Jessica Kaufman
Heather Ames
Xavier Bosch-Capblanch
Yuri Cartier
Julie Cliff
Claire Glenton
Simon Lewin
Artur Manuel Muloliwa
Afiong Oku
Angela Oyo-Ita
Gabriel Rada
Sophie Hill
Publication Date
May 10, 2017

School of Psychology and Public Health, La Trobe University (Kaufman); Norwegian Institute of Public Health (Ames); Swiss Tropical and Public Health Institute (Bosch-Capblanch); University of Basel (Bosch-Capblanch); International Union for Health Promotion and Education (Cartier); Eduardo Mondlane University (Cliff); Norwegian Institute of Public Health (Glenton, Lewin); South African Medical Research Council (Lewin); Provincial Directorate of Health (Muloliwa); University of Calabar (Oku); Pontifical Catholic University of Chile (Rada, Hill)

"Without a comprehensive framework integrating communication interventions from routine and campaign contexts, it is not possible to conceptualise the full range of possible vaccination communication interventions. Therefore, vaccine programme managers may be unaware of potential communication options and researchers may not focus on building evidence for interventions used in practice."

This paper from the Communicate to Vaccinate (COMMVAC) project broadens the scope of its previously published taxonomy of communication interventions for routine vaccination (see Related Summaries, below) to include communication used in large-scale vaccination campaigns such as supplementary immunisation activities (SIAs), integrating these into a comprehensive taxonomy of vaccination communication interventions for any vaccine context. This taxonomy provides a standardised way to think and speak about vaccination communication. It can be utilised by programme planners, implementers, researchers, and funders to see the range of communication interventions used in practice, facilitate evidence synthesis, and identify evidence gaps. "By presenting communication in terms of purpose, the taxonomy encourages people to view communication options through a problem-solving lens, mapping context-specific barriers to intervention purposes."

The researchers extracted vaccination campaign communication intervention descriptions from 3 sources: a targeted literature search of vaccination campaign descriptions; primary observation of vaccination communication in 3 countries (Cameroon, Mozambique, and Nigeria); and consultation with low- or middle-income country (LMIC) vaccination stakeholders and experts. The taxonomy is categorised by purpose to help conceptualise communication interventions used in campaigns and routine childhood vaccination as potential solutions to address needs or problems. Table 1 in the paper [PDF] details the 7 purpose categories, with examples, which are:

  1. Inform or Educate: Interventions to enable people to understand the meaning and relevance of vaccination to their health and the health of their family or community. Interventions may be tailored to particular populations and can also serve to address misinformation. Examples include interpersonal communication, printed material, phone- or web-based communication, community events, school curriculum, edutainment performances, mass media advertising, and messages delivered by celebrity spokespeople.
  2. Remind or Recall: interventions to remind consumers of required vaccinations and to recall those who are overdue - for example, vaccination cards, printed mugs, t-shirts, magnets, or calendars.
  3. Enhance Community Ownership: Interventions to increase community participation and promote interaction between the community and health services. Interventions may build trust among consumers and generate awareness and understanding of vaccination. Interventions of this nature embrace community involvement in planning, programme delivery, research, social mobilisation, advocacy, or governance. One example would be vaccine organisers forming partnerships with local businesses, religious centres, or community organisations.
  4. Teach Skills: Interventions focusing on the acquisition of skills related to accessing vaccination services and communicating about vaccination. Such interventions aim to teach parents early parenting skills such as how to find, access, and utilise vaccination services. They also include interventions to train parents, communities, and health care providers on how to communicate or provide vaccination-related education to others.
  5. Provide Support: Interventions, often tailored or personalised, to assist people in addressing specific challenges to vaccination that arise within their day-to-day lives (e.g., social issues such as disagreement within a family regarding vaccinating or emotional issues such as parental anxiety about vaccination). Examples of tools include online forums, social media, and websites.
  6. Facilitate Decision Making: Interventions that extend beyond informing or educating by presenting all options related to vaccination decision-making in an unbiased and impartial manner. These interventions should explain the decision to be made, provide detailed, evidence-based information about the risks and benefits of vaccination, and help people consider their personal values and options related to the decision to vaccinate their child. Examples include: written or interactive decision aid tools presenting all options and aspects of vaccination decisions; and decision coaching (face to face interactions, one on one or in groups).
  7. Enable Communication: Interventions that explicitly and purposefully aim to bridge a communication gap/make communication possible with particular people or groups. This may include translation beyond routine practice in a particular setting, such as translation into local or minority languages, adaptation of materials for a low- or no-literacy population, translation into Braille, or the use of interpreters.

The comprehensive taxonomy reflects the multi-directional nature of communication. As a supplemental exploration of the varied actors and channels involved in campaigns, the researchers developed a visual map to illustrate a small selection of these complex interactions (see above and Figure 2 in the text).

The researchers explain that a single intervention may include printed material to inform or educate as well as a face-to-face session intended to teach skills, or a postcard may include vaccine information as well as a reminder about an upcoming campaign. These examples could be appropriately categorised into more than one purpose or intervention type. Thus, the aim of the taxonomy is not to create wholly exclusive categories but, rather, to help conceptualise communication interventions as a range of potential solutions to address needs or problems. It is also important to acknowledge that communication strategies do not need to address all purposes at all times, and the taxonomy is not itself a "menu" of options that are all of equal effectiveness and appropriateness.

They go on to make observations about the differences and similarities between communication in campaigns and communication for routine vaccination, as well as the ways in which the taxonomy may be utilised, as identified by the international experts consulted at a September 2015 Paris, France workshop. In brief, they note that campaigns take a more multi-faceted approach to communication design and delivery than routine vaccination communication. In part, this may be due to the fact that communication and social mobilisation efforts tend to be allocated more resources in campaigns. "But while they may face resource limitations, routine vaccination communication programmes can apply lessons and concepts from campaigns on a smaller scale, such as encouraging community involvement and promoting two-way input and feedback. In the interventions we identified, communication involving community engagement tended to be more common in campaigns than in routine vaccination....Given that peer-to-peer communication and other health initiatives aimed at communities can influence social norms and behaviour..., such interventions may be a valuable approach for routine vaccination in both LMICs and HICs [high-income countries] to address issues like vaccine hesitancy or pockets of resistance..."


BMC Public Health (2017) 17:423. DOI 10.1186/s12889-017-4320-x