"Communicate to Vaccinate": The Development of a Taxonomy of Communication Interventions to Improve Routine Childhood Vaccination

"Despite the importance of communication to vaccine delivery and uptake we were unable to find any published comprehensive approaches to organising, and therefore understanding, the full range of communication interventions related to childhood vaccination....We aimed to meet this need..."

The Communicate to Vaccinate (COMMVAC) project (see Related Summaries, below) acknowledges the important role of communication in health and aims to clarify and build upon the available evidence of communication interventions to improve vaccination uptake in low- and middle-income countries (LMICs). The project has 6 sub-studies, as outlined in Figure 1 of the paper. The objective of the stage of the COMMVAC project that is described in this paper was to develop a formal taxonomy of communication interventions for routine childhood vaccination [PDF], and this article outlines the organisers' motivations and methods.

The strategy is inspired by the belief that developing a classification system based on conceptual similarities among communication interventions will help to: clarify the key purposes and features of interventions; introduce a common language of communication interventions in the vaccination field; and assist with the conceptualisation of communication as an intervention in its own right.

There were 2 main stages: Stage 1 focused on searching for and selecting interventions; Stage 2 involved developing the taxonomy, consulting on drafts of the work, and finalising the taxonomy. Both stages included a number of key tasks, which are described in detail in the paper. For instance, as one part of the effort to refine the taxonomy, COMMVAC consulted vaccination and communication experts to gather their unique practice perspectives. Organisers presented the initial version of the taxonomy to a range of international stakeholders at deliberative forums, which included two face-to-face consultations and one online forum.

Incorporating the principles of evidence-informed public health and guided by current practice, the taxonomy includes definitions of the 7 main communication purposes; within these categories, the interventions are broken down into 43 types and are also categorised according to their main intended audience: parents or soon-to-be parents; communities, community members or volunteers; and health care providers. Here is a summary of the main overarching "intervention purpose" categories in the taxonomy, with examples of the interventions included in these categories (footnote numbers have been removed from the excerpted material):

1. Inform or educate: "Communication interventions in this category are tailored towards empowering parents and communities to understand the benefit and relevance of vaccination to their health and the health of their family and community....[N]urses or vaccine providers can communicate directly with children about vaccines through methods such as puppet shows. Letters/emails, pamphlets, telephone calls/text messages and face to face interactions are typically targeted towards parents or soon to be parents, whereas television documentaries, immunisation carnivals and media campaigns can be used to disseminate information to entire communities."
2. Remind or recall: "Interventions in this category prompt parents of upcoming or overdue vaccinations through a variety of delivery mechanisms and evolving forms of technology. Letters/emails, telephone calls/text messages, face to face interactions or tools (e.g. fridge magnets) are all mechanisms by which parents can be reminded to have their child vaccinated. Health care providers can also be reminded of due vaccinations at specific health appointments. These reminders usually take the form of chart prompts or alerts at the point of care, thus influencing the parent-provider interaction..."
3. Teach skills: "Parents are taught various skills related to child health such as breast feeding, oral rehydration and general parenting skills. Early childhood vaccination is often an integral component of these programmes, which not only include an educational element but also guidance for parents on how to ensure their child is vaccinated appropriately. Another important feature of this category is interventions aimed at training parents, communities and health care providers in how to communicate or provide education to others. This can include suggestions for how a mother can communicate to her child to reduce stress at vaccination appointments or the training of local health workers in how to educate others."
4. Provide support: "Communication interventions typically described in the literature as providing support to parents are important aspects of vaccination uptake. Their purpose is to provide assistance or advice to parents outside of the traditional consultation environment about vaccination. Support and information exchange between parents via an online chat forum is an example."
5. Facilitate decision-making: "Decision aids are evidence-based tools that prepare consumers to make decisions when confronted with multiple health care options."
6. Enable communication: "This...category...includes interventions that aim to make communication between parents and health care providers possible, specifically in the face of a practical obstacle such as disability or a language difference. For example, the use of interpreters to translate important vaccination messages is a unique intervention type that is more purposeful than simply translating information."
7. Enhance community ownership: "Community participation in all aspects of vaccination programme delivery, planning, research or governance may contribute to building trust among consumers. Community involvement and grassroots support for vaccination programmes may also influence the uptake of vaccination on a community-wide scale. Interventions in this category include: community coalitions charged with overseeing the implementation of vaccination programmes; enlisting local opinion leaders such as village chiefs to serve as vaccination 'champions'; recruiting village members to assist with vaccination programme delivery; or community input into the design of vaccination strategies."

The hope is that the taxonomy will:

• assist both researchers and practitioners in identifying the key purposes of communication interventions by helping them design communication initiatives based on the goal or purpose of the communication, cutting across the myriad different intervention formats and ever-changing forms of communication technology;
• contribute to improving and standardising the description of communication interventions in the vaccination field, thereby improving the information available to vaccination programme managers and to researchers;
• assist in selecting for implementation those interventions shown to be effective, as well as in identifying evidence gaps; and
• facilitate evidence mapping, a method whereby evidence is located and where future research should be conducted to close evidence gaps.

"In addition, the process of developing the taxonomy has identified a number of research questions (e.g. mapping theoretical perspectives of interventions), as discussed in more detail above [in the paper]."