KAP studies - understanding barriers to immunization

Transmission of wild poliovirus in the endemic regions of northern Nigeria; Bihar and Uttar Pradesh, India; and cross-border areas of Afghanistan and Pakistan persists simply because children have not been immunized with a sufficient number of doses of oral polio vaccine (OPV) to stop virus circulation.

Although the primary reasons for ongoing vaccination coverage gaps are operational, as indicated by independent monitoring data of supplementary immunization activities (SIAs), increasing community engagement and acceptance of vaccination services can improve coverage and remains a key cornerstone of SIA micro-planning.

Periodic knowledge, attitude and practice (KAP) studies serve as an educational diagnosis of a population or community and are an important way to measure changing beliefs and behaviours over time. Information from KAP studies, when guided by insights from health communication theory, provides formative insights and baseline data. This information helps programmes set communication objectives linked to increased community engagement and demand for vaccination services and develop tailored strategies appropriate for the social, cultural and political contexts of at-risk communities.

Information on where and when caregivers receive information, whether parents perceive polio as a threat to their children or why communities may reject immunization services allow countries to develop messaging and communication strategies to overcome specific programme challenges. When tracked over time, the impact of these strategies towards meeting communication objectives can be measured and evaluated and strategies tailored as necessary. Data from KAP studies and other forms of social research is an important element of the programme that ensures a data-driven, evidence-based approach to communication for polio eradication.

In the last quarter of 2008, KAP studies were planned for Nigeria, Pakistan and India. Afghanistan will conduct a new study in early 2009. Each of the studies will be invaluable to identifying trends and changes in communities, measuring impact of social interventions and to guiding communications planning in 2009 and beyond.

Information from studies conducted in Pakistan and India in 2007 shows the impact of
communication interventions.

For example, in Pakistan, communication activities including interpersonal dialogue and sustained electronic media increased the number of caregivers who saw polio as a threat to 94%, up from 75% in 2005, while 95% of those surveyed now see polio as a health priority for the country compared to only 76% reported in the earlier study. India’s «Underserved Strategy» which focuses on sensitizing minority or underserved populations, especially large Muslim communities in Bihar and Uttar Pradesh, continues to help support the improvement of vaccination coverage and has built ownership and participation from local religious leaders and scholars.

Social research, which includes KAP studies and other activities such as focus groups, community dialogues and in-depth discussions with members of communities, has become a cornerstone for communication planners of polio eradication activities. Similarly, this data has increasingly been applied to help develop tailored eradication tactics to overcome the remaining operational challenges which continue to affect the quality of polio SIAs at country-level.

For those with a special interest in polio communications, “stay tuned” for the results of these important studies in future editions of the Polio pipeline.