When a Toolkit Is Not Enough: A Review on What Is Needed to Promote the Use and Uptake of Immunization-Related Resources

"Practitioners can use the characteristics and factors identified in this article to develop context-specific strategies to ensure optimal uptake and use of resources and to evaluate existing resources for use."

Global immunisation stakeholders have developed evidence-based resources - including toolkits, guidance, and capacity-building materials - that can be used to ensure routine immunisation programmes are implemented effectively and equitably to meet their objectives. These resources can help spread information, change or improve behaviours, or build capacity. Recognising the challenges associated with implementing an evidence-based resource in practice, the MOMENTUM Routine Immunization Transformation and Equity project partnered