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"The TIP approach is an adaptable, people-centred approach to immunization programmes, engaging individuals and communities in shaping how vaccination services are provided, in order to achieve and sustain high immunization coverage in the WHO European Region."

Although the World Health Organization (WHO) recommends seasonal influenza vaccination of pregnant women to protect them and their newborn babies from infection and despite widespread national policies that support this, maternal influenza vaccination uptake remains low in most of the WHO European Region. In response, the WHO Regional Office for Europe has developed an approach - tailoring immunisation programmes for seasonal influenza (TIP FLU) - founded on health promotion planning models and social and behavioural insights to design evidence-informed solutions to increase uptake of maternal influenza vaccination among pregnant women. (See also Related Summaries, below.) This publication offers information and concepts on which TIP FLU is founded (part one) and a step-by-step guide (part two), so that health professionals working on maternal influenza vaccination programmes can apply the approach.

TIP and TIP FLU build on an understanding of the behavioural, social, and environmental factors that influence vaccination behaviours and demand in a given context and on health promotion planning models. This guide provides information and resources through multiple steps to:

  1. identify, prioritise, and describe intended populations for vaccination interventions;
  2. diagnose the demand- and supply-side barriers and facilitators for vaccination among these populations and those who influence them;
  3. design evidence-based interventions tailored to the specific vaccine, context and characteristics of these populations; and
  4. deliver, monitor, and evaluate the interventions aimed to increase uptake of influenza vaccination among pregnant women.

As detailed here, implementing the TIP FLU approach requires the application of knowledge and skills from multiple disciplines, including public health, social and behavioural sciences, communication, epidemiology, and medicine. Engaging multiple stakeholders from diverse institutions or different departments is also necessary. Stakeholders may include representatives of the health ministry, national health insurance bodies, public health institutions, health care facilities, professional associations, academia, civil society organisations, communications agencies, the media and different socio-cultural or ethnic communities, and family members. WHO suggests that a multidisciplinary working group be established that includes a person with expertise in social marketing or social and behavioural change to help design TIP FLU interventions is advantageous. "A well- functioning working group will help to maintain partners' commitment and participation in the TIP FLU interventions and contribute to sustainable behaviour change."

Table of contents:

  • Importance of maternal vaccination
  • The TIP and TIP FLU approach
  • Implementation requirements
  • Intended audience
  • Using this publication

Part one. Background information and concepts for TIP FLU

  • Influenza in pregnant women and newborns
    • Maternal influenza vaccination
  • Considerations for promotion of maternal influenza vaccination
    • Influenza vaccine effectiveness
    • New target groups: new providers and new recipients of seasonal influenza vaccination
    • Determinants of acceptance and uptake of maternal influenza vaccination
  • Concepts and frameworks that TIP FLU applies
    • Health promotion
    • Behaviour change
    • Social marketing
  • The socioecological model - understanding the determinants of maternal influenza vaccination

Part two. Implementing TIP FLU for pregnant women step-by-step

  • Objective 1: Describe the situation, target groups and partners to involve
    • Step 1. Decide the scope of TIP FLU
    • Step 2. Review the situation
    • Step 3. Analyse the situation
    • Step 4. Write a preliminary problem statement
  • Objective 2: Diagnose the demand- and supply-side facilitators and barriers
    • Step 5. Collect new information
    • Step 6. Describe the main target populations and the determinants of their behaviours
    • Step 7. Complete the problem statement with a behavioural analysis
  • Objective 3: Design evidence informed interventions to promote maternal influenza vaccination
    • Step 8. Set the TIP FLU objectives
    • Step 9. Use the social marketing framework to design TIP FLU interventions
    • Step 10. Develop the TIP FLU communications strategy, messages and materials
  • Objective 4: Deliver, monitor and evaluate TIP FLU interventions
    • Step 11. Deliver, monitor and evaluate the TIP FLU interventions


Annex 1. Semi-structured interview guide to gather information on health care providers
Annex 2. Focus group discussion guide to gather information on pregnant women
Annex 3. Sample survey questionnaire on influenza vaccination during pregnancy
Annex 4. Sample pretest questions for communications materials
Annex 5. List of possible outcome indicators

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Posting by Alma Sokolovic-Rasmussen to the Immunize Europe Forum, December 19 2017 and WHO Regional Offfice for Europe website - both accessed on January 8 2018. Image credit: WHO/Europe on Twitter