title: Factors affecting the implementation of childhood vaccination communication strategies in Nigeria: a qualitative study.
abstract: The role of health communication in vaccination programmes cannot be overemphasized: it has contributed significantly to creating and sustaining demand for vaccination services and improving vaccination coverage. In Nigeria, numerous communication approaches have been deployed but these interventions are not without challenges. We therefore aimed to explore factors affecting the delivery of vaccination communication in Nigeria.
  
  
  
  We used a qualitative approach and conducted the study in two states: Bauchi and Cross River States in northern and southern Nigeria respectively. We identified factors affecting the implementation of communication interventions through interviews with relevant stakeholders involved in vaccination communication in the health services. We also reviewed relevant documents. Data generated were transcribed verbatim and analysed using thematic analysis.
  
  
  
  We used the SURE framework to organise the identified factors (barriers and facilitators) affecting vaccination communication delivery. We then grouped these into health systems and community level factors. Some of the commonly reported health system barriers amongst stakeholders interviewed included: funding constraints, human resource factors (health worker shortages, training deficiencies, poor attitude of health workers and vaccination teams), inadequate infrastructure and equipment and weak political will. Community level factors included the attitudes of community stakeholders and of parents and caregivers. We also identified factors that appeared to facilitate communication activities. These included political support, engagement of traditional and religious institutions and the use of organised communication committees.
  
  
  
  Communication activities are a crucial element of immunization programmes. It is therefore important for policy makers and programme managers to understand the barriers and facilitators affecting the delivery of vaccination communication so as to be able to implement communication interventions more effectively.
authors.affiliation: Community Medicine Department, University of Calabar, P.M.B 1115, Calabar Municipality, Cross River State, Nigeria.
authors.forename: Afiong
authors.initials: A
authors.lastname: Oku
authors.affiliation: Community Medicine Department, University of Calabar, P.M.B 1115, Calabar Municipality, Cross River State, Nigeria.
authors.forename: Angela
authors.initials: A
authors.lastname: Oyo-Ita
authors.affiliation: Norwegian Institute of Public Health, Postboks 4404 Nydalen, 0403, Oslo, Norway.
authors.forename: Claire
authors.initials: C
authors.lastname: Glenton
authors.affiliation: Norwegian Institute of Public Health, Postboks 4404 Nydalen, 0403, Oslo, Norway.|Institute of Health and Society, University of Oslo, P.O box 1130, Blindern, 0318, Oslo, Norway.
authors.forename: Atle
authors.initials: A
authors.lastname: Fretheim
authors.affiliation: Sociology Department, University of Calabar, P.M.B 1115, Calabar Municipality, Cross River State, Nigeria.
authors.forename: Glory
authors.initials: G
authors.lastname: Eteng
authors.affiliation: Norwegian Institute of Public Health, Postboks 4404 Nydalen, 0403, Oslo, Norway.
authors.forename: Heather
authors.initials: H
authors.lastname: Ames
authors.affiliation: Departamento de Saúde, Direcção Provincial de Saúde de Nampula, Av. SamoraMachel n° 1016 R/C, C.P. N° 14, Nampula, Mozambique.
authors.forename: Artur
authors.initials: A
authors.lastname: Muloliwa
authors.affiliation: Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Health Sciences 2, Victoria, 3086, Australia.
authors.forename: Jessica
authors.initials: J
authors.lastname: Kaufman
authors.affiliation: Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Health Sciences 2, Victoria, 3086, Australia.
authors.forename: Sophie
authors.initials: S
authors.lastname: Hill
authors.affiliation: Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique.
authors.forename: Julie
authors.initials: J
authors.lastname: Cliff
authors.affiliation: International Union for Health Promotion and Education, 42 Blvd. de la Libération, 95203, St. Denis, Cedex, France.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Cartier
authors.affiliation: Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland.|University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
authors.forename: Xavier
authors.initials: X
authors.lastname: Bosch-Capblanch
authors.affiliation: Evidence-based Healthcare Program, Pontificia Universidad Católica de Chile, Avda. Libertador Bernardo O'Higgins 340, Santiago, Chile.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Rada
authors.affiliation: Norwegian Institute of Public Health, Postboks 4404 Nydalen, 0403, Oslo, Norway. simon.lewin@fhi.no.|Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parowvallei, PO Box 19070, 7505, Tygerberg, South Africa. simon.lewin@fhi.no.
authors.forename: Simon
authors.identifier: 0000-0001-7521-9515
authors.initials: S
authors.lastname: Lewin
mesh_terms: D001291:Attitude of Health Personnel; D017028:Caregivers; D058015:Health Communication / Q000379:methods*; D006280:Health Workforce; D006801:Humans; D009549:Nigeria; D010290:Parents; D011057:Politics; D036301:Qualitative Research; D014611:Vaccination
keywords: Barriers; Communication strategies; Facilitators; Nigeria; Qualitative study; Vaccination