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Understanding Caregivers' Perceptions of Childhood Immunization Oliver Anyabolu Walden University

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Understanding Caregivers' Perceptions of Childhood Immunization Oliver Anyabolu Walden University Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2016 Understanding Caregivers' Perceptions of Childhood Immunization Oliver Anyabolu Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Epidemiology Commons, and the Public Health Education and Promotion Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Health Sciences This is to certify that the doctoral dissertation by Oliver Anyabolu has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Mary Lou Gutierrez, Committee Chairperson, Public Health Faculty Dr. Patrick Tschida, Committee Member, Public Health Faculty Dr. Jacqueline Fraser, University Reviewer, Public Health Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2016 Abstract Understanding Caregivers’ Perceptions of Childhood Immunization by Oliver Ifeanyi Anyabolu MA, University of Central Oklahoma 1993 BA, University of Central Oklahoma, 1986 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University August 2016 Abstract Low immunization in Nigeria is associated with high prevalence of childhood diseases. The purpose of this qualitative phenomenological study was to describe caregivers’ perceptions of routine immunization of their children ages 24 to 36 months. Caregivers’ attitudes, cultural beliefs, and knowledge regarding immunization were examined. The health belief model was used to guide study. Interviews were conducted with 5 caregivers of fully immunized and 5 caregivers of partially and nonimmunized children. Digital recordings were analyzed using NVivo 10 to identify themes and subthemes. Attitudes of caregivers with fully immunized children included both perceived barriers (distance to health center, lack of information) and perceived benefits (vaccine safety and effectiveness), whereas caregivers with incomplete vaccinations reported multiple transportation-related barriers. Cultural beliefs were limited to religious beliefs and emerged as a theme among both caregiver groups, where full vaccination associated with Christian beliefs and lack of vaccination with belief in traditional healers. Caregivers’ knowledge associated with full vaccination included cues to action (information from nurses and reminders by others) and self-efficacy (kept vaccination cards ready and prepared for vaccination day), and incomplete vaccination associated with lack of reminders and preparation. Perceived severity, susceptibility, and benefits were associated with full vaccination status, while lack of perceived severity, susceptibility, cues to action, and self-efficacy constituted barriers to vaccination. Social change implications include education on disease severity, susceptibility, and vaccination safety, and expanding transportation, access to vaccination centers, and religious outreach programs to increase immunization of Nigerian children. Understanding Caregivers’ Perceptions of Childhood Immunization by Oliver Ifeanyi Anyabolu MA, University of Central Oklahoma, 1993 BA, University of Central Oklahoma, 1986 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University August 2016 Dedication I dedicate this work to my family, especially my wife, Stella, for her great understanding, and emotional and financial support to pursue the doctoral program. Also, for her taking care of my children Andre, Colleen, Oscar, Collins, and Fidel. Special thanks go to my brother, Hillary, who insisted on accomplishing the goal. Finally, I thank the people of Awba Ofemili for their unflinching support to conduct this study. I hope that improvement will occur in health services in Nigeria. Acknowledgments I thank God for the strength and wisdom to carry on this great program and get it completed. My gratitude goes to my dissertation chair, Dr. MaryLou Gutierrez, and my methods advisor, Dr. Patrick Tschida, for their unflinching support to enable me to complete the program. Their perseverance and patience was unlimited. Thanks to Dr. Jacqueline Fraser for serving as my University Research Reviewer. Table of Contents List of Tables ..................................................................................................................... vi List of Figures ................................................................................................................... vii Chapter 1: Introduction to the Study ....................................................................................1 Introduction ....................................................................................................................1 Background of the Study ...............................................................................................1 Government Role in Immunization ...............................................................................6 Literature Gap ................................................................................................................7 Statement of the Problem ...............................................................................................8 Purpose of the Study ......................................................................................................9 Theoretical Framework ..................................................................................................9 Nature of the Study ................................................................................................................. 11 Research Questions ......................................................................................................12 Definitions of Terms ....................................................................................................12 Scope and Delimitations ..............................................................................................13 Limitations ...................................................................................................................14 Assumptions .................................................................................................................14 Significance of the Study .............................................................................................15 Social Change Among Family Caregivers ...................................................................15 Summary and Transition ..............................................................................................15 Chapter 2: Literature Review .............................................................................................17 Introduction ..................................................................................................................17 Literature Search Strategy............................................................................................17 i Anambra State ..............................................................................................................18 Immunization Programs ...............................................................................................20 Community Partnership .........................................................................................20 State and Local Partnerships ..................................................................................21 International Partnerships ......................................................................................23 Health Care Structure of Nigeria ...........................................................................24 State Government Level ........................................................................................26 Tertiary Health Care ..............................................................................................27 Theoretical Foundation ................................................................................................28 Review of Literature ....................................................................................................31 Poor Knowledge of Vaccines.................................................................................31 Education and Immunization Rates .......................................................................35 Misconceptions About the Adverse Effects of Vaccines .......................................36 Traditional Healers and Lack of Vaccine Knowledge ...........................................37 Culture, Beliefs, and Attitudes ...............................................................................38 Poverty as a Cause of Low Immunization .............................................................40 Inadequate Health Facilities and Long Distance ...................................................42 Lack of Cold Chain and Vaccine Supplies ............................................................44 Summary and Transition ..............................................................................................47 Chapter
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