Pratibha Kumar’s children returned home from school with a consent form (see below) for her to sign. A cover note from the school accompanied the form informing her that the Department of Health had issued the form and it had to be filled, signed, and returned immediately. No other details were given to her.

Pratibha had never heard of XYZ before, but had heard that some vaccinations were dangerous. Not knowing what to do she called up a few of her friends and asked them what they were doing.

• Some parents said the disease was very dangerous and affected the brain.
• Others said they would check with their paediatrician.
• Others said that there would be no follow up for the booster doses
• Some said the side effects of the vaccinations were dangerous.
• Others felt they were forced to give consent if the child did not have any of the conditions listed in the form.
• Some said they had heard children had fallen ill after the vaccination and had to be rushed to the hospital.

Pratibha was completely bewildered. She did not know whom to believe and was unable to contact her children’s paediatrician. She decided not to give consent and randomly ticked “yes” to item 1 and 6 on the form. However, a nagging doubt persisted about whether she had made the right decision or not. She felt better the next day knowing that others had made the same decision — an article in the local newspapers reported that the vaccination campaign was not a success since many parents had refused to give consent.

Pratibha might have felt better, but for society, failed preventive health initiatives such as vaccination campaigns are a sad but recurrent reality.

WHY DO VACCINATION CAMPAIGNS FAIL?

Why do people refuse to participate in preventive health programs even when the programs are free and conducted at convenient locations? Social scientists, in the 1950’s, developed a list of factors that helped explain preventive health related behaviour. This model known as the Health Belief Model (HBM) provides useful insights that can help us design better preventive health programs and increase the probability that people will participate in them.

People are ready to act if they:

• Believe they are susceptible to the condition (Perceived Susceptibility)
• Believe the condition has serious consequences (Perceived Severity)
• Believe taking action would reduce their susceptibility to the condition or its severity (Perceived Benefits)
• Believe costs of taking action (Perceived Barriers) are outweighed by the benefits
• Are exposed to factors that prompt action (eg, a television ad or a reminder from one’s physician to get a mammogram) (Cues To Action)
• Are confident in their ability to successfully perform an action (Self-Efficacy)

GOOD VACCINATION CAMPAIGNS

Campaigns must begin with the dissemination of information and discussions that engage decision makers like Pratibha, paediatricians, public health specialists, school representatives, and other key opinion leaders.

Pratibha needs to know:

1. How likely is it that her children will develop the disease if not vaccinated against it? Why and to what extent are her children at risk? Does age, where they live, the changing weather, a recent outbreak, etc make them more susceptible? (Perceived Susceptibility)
2. What is XYZ? How severe is it? Is it fatal? What treatments are available? Are the treatments effective? What are the symptoms? How is it spread? (Perceived Severity)
3. How will the vaccination help? How effective is the vaccination? Will the vaccination have side effects? How serious will these be? Is the school equipped to handle any emergency after the vaccination is administered? What precautions need to be taken?

Do the benefits of the vaccination outweigh the risks? What arrangements have been made for the administration of booster doses? (Perceived Barriers and Benefits)

Distribution of consent forms should be one of the last stages of a well-designed program and accompanied by media messages (Cues to Action) that provide Pratibha with the impetus to make a decision. Discussions and information provided beforehand will ensure that she is now confident and capable of making the right decision (Self-Efficacy).

Pratibha Kumar can actively seek out information, arrange discussions groups, ask for advice from experts, and request that she be given more time and information before being asked to make such a crucial decision. The HBM is a useful starting point for her to gauge how much she knows and what is preventing her from making a confident choice.

[Ayesha Gonsalves is a faculty at the Marian Institute of Healthcare Management and can be contacted at ayeshagonsalves@marianinstitute.in]