Evaluation of the Impact of the Communication Campaign on Immunization - Communication for Behavioral Impact (COMBI) in Georgia

This 404-page report details the results of an evaluation of "Timely Immunization is your Child's Bodyguard", a yearlong behaviour change communication (BCC) campaign launched nationwide in the Republic of Georgia in February 2007 by the Ministry of Labour, Health and Social Affairs in collaboration with the Ministry of Education and Science and with the support of the United Nations Children's Fund (UNICEF)/Georgia. The aim of the campaign was to improve the timely immunisation coverage of the children aged under 1 year by urging mothers to adhere to the national immunisation calendar (the ages of 2,3,4 months).

As detailed here, a study conducted in 2006 by UNICEF among the population of Georgia regarding knowledge levels related to immunisation-related practice and behaviour revealed that knowledge about controllable infections was quite low among parents (29.3% of respondents did not have information regarding diseases such as diphtheria, pertussis, tetanus (DPT), poliomyelitis, and hepatitis). The situation among ethnic Armenian respondents was found to be the most dramatic (58% did not know). Knowledge about the dates for conducting vaccination was also low: 62% of the population did not know when to conduct vaccination for DPT and Hepatitis B, and 59% did not know when to conduct vaccination for poliomyelitis. Only 58% of parents living in Georgia and 35% of Azerbaijani parents considered it necessary to ensure timeliness of vaccination themselves. The perception of security of vaccination against controllable diseases among the Georgian population was quite high, though only 58% of ethnic Azerbaijani population considered vaccination safe. Also, the research uncovered lingering problems that hinder total coverage of the child sector through preventive vaccination. For example, there are cases of parents' refusal to consent to preventive vaccination of their children, and "some of the medical workers' absolutely non-motivated and incomprehensible negative attitude towards vaccination are especially damaging." Furthermore, a so-called "communication crisis" was found to exist, calling for intensive implementation of communication and social mobilisation from the government's side by using effective modern technologies.

To overcome these gaps and problems, the "Timely Immunization is your Child's Bodyguard" campaign focused on the shift of mothers' attitudes. It covered the following spheres: advocacy, awareness-raising, advertising via mass media, personal communication, school-centred initiatives, and mobilisation of the private sector.

In order to estimate the effectiveness and results of the campaign, a marketing and research firm was commissioned to conduct research throughout all regions of Georgia in February and March of 2008. Key research results are outlined in the report along the lines of the following issues: medical registrations; attitudes toward vaccination and, more concretely, the significance of timely vaccination and safety; the awareness of diseases being covered by vaccinations; parental behaviour regarding timely immunisation; and effectiveness of various communication channels. Selected communication-related findings include:

• Registration: The population of children under the age 1 not having civic registration diminished by 3% from 2007-2008. The report notes that that the number of children registered by medical personnel during home visits increased in 2008, signifying "the activeness of medical personnel through campaign, which partly was motivated by doctors' motivation during campaign as a result of encouraging arrangements."
• Awareness: The awareness of controllable infections diseases, overall, if compared with 2007, has increased by 17.7%.
• Perception of immunisation: The percentage of parents who consider vaccination to be unnecessary diminished by 5.8% (2007 to 2008).
• Trust of vaccination: This increased by 21.6% compared with past years and is 82.5%. The fear of post-vaccination complication diminished by 6.3% compared with past years.
• Trust of medical personnel and the perception of the mothers role: The research makes clear increased trust of nurses and doctors, as well as increased responsibility on the part of parents with regard to correctly carrying out the immunisation process. One indicator: The role of medical personnel as information sources for infectious diseases has increased in Georgia - now reaching 13% (doctors), 6.6% (nurses), and dispensaries/policlinics and other medical personnel (1.7%). This fact is reflected in the frequency of contact of mothers with medical personnel compared with past years.
• Parents' actions towards timely immunisation: The research showed a possible shift in mothers' positive attitudes. One finding: Armenian children's correct DPT vaccination timing level increased by 10%, polyomyelitis vaccination total coverage increased by 11.2%, and Hepatitis B by 17.5%.
• Effectiveness of various communication channels used through the campaign: "The most effective source of information regarding immunization is face to face communication with a doctor (doctors, communicational conversations, family members, parents, relatives) as well as TV programs, TV advertisements, books, immunization calenders and medical books..."

In conclusion, the report notes that "Timely Immunization is your Child's Bodyguard" communication campaign "generally should be considered to be successful." As a result of the activities that were conducted, there was an average increase of 16% vaccination coverage on the 3 targeted antigens (DPT, oral polio vaccine (OPV), and hepatitis B). The increase was noted throughout the entirety of Georgia - that is, it included ethnic minorities. "The successful, indirect result of the campaign is the increase of the coverage of the targeted antigens nationwide among the children aged under 1 year: the coverage of DPT3 is increased by 10.5% and OPV3 in 0.2% in comparison to the last year (data provided by the national centre for disease control and social healthcare)." The report notes that the increase in timely immunisation is due to the adequate behaviour of mothers, which is sparked by: an increase in positive attitudes towards immunisation and improvement of knowledge of infectious diseases by an average of 17.7%; the necessity of vaccination by 4%; and increase of trust about the safety of vaccination by 21.6%.

Communication-related recommendations offered include:

• Considering that so many mothers cite television as their information source, this media means should become a stronger lever for distribution of positive information on immunisation.
• Because every 6th-questioned mother does not consider immunisation to be safe, it is necessary that the benefits of vaccination and distinct identification of risks be identified, as well as safety of vaccination.
• The media - e.g., a TV advertisement - should be more focused on giving the preventive signals (alarming - for instance: "Please, define how many days do you have left for vaccination of your child, do not leave your child unprotected"), than on passing along detailed information. The necessity of distributing deep information is undoubtable, and different channels should be used for this. More specifically, according to the survey results, the role of a doctor in communication on immunisation is unique.
• "The role of media is not visible in ethnic minorities. Thus, the local media should be used for informing about the campaign..."
• Medical personnel need communication-specific trainings, in addition to thematic information, in order to raise the public's degree of trust in broadcasted information on immunisation.

Please contact Maya Kurtsikidze (see below) to inquire about access to the full document in MS Word format.