Community insights to identify determinants of zero-dose children in Melanesia: A World Health Organization Behavioural and Social Drivers (BeSD) tool adaptation

• To explore the applicability of WHO’s BeSD tool in identifying barriers to immunisation uptake amongst zero-dose children in Vanuatu, Solomon Islands and PNG. This project will use a human-centred design approach with a range of immunisation stakeholders to identify which elements of the BeSD tool are effective at identifying relevant barriers and the value of adapting these tools, by including additional questions for analysis.
• To identify key barriers to reaching zero-dose and under-immunised children that would help to inform the development of key strategies. 

May 2023 – August 2024

A three-staged human-centred design approach will be implemented with stakeholders. Descriptive qualitative methods will be used to understand the human factors and environmental context that impact the determinants of routine childhood vaccine uptake amongst zero-dose children in the Solomon Islands, Vanuatu and PNG. 

The first step inspiration will include ideation sessions and interviews with key stakeholders to better understand the barriers to routine immunisation in communities with a high proportion of un(der)-vaccinated children. There will be three groups of participants in each country: 1) parents/caregivers and community members; 2) frontline healthcare workers; and 3) senior health management staff. This process will highlight which factors that contribute to zero-dose children are identified by the current BeSD tool and will generate ideas and opportunities for how supplementary tools may assist in gathering additional information. 

The second step ideation will be undertaken independently by the research team, following the initial ideation sessions and focus groups. This step will involve thematic analysis of the data collected and idea generation to develop additional questions to supplement the BeSD tool and capture key factors which impact vaccine uptake among zero-dose children. A prototype of this enhanced tool will be developed during this step for further testing and validation with stakeholders in step three.

The third step implementation will involve the piloting of the prototype of the enhanced tool with representatives from stakeholder groups similar to those previously consulted in step one. Individual interviews will be undertaken to determine if the tool aligns with their perspectives and identifies the factors impacting immunisation uptake amongst zero-dose children within their communities. It is anticipated that as testing of the prototype is undertaken, its content will be reshaped to ensure it meets the required form and function, based on community feedback.

It is anticipated that this project will provide communities with a context-specific tool that can be used to identify key barriers impacting immunisation uptake amongst zero-dose children within the three target areas. The preliminary barriers, identified through the prototype piloting phase, will support ministries of health in targeted areas inform their immediate immunisation strategy development and implementation. Refinement of the WHO BeSD tool to ensure it is applicable to the broader Melanesian context will be used to identify barriers to immunisation uptake in these settings going forward.