The Impact of Trust & Patient-Centered Care on Vaccination Rates in Kenya

Despite the importance of vaccination in preventing disease outbreaks, vaccination rates have faced challenges globally, and this has been exacerbated by the COVID-19 pandemic. In Kenya, where healthcare access and trust can vary widely, understanding the factors that influence vaccination is vital. A recent study funded through our Social and Behavioral Research Grants program highlights how trust in health workers and patient-centered care can facilitate increased uptake of routine vaccination.
Historically, vaccination efforts in Kenya have been robust, with programs aimed at eradicating diseases like polio and measles. However, vaccine hesitancy has been a growing concern, particularly during the COVID-19 pandemic. In this study, 13.5% of the children were found to be under-vaccinated, with the highest rates observed during the later stages of the COVID-19 pandemic. Disruptions caused by the pandemic, including misinformation and healthcare access issues, have highlighted the need for strategies to maintain and improve vaccination coverage.
To that end, researchers conducted a cross-sectional study to investigate the factors affecting uptake of vaccination in Kenyan children born between 2017 and 2022. The research team created a survey tool based on the World Health Organization’s Behavioral and Social Drivers of Vaccination framework. From April to July 2022, the team reached out to mothers from Kiambu and Nairobi counties who gave birth during the study period (2017-2022) and invited them into the study. Of the 1251 mothers contacted, 846 agreed to participate in the study and completed the survey.
Contributing Factors to Vaccine Hesitancy
Vaccine Attitudes
The survey included 13 questions on vaccine beliefs and attitudes, and more than half of respondents were worried about serious side effects from childhood vaccines. Mothers who agreed with some of the statements related to vaccine confidence (“If I vaccinate my child, he/she may have serious side effects” and “Children receive too many vaccines”) were more likely to have missed a vaccine dose than mothers who did not agree to these statements.
Social Norms
Social norms were assessed through statements regarding the community’s views on vaccination. Mothers who felt that health providers viewed vaccination favorably were less likely to have under-vaccinated children.
Trust in Health Workers
Trust in health care providers was measured using a validated scale, and the study revealed that higher trust in health workers correlated with lower odds of children missing or delaying vaccinations. Trust was identified as a crucial factor, with mothers who had high trust in their healthcare providers being significantly more likely to ensure their children were vaccinated on time.
Patient-Centered Care
The quality of care was measured using the Person-Centered Maternity Care Scale. Mothers who reported higher levels of patient-centered care had children with better vaccination outcomes. Elements such as being treated with respect, receiving clear explanations, and feeling involved in vaccination decisions were associated with higher uptake of on-time vaccination.
Policy Implications
The study suggests several policy actions to improve vaccination rates:
- Enhance training: Equip healthcare workers with skills to address vaccine safety concerns effectively.
- Build trust: Develop programs aimed at building and maintaining trust in health care providers.
- Improve quality care: Ensure vaccination services are patient-centered, focusing on respect, clear communication, and involvement in care decisions.
This study highlights the critical role of trust in health care workers and patient-centered care in facilitating uptake of vaccination, findings which have implications far beyond Kenya.
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