Using best-worst scaling to rank factors affecting vaccination demand in northern Nigeria

Sachiko Ozawa; Chizoba Wonodi; Olufemi Babalola; Tukur Ismail; John Bridges

doi:10.1016/j.vaccine.2017.09.079

Using best-worst scaling to rank factors affecting vaccination demand in northern Nigeria

Vaccine. 2017 Nov 7;35(47):6429-6437. doi: 10.1016/j.vaccine.2017.09.079. Epub 2017 Oct 14.

Authors

Sachiko Ozawa¹, Chizoba Wonodi², Olufemi Babalola³, Tukur Ismail⁴, John Bridges⁵

Affiliations

¹ Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: ozawa@unc.edu.
² Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
³ Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁴ Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
⁵ Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

PMID: 29037575
DOI: 10.1016/j.vaccine.2017.09.079

Abstract

Background: Understanding and ranking the reasons for low vaccination uptake among parents in northern Nigeria is critical to implement effective policies to save lives and prevent illnesses. This study applies best-worst scaling (BWS) to rank various factors affecting parents' demand for routine childhood immunization.

Methods: We conducted a household survey in Nahuche, Zamfara State in northern Nigeria. Nearly two hundred parents with children under age five were asked about their views on 16 factors using a BWS technique. These factors focused on known attributes that influence the demand for childhood immunization, which were identified from a literature review and reviewed by a local advisory board. The survey systematically presented parents with subsets of six factors and asked them to choose which they think are the most and least important in decisions to vaccinate children. We used a sequential best-worst analysis with conditional logistic regression to rank factors.

Results: The perception that vaccinating a child makes one a good parent was the most important motivation for parents in northern Nigeria to vaccinate children. Statements related to trust and social norms were ranked higher in importance compared to those that highlighted perceived benefits and risks, healthcare service, vaccine information, or opportunity costs. Fathers ranked trust in the media and views of their leaders to be of greatest importance, whereas mothers placed greater importance on social perceptions and norms. Parents of children without routine immunization ranked their trust in local leaders about vaccines higher in considerations, and the media's views lower, compared to parents with children who received routine immunization.

Conclusions: Framing immunization messages in the context of good parenting and hearing these messages from trusted information sources may motivate parental uptake of childhood vaccines. These results are useful to policymakers to prioritize resources in order to increase awareness and demand for childhood immunization.

Keywords: Best-worst scaling; Immunization; Nigeria; Preferences; Trust; Vaccine.

MeSH terms

Adolescent
Adult
Aged
Child, Preschool
Decision Making / physiology*
Family Characteristics
Female
Humans
Infant
Infant, Newborn
Male
Middle Aged
Nigeria
Patient Acceptance of Health Care / psychology*
Surveys and Questionnaires
Vaccination / psychology*
Vaccination Coverage*
Young Adult