitative study of provider perspectives in Sichuan, Guangdong, and Henan Provinces |
| title_sort | vaccination coverage determinants in low uptake areas of china a qualitative study of provider perspectives in sichuan guangdong and henan provinces |
| topic | vaccination migrant children left-behind children coverage determinants china |
| url | http://dx.doi.org/10.1080/21645515.2022.2030623 |
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