A qualitative study using an ecological model to understand factors affecting childhood immunization in Papua New Guinea

Early Abstract:

Introduction: Immunization is an effective public health intervention for preventing and reducing vaccine preventable diseases. This qualitative study was designed to explore individual, interpersonal, organizational, and social relationships influencing the use of routine childhood immunization services in two rural health centers in Eastern Highlands Province of Papua New Guinea. 
Methods: A total of 28 mothers with children under five years were identified through purposive sampling. We conducted 12 semi-structured interviews with mothers and two focus group discussions with eight mothers each who attended immunization services. Data were transcribed verbatim and translated from Tok Pisin into English. A thematic analysis was conducted using both an inductive and deductive processes, interpreted by applying the ecological model of health promotion/primary prevention.
Results: Participants discussed factors at an intrapersonal level that included knowledge about immunization and concern of side effects. At the interpersonal level family support had a positive and negative effect to decision-making, as well as relations with older community members created agency to opt for vaccination services. Despite unequal gender-based power relations, women demonstrated agency and demonstrated independent capacity to act and attend immunization services. Institutional issues such as health worker attitudes and waiting times affected vaccination uptake decisions. Societal environments including cultural obligations such as funerals, tribal fights, and sorcery also influenced vaccination uptake. 
Conclusion: Complex and multi-level factors influence childhood vaccination services use. Understanding the influences of these multi-level factors power relationships is significant for informing policy and practice in redesigning immunization services. Engaging parents, extended families, communities, and health workers in the redesign and implementation planning is crucial for fostering positive decision-making regarding childhood immunization.
Keywords: childhood immunization, ecological model, gender, Papua New Guinea, qualitative research.