Strengthening Capacity for Tailored Immunization Programs Using Adult Learning Principles: A Case Study from Nigeria

Chisom Obi-Jeff; Funmilayo Oguntimehin; Abduljaleel Adejumo; Abdulrahman Ibrahim; Olympus Ade-Banjo; Dan Gadzama; Nicholas Okoli; Chidera Obi; Rachael Olorupo; Ifeyinwa Martins; Amina Usman; Audu Joy; Tanko Chadwafwa; Anthony Onimisi

doi:10.9745/GHSP-D-23-00465

Key Findings

Skilled immunization program managers (PMs) and health care workers (HCWs) are critical for influencing vaccine uptake, which is essential for improving immunization coverage; however, the “training of trainers” (TOT) model used to deliver training neglects the different learnings needs of adults, resulting in reduced program effectiveness.
Adult learning principles (ALPs) were used to design and deliver the TOT for PMs and HCWs on Human-Centered Design for Tailoring Immunization Programs (HCD-TIP).
Three months post-training, data revealed increased vaccine uptake and behavior change in work practices, specifically increased PMs and HCWs’ capacity to engage undervaccinated communities to address barriers to vaccination and co-design people-centered, culturally appropriate, practical, and low-cost solutions to improve vaccination uptake and service delivery.

Key Implications

Program implementers should incorporate ALPs in designing and delivering capacity-building interventions for PMs and HCWs for an effective immunization program.
Policymakers should create policies to integrate behavioral science into immunization programs to address the behavioral and social drivers of vaccine uptake and incorporate HCD approaches when engaging with communities to enhance people-centered, participatory, and data-driven interventions for equitable immunization coverage.

ABSTRACT

Introduction: Nigeria has the highest number of children who have not received any vaccines in Africa. The training-of-trainers (TOT) model used to train program managers (PMs) and health care workers (HCWs) is ineffective for adult learning and limits immunization programs’ success. We incorporated adult learning principles (ALPs) in designing and delivering TOT for immunization PMs and HCWs to use data to engage communities for tailored immunization strategies.

Methods: Our study was implemented in 3 local government areas (LGAs) of the Federal Capital Territory, Nigeria. A training curriculum was developed, integrating ALPs and technical and operational content based on best practices in delivering immunization training and the training needs assessment findings. State PMs (n=10), LGA PMs (n=30), and HCWs (n=42) were trained on the human-centered design for tailoring immunization programs (HCD-TIP) approaches using ALPs. We used interviews and surveys with purposively and conveniently sampled PMs and HCWs, respectively, and observations to assess participants’ satisfaction, knowledge and competence, behavior changes, and results. The interviews were analyzed thematically, and surveys were statistically.

Results: There was a high level of satisfaction with the training among LGA PMs (100%), state PMs (91%), and HCWs (85%), with significant knowledge and competence improvements post-training (P<.001). The trained participants conducted 2 HCD sessions with 24 undervaccinated communities and co-designed 24 prototype solutions for testing. Results showed increased coverage of the pentavalent vaccine first dose (54%) and third dose (188%) across 12 participating communities. Improved community colaboration, communication skills, and data-driven approaches were the most cited behavior changes in practice.

Conclusion: The application of ALPs in training, use of HCD-TIP approaches and tools, and supportive supervision enhanced PMs’ and HCWs’ capacity for tailored interventions. Countries should consider adopting a holistic approach that focuses on using these approaches in immunization programs to strengthen the health system for equitable vaccine coverage.

Received: February 8, 2024.
Accepted: August 20, 2024.
Published: October 29, 2024.

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