Qualitative assessment of caregiver experiences when navigating childhood immunisation in urban communities in Sierra Leone

Objective To gain in-depth understanding of the caregiver experience when navigating urban immunisation services for their children. Design An exploratory qualitative assessment comprising 16 in-depth interviews using an interpretative phenomenology approach. Setting Caregivers were purposively recruited from slums (n=8) and other urban communities (n=8) in the capital city of Sierra Leone. Participants Caregivers of children ages 6-36 months old who were fully vaccinated (n=8) or undervaccinated (n=8). Results Emotional enablers of vaccination were evident in caregivers' sense of parental obligation to their children while also anticipating reciprocal benefits in children's ability to take care of their parents later in life. Practical enablers were found in the diversity of immunisation reminders, information access, information trust, getting fathers more involved, positive experiences with health workers and postvaccination information sharing in the community. Underlying barriers to childhood vaccination were due to practical constraints such as overcrowding and long waiting times at the clinic, feeling disrespected by health workers, expecting to give money to health workers for free services and fear of serious vaccine side effects. To improve vaccination outcomes, caregivers desired more convenient and positive clinic experiences and deeper community engagement. Conclusions Health system interventions, community engagement and vaccination outreach need to be tailored for urban settings. Vaccine communication efforts may resonate more strongly with caregivers when vaccination is framed both around parental responsibilities to do the right thing for the child and the future benefits to the parent.