Determinants of Caregiver Acceptance and Uptake of Newly Introduced Vaccines in Uganda: Insights from the Health Belief and Diffusion of Innovation Frameworks
Abstract:
Uganda introduced new vaccines (Measles-Rubella second
dose [MR2], Inactivated Polio Vaccine second dose [IPV2], Hepatitis B Birth
Dose [HepB-BD], and Yellow Fever [YF]), to strengthen routine immunization.
However, caregiver acceptance and uptake remain uneven across cities and districts.
Understanding behavioural determinants is critical for improving demand. We
examined factors influencing uptake of newly introduced vaccines using the
Health Belief Model (HBM) and the Diffusion of Innovation (DoI) theory. A
mixed-methods study was conducted using Post-Introduction Evaluation (PIE)
caretaker surveys (n = 85) from Six cities and 11 districts, 24 key informant
interviews and eight focus group discussions. Quantitative data were analyzed
using descriptive statistics and multivariate logistic regression to identify
predictors of vaccine uptake. Qualitative data were thematically analyzed and
integrated using the HBM and DoI frameworks. High acceptance was associated
with caregiver vaccine benefits knowledge (OR 2.16, 95% CI 1.32–3.55), trust in
health workers (OR 1.88, 95% CI 1.11–3.17), and perceived susceptibility to
disease. Barriers included misconceptions, side effects fear, long waiting
times, and inconsistent communication. Early adopters of new vaccines were
influenced by strong health worker engagement and timely information flow,
whereas late adopters by social norms, peer reassurance, and community
mobilizers. Qualitative insights highlighted trust, social influence, and
perceived vaccine usefulness as key determinants. Caregiver acceptance of newly
introduced vaccines in Uganda is shaped by health beliefs, perceived benefits,
social influence, and communication pathways. Strengthening behavioural
communication strategies, addressing misconceptions, and enhancing health
worker engagement will improve uptake and reduce inequities in future vaccine
introductions.
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