Our experts supported a major UN client to understand the impact of interpersonal communication and motivational interviewing on timely immunization uptake among children in selected counties and localities.

The client is a major UN institution that works in 190 countries to reach the most disadvantaged children and adolescents, the Ministry of Health and Directorates of Public Health.

Countries worldwide are confronted with low vaccination uptakes. The low vaccination rates can be attributed to a broad range of factors: stockouts, lack of data on unvaccinated children, lack of information, migration of families with children. The decision by caregivers to refuse or delay vaccinations for their children is one-factor affecting vaccination coverage. It is strongly connected to the availability of information about immunization, its benefits, side effects, and interaction between caregivers and health workers.

Motivational interviewing (MI) is an example of a brief behavioral counseling intervention that improves the interpersonal communication (IPC) skills of health care workers (HCWs). IPC skills enable HCW to engage with caregivers to encourage timely uptake of recommended vaccines, with the ultimate goal of changing knowledge, attitude, and practices of caregivers towards immunizations. MI and other IPC techniques have been used successfully to encourage uptake of various health behaviors and improve the interaction between HCWs and caregivers by encouraging active listening and providing feedback to caregivers’ concerns (2-4). The interventions aimed at teaching hospital, primary and community-based health care workers how to initiate and maintain conversations with new mothers about vaccination and teach community-based mobilizers how to approach caregivers who defaulted on childhood vaccination visits. The goal of these conversations will be to deliver information about vaccines, probe for vaccine hesitancy, address concerns, and establish a personal relationship with the caregiver.

The client wanted to know whether the MI training produces any changes in the HCPs, caregivers’ behavior, and ultimately vaccination uptake.

To evaluate the impact of MI training on HCPs, caregivers’ behavior, and ultimately on vaccination uptake, HDI Group designed and implemented a 3-year impact evaluation. Briefly, we considered the difference in difference (DiD) method. In a DiD design, we will be collecting data on all the eligible units of the reference population: those who will enroll in the program (whether finally participating or not). To minimize bias associated with assuming that the treatment group would have experienced any changes in the control group’s outcome in the absence of the MI intervention, we will consider either randomization or propensity score matching. Propensity score matching groups individuals based on their likelihood to participate in the project training. Hence, this will account for extraneous factors that may influence the outcome of interest. For this purpose, registry data, semi-structured surveys on Knowledge, Attitudes, and Practices, in-depth interviews, and vignettes will be used with caregivers and HCWs.

This study is ongoing.