Browsing by Author "Vasudevan, Lavanya"

Abstract

There are over 250 million children in adversity (CIA) globally; however, insufficient information on prevalence of CIA and their daily needs limits case management of this group by social welfare systems. Recently, mobile technology-based (mHealth) systems have been used successfully to extend health services and information to clients in hard-to-reach, under resourced areas. This study aimed to determine the suitability of mHealth systems for improving case management of CIA in Battambang Province, Cambodia.

Methods used included focus group discussions (FGDs), in depth interview and direct observation with government and NGO social workers, their supervisors and street-based CIA (10-17 years). Data on daily workflows, roles, responsibilities and case management activities of social workers were documented. Mobile phone ownership, use and attitudes among social workers were used to assess suitability of an mHealth tool in the Cambodian context. Daily life experiences and case management needs of CIA were documented.

Our data suggests that routine case management of CIA is limited by low capacity of social workers, logistical constraints, a burdensome paper-based data collection system, scanty resources and poor supportive supervision. All social workers participating in the study owned and used mobile phones, and enthusiasm for further incorporation of these devices into daily work activities was high. Street children came from different situations of adversity, were under-served and had diverse case management needs such as referral to vocational programs, early intervention to prevent violence in the home and continuous follow-up.

An mHealth system could be developed to overcome constraints in case management of CIA by streamlining social worker workflows, facilitating timely data collection, and enabling continuous training of social workers. Such a system, implemented in conjunction with other initiatives to strengthen the social welfare system, could promote better case management for CIA in Cambodia, and globally.

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Conclusion

In the United States, there has been over 1,000,000 deaths and more than 90 million cases of COVID-19. As of April 19, 2021, all adults aged 16 and older were eligible to receive vaccination. Nevertheless, young adults are being vaccinated at a slower rate than older adults. The current study aimed to identify potential factors associated with young adult vaccine hesitancy through a mixed methods approach comparing vaccinated and unvaccinated through both a quantitative survey and qualitative in-depth interviews. The survey captured 350 responses from young adults aged 20 to 30 living in four states: California, Mississippi, Oregon and Texas. The online survey differentiated between vaccinated and non-vaccinated individuals and analyzed different aspects of vaccine hesitancy from political trust to COVID-19 vaccine beliefs. Sixteen semi-structured in-depth interviews lasting 20 to 30 minutes were performed on Zoom. The main factors associated with vaccine hesitancy in young adults for both the survey and interviews were social drivers, trust in institutions, barriers to vaccination, perceptions of the vaccine, and COVID-19 vaccine information quality. Study findings will increase understanding of COVID-19 vaccination decision-making pathways of young adults with the purpose of informing future interventions and policy for promoting vaccination rates in young adults.

Background: Routine immunization is the most effective way to prevent mortality from vaccine preventable diseases. Though vaccination coverage rates have improved over the past decade, vaccinations still fail to be delivered and received within a proper timeframe. Across low and middle income countries the median vaccination delay falls between 2.3 to 6.2 weeks for birth through third dose vaccinations [1]. Countries in the African region have 5 to 6 percent lower coverage and face lower timeliness than LMICs overall, and in Tanzania, vaccination delays reach up to 70 percent [1, 2]. This study seeks to investigate the determinants of timely vaccination delivery using two approaches. First, a review is conducted to assess the causes of delayed vaccination in Sub-Saharan Africa (SSA) and, second, an analysis of the Tanzania Demographic and Health Surveys (DHS) data provides evidence of the timeliness factors of concern. Methods: Peer-reviewed literature on vaccination coverage and timeliness in SSA was searched on several databases and was subsequently selected if it pertained to the determinants of vaccination coverage or vaccination timeliness for humans. Pharmacological interventions and vaccine efficacy research was excluded. The literature is rigorously reviewed by classification of determinants into four framework clusters (family characteristics, immunization systems, parental knowledge/ attitudes, and communication and information). The 2015 Tanzania DHS data is used to measure timely immunization. Determinants of fully timely immunization are analyzed through logistic regression. Results: The results of the literature review provided 36 papers on vaccination timeliness and 15 papers on vaccination timeliness. Family characteristics are found to be the major determinants of both vaccination coverage and timeliness appearing 29 and 6 times, respectively. The immunizations system was also found to impact vaccination coverage and vaccination timeliness with 24 and 3 appearances. Our DHS analysis supports these findings, showing statistically significant links between complete timeliness and family characteristics (maternal age, wealth quintile, maternal education, and region) and the immunization system (antenatal care visits and tetanus toxoid vaccine). Conclusions: This investigation finds several family characteristics and the immunization system as determinants of delayed vaccination delivery. Escalating the number of vaccination facilities or health facilities in underserved regions could alleviate disparities found amongst families, as these characteristics are often clustered regionally. Further, action must be taken to improve the immunization system by ensuring availability of vaccines everywhere, good vaccine management, and adequate staff. Understanding the causes of poor vaccination timeliness is crucial in efforts to improve problems and provide timely vaccination to prevent child mortality.

Background: Vaccine hesitancy is driven by various contextual, group, and individual determinants and vaccine-specific factors. Vaccine hesitancy acts as a barrier to childhood vaccination. While literature suggests narrative communication may be influential towards promoting health behavior, there is a gap in understanding how narrative communication approaches can be utilized to support parent-provider conversations around childhood vaccines. The objectives of this study were to: (1) Conduct secondary analysis of in-depth interview data from parents and providers to identify commonalities within the decision-making process for parents making vaccine choices for their children and determine aspects of priority for providers when engaging in vaccine communication. (2) Develop fictional narratives that represent the four distinct parental positions on childhood vaccination (unquestioning acceptors, cautious acceptors, go along to get along, late/selective vaccinators, and refusers) (3) Assess the feasibility and acceptability of the fictional narratives to guide parent-provider communications related to childhood vaccines. Methods: This study conducted a secondary data analysis from the study Development and Testing of ADEPT: A Parent Decision Support for Childhood Vaccinations (ADEPT) by Vasudevan et al. Additionally, we recruited parents and healthcare providers to conduct interviews via zoom. We developed four fictional narratives, by aggregating stories from healthcare providers currently administering childhood vaccines, and parents of young children, that followed a range of mothers making vaccine decisions and their varying concerns. In-depth interviews with vaccine-hesitant and nonvaccine-hesitant parents provided feedback on the acceptability and feasibility of these narratives. Results: 5 healthcare providers and 12 parents with children 3-6 years of age we interviewed. Parents with shared decisions to accept, refuse or delay vaccines describe similar factors influencing their decision such as family experiences and vaccine-specific concerns. Healthcare providers’ steps in vaccine conversation first address parent concerns, create a trusting environment and provide a strong recommendation. Parents chose none, one, or multiple narratives they resonated with, and there was no relationship between vaccine decision-making history and the parental position represented in the narrative. Conclusions: The results suggest that the providers approach vaccine conversation by understanding parents' perspectives and providing a solid recommendation. A multitude of factors influences parents' vaccine decisions. This study suggests the use of narrative in the distribution of healthcare information, and further research can further validate the narratives and refine them for broader use.