A qualitative interview study with parents to identify barriers and drivers to childhood vaccination and inform public health interventions.

Vaccination coverage in the Federation of Bosnia and Herzegovina, in Bosnia and Herzegovina, has been declining since 2014. This qualitative study aimed to identify barriers and drivers to childhood vaccination for parents. The COM-B (capability-opportunity-motivation-behavior) model was the underpinning theoretical framework. Face-to-face interviews with 22 parents of fully (n = 6), delayed/partially vaccinated (n = 9) and unvaccinated (n = 7) children were conducted. Interviews explored individual factors (capability-knowledge and skills; motivation-attitudes, confidence and trust) and context factors (physical opportunity-information, access, health systems; and social opportunity - social support, norms). Data were analyzed in NVivo using content analysis exploring differences in COM factors by vaccination status and location. Parents of fully vaccinated children typically reported individual and context drivers to vaccination. They accepted vaccination, trusted health workers, and were content with services. Parents of delayed/partially vaccinated children fell into two subgroups: (1) Those who accepted vaccination and attributed delays to their organizational skills or frustration with appointment times. (2) Those fitting the profile of "vaccine hesitant" - generally valuing vaccination and health worker advice, yet with concerns often triggered by media/social media. Parents of unvaccinated children mentioned individual and context barriers to vaccination, notably significant concerns about safety, some distrust of health workers and resentment of mandatory vaccination. Urban/rural differences included urban parents being more likely to report experiences with vaccine shortages and very few had received information leaflets. The study identified complex and inter-related barriers and drivers to parents' childhood vaccination behaviors. These insights have informed the development of tailored interventions to improve coverage.

Identifying barriers and drivers to vaccination: A qualitative interview study with health workers in the Federation of Bosnia and Herzegovina.

BACKGROUND: Vaccination coverage in Bosnia and Herzegovina has been declining over recent years. A World Health Organization Tailoring Immunization Programmes (TIP) project is underway to gain insights into the underlying reasons for this, to develop tailored interventions. As part of TIP, this study aimed to investigate the views of health workers on their barriers and drivers to positive childhood vaccination practices. METHODS: Face-to-face qualitative interviews explored 38 health workers' views on vaccination coverage, their vaccination attitudes, and system, programme and institutional influences on their vaccination practices. The data were analysed using content analysis and organised by the COM (Capability, Opportunity and Motivation) factors. FINDINGS: Very few differences in barriers and drivers were evident between high and low coverage primary care centres or across different professional roles. Capability: Drivers included awareness of the risks of low vaccination coverage, regular use of the Rulebook and Order, knowledge of how to advise parents on mild side effects and recognition of the importance of good communication with parents. Key barriers were the use of false contraindications to postpone vacination and poor skills in tailoring communication with parents. Opportunity: Drivers were sufficient time for adminstering vaccination and good availability of vaccines. Several barriers were evident: lack of implementation of mandatory vaccination, no uniform recall and reminder system or system for detecting under-vaccinated children, staff shortages and lack of time to discuss vaccination with parents. MOTIVATION: Drivers were a belief in the value, safety and effectiveness of vaccination and seeing that they have an important role to play. Barriers were a tendency to blame external factors e.g. anti-vax movement and a fear of being blamed for adverse events. CONCLUSIONS: The study identified complex and inter-related barriers and drivers to health worker positive vaccination practices. These insights will now inform a process to identify and prioritize interventions.

Depressive Symptoms Among Sarajevo University Students: Prevalence and Socio-Demographic Correlations.

OBJECTIVES: The aim of this research was to detect the presence of depressive symptoms among the student population at a Faculty of Medicine, as well to determine the correlation between the socio-demographic characteristics and students' lifestyle and depressive symptoms. SUBJECTS AND METHODS: Of 800 students enrolled and asked to participate, 412 responded to the survey. The study included students from all 6 years of studies. The degree of depressive symptoms was measured by a 21-item revised form of the Beck Depression Inventory (BDI). We built bivariate logistic regression models to study whether age, gender, housing accommodation, year of medical training, and school success status (Grade Point Average - GPA) were associated with depressive symptoms. The results are reported as odds ratios (OR) with 95% confidence intervals (CI). RESULTS: The study revealed that almost one third of students reported BDI >16 (30.1%). The present study did not find any association between BDI scores and study year or age difference, but we found that there was an association between housing accommodation and depressive symptoms. Students who lived with their parents had lower BDI scores than those who lived in a dormitory. The results of this study showed there is a negative correlation between physical activity and depressive symptoms in students, as well as that there is a positive correlation between depressive symptoms and substance abuse. CONCLUSION: Overall, our study confirms that the factors associated with an increase in medical students' depressive symptoms are housing accommodation, a lack of physical activity and substance abuse. Regarding failing a year of study at the medical school, as well as gender and age differences, we did not find any significant difference between students with higher compared to those with lower depressive symptoms.