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Background: Vaccination literature highlights programmatic and ethical pertinence of ‘community engagement’ in ensuring efficacious vaccines becoming effective vaccinations. However, lack of consensual definition of community engagement, recurring evidence of community backlashes especially during vaccine introductions, and paucity of literature on community engagement’s effectiveness in achieving vaccination outcomes is problematic because assuming a shared understanding of community engagement will only lead to erroneous assumptions about its value, or lack thereof. This study examines conceptualization of community engagement by vaccine decisionmakers in India and efforts to foster it during the Decade of Vaccines.
Methods: Elite interviews were carried out (December 2017 to February 2018) with 25 national-level vaccine decisionmakers in India. Study participants included policymakers, immunization program heads, and vaccine technical committee leads representing Government, international non-profits, and donors. Using Schutz’ Social Phenomenological theory, an a priori framework guided coding decisionmakers’ conceptualizations of ‘communities’, ‘community engagement’, and fostering the same. NVivo12 was used for data analysis placing exemplar community engagement interventions on a low to high spectrum. Findings were validated in a one-day member check-in meeting with study participants and teams.
Results: Barring themselves, decisionmakers defined ‘communities’ as vaccine-eligible children, their parents, frontline healthcare workers, and vaccination influencers namely- religious leaders, and members of local youth clubs and non-profits. ‘Community engagement’ was variously defined as vaccine outreach, capacity-building of healthcare workers, and information dissemination to guardians of vaccine-eligible children. There was no explicit policy guideline defining community engagement, and no metrics assessing its effectiveness in vaccination uptake. Participants agreed that ‘community engagement’ though evolving is a complex and under-researched area. Community engagement spectrum exemplified seven intersecting layers, with ‘low’ as ‘vaccine impositions’, and ‘high’ as ‘community’s vaccination decision-making’. Participants in the member check-in meeting proposed an operational definition of community engagement and discussed gaps/concerns related to defining/implementing it.
Conclusions: It is critical to build-in the operational definition of community engagement in vaccine guidelines, develop its performance and outcome indicators, and advocate their incorporation in immunization surveillance instruments in India. Acknowledging relational gains of community engagement is pertinent to improve vaccination outcomes in India and is relevant for consideration by other countries too.
Keywords
vaccination, India, vaccine eligibility
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CURRENT STATUS: Published
View the published article at International Journal for Equity in Health.
No community comments so far
Review #1 received
Received 23 Sep, 2020
Editorial decision: Accept
On 23 Sep, 2020
Reviewer #1 agreed
On 15 Sep, 2020
Editor assigned
On 14 Sep, 2020
Reviewers invited
Invitations sent on 14 Sep, 2020
Submission checks complete
On 13 Sep, 2020
Editor invited
On 13 Sep, 2020
No comments provided
Review #1 received
Received 08 Sep, 2020
Editorial decision: Minor Revision
On 08 Sep, 2020
Reviewer #1 agreed
On 24 Aug, 2020
Editor assigned
On 19 Aug, 2020
Reviewers invited
Invitations sent on 19 Aug, 2020
Submission checks complete
On 18 Aug, 2020
Editor invited
On 18 Aug, 2020
No comments provided
Review #1 received
Received 11 Aug, 2020
Editor assigned
On 28 Jul, 2020
Reviewers invited
Invitations sent on 28 Jul, 2020
Reviewer #1 agreed
On 28 Jul, 2020
Submission checks complete
On 27 Jul, 2020
Editor invited
On 27 Jul, 2020
Version 1
Posted 09 Jun, 2020
No comments provided
Editorial decision: Major Revision
On 13 Jul, 2020
Review #2 received
Received 11 Jul, 2020
Review #1 received
Received 03 Jul, 2020
Reviewer #2 agreed
On 18 Jun, 2020
Reviewer #1 agreed
On 15 Jun, 2020
Editor assigned
On 02 Jun, 2020
Reviewers invited
Invitations sent on 02 Jun, 2020
Submission checks complete
On 01 Jun, 2020
Editor invited
On 01 Jun, 2020
First submitted
On 28 May, 2020
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at International Journal for Equity in Health.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at International Journal for Equity in Health.
