Abstract
Recommendations by health professionals are important for vaccines that are not included in national schedules. This study explored health professionals’ perspectives on recommending non-scheduled (user-fee) childhood vaccinations in China, identifying key influences on professionals’ interactions with caregivers. We conducted individual semi-structured interviews with 20 health professionals from three provinces in China and analyzed data thematically using deductive and inductive coding. Health professionals from all three provinces were uncomfortable about being perceived to encourage parents to accept vaccines that incurred a fee. They provided information about non-scheduled vaccines but emphasized parental autonomy in decision-making. Rural parents were less aware of unscheduled vaccines and health professionals were more likely to encourage parents living in more affluent areas to consider these vaccines; varicella vaccine was preferred by parents as a way of preventing school absence. Economic incentives for unscheduled vaccines were given to staff at most study sites, although the amount given varied widely. These variations meant that staff receiving lower incentives were not motivated to promote non-scheduled vaccines if their workload was high; on the contrary, those receiving higher incentives were more likely to promote these vaccines. Health professionals need more guidance on how to recommend unscheduled vaccines in an informative, positive and appropriate manner. It is evident that parents’ awareness of these vaccines, and their economic circumstances, influence vaccinators recommendation practice. Economic incentives prompted health professionals to recommend non-scheduled vaccines; however, the application of such staff incentives varied widely in China. To adopt appropriate economic incentives, professional organizations should develop protocols for the use of incentives that account for their influence on recommendation practices. Suitable recommendation policy needs to balance basic salaries with performance-based incentives, consider overall workload, and include monitoring and evaluation of economic incentives.
Highlights
Recommendations by Health Professionals (HPs) are important catalysts for parental uptake of vaccines, especially for those not included in routine national immunization schedules [1]
Most HPs in all three provinces reported telling caregivers about non-Expanded Program of Immunization (EPI) vaccines to fulfil their responsibilities of informing caregivers and allowing them to decide whether to get their child vaccinated
Their general perspectives were that vaccines could prevent infectious diseases, but they did not want to be perceived as actively recommending nonEPI vaccines
Summary
Recommendations by Health Professionals (HPs) are important catalysts for parental uptake of vaccines, especially for those not included in routine national immunization schedules [1]. The Chinese public health system delivers two complementary immunization programs for children under 6 years of age. Category I and II vaccines are delivered at points of vaccination (POVs), found at a range of health facilities including township and community health centers. HPs based at POVs are responsible for offering vaccination services and promoting the uptake of vaccines that can prevent common diseases. During their daily work they are responsible for providing vaccine information, addressing service users’ questions and administering vaccines. Previous research has identified a variety of factors that influence HPs’ vaccination recommendation behaviors: individual characteristics (e.g., educational level [4,5], working years [4,6,7,8,9], age [10]), knowledge of vaccines [5,8,11], vaccine confidence [12,13], and motivation related to income or economic incentives [5,7,14,15,16]
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