No community comments so far
Review #1 received
Received 23 Sep, 2020
Editorial decision: Accept
On 23 Sep, 2020
Reviewer #1 agreed
On 15 Sep, 2020
Editor assigned
On 14 Sep, 2020
Reviewers invited
Invitations sent on 14 Sep, 2020
Submission checks complete
On 13 Sep, 2020
Editor invited
On 13 Sep, 2020
No comments provided
Review #1 received
Received 08 Sep, 2020
Editorial decision: Minor Revision
On 08 Sep, 2020
Reviewer #1 agreed
On 24 Aug, 2020
Editor assigned
On 19 Aug, 2020
Reviewers invited
Invitations sent on 19 Aug, 2020
Submission checks complete
On 18 Aug, 2020
Editor invited
On 18 Aug, 2020
No comments provided
Review #1 received
Received 11 Aug, 2020
Editor assigned
On 28 Jul, 2020
Reviewers invited
Invitations sent on 28 Jul, 2020
Reviewer #1 agreed
On 28 Jul, 2020
Submission checks complete
On 27 Jul, 2020
Editor invited
On 27 Jul, 2020
Version 1
Posted 09 Jun, 2020
No comments provided
Editorial decision: Major Revision
On 13 Jul, 2020
Review #2 received
Received 11 Jul, 2020
Review #1 received
Received 03 Jul, 2020
Reviewer #2 agreed
On 18 Jun, 2020
Reviewer #1 agreed
On 15 Jun, 2020
Editor assigned
On 02 Jun, 2020
Reviewers invited
Invitations sent on 02 Jun, 2020
Submission checks complete
On 01 Jun, 2020
Editor invited
On 01 Jun, 2020
First submitted
On 28 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at International Journal for Equity in Health.
Background: Vaccination literature highlights programmatic and ethical pertinence of ‘community engagement’ in ensuring efficacious vaccines becoming effective vaccinations. However, lack of consensual definition of community engagement, recurring evidence of community backlashes especially during vaccine introductions, and paucity of literature on community engagement’s effectiveness in achieving vaccination outcomes is problematic because assuming a shared understanding of community engagement will only lead to erroneous assumptions about its value, or lack thereof. This study examines conceptualization of community engagement by vaccine decisionmakers in India and efforts to foster it during the Decade of Vaccines.
Methods: Elite interviews were carried out (December 2017 to February 2018) with 25 national-level vaccine decisionmakers in India. Study participants included policymakers, immunization program heads, and vaccine technical committee leads representing Government, international non-profits, and donors. Using Schutz’ Social Phenomenological theory, an a priori framework guided coding decisionmakers’ conceptualizations of ‘communities’, ‘community engagement’, and fostering the same. NVivo12 was used for data analysis placing exemplar community engagement interventions on a low to high spectrum. Findings were validated in a one-day member check-in meeting with study participants and teams.
Results: Barring themselves, decisionmakers defined ‘communities’ as vaccine-eligible children, their parents, frontline healthcare workers, and vaccination influencers namely- religious leaders, and members of local youth clubs and non-profits. ‘Community engagement’ was variously defined as vaccine outreach, capacity-building of healthcare workers, and information dissemination to guardians of vaccine-eligible children. There was no explicit policy guideline defining community engagement, and no metrics assessing its effectiveness in vaccination uptake. Participants agreed that ‘community engagement’ though evolving is a complex and under-researched area. Community engagement spectrum exemplified seven intersecting layers, with ‘low’ as ‘vaccine impositions’, and ‘high’ as ‘community’s vaccination decision-making’. Participants in the member check-in meeting proposed an operational definition of community engagement and discussed gaps/concerns related to defining/implementing it.
Conclusions: It is critical to build-in the operational definition of community engagement in vaccine guidelines, develop its performance and outcome indicators, and advocate their incorporation in immunization surveillance instruments in India. Acknowledging relational gains of community engagement is pertinent to improve vaccination outcomes in India and is relevant for consideration by other countries too.
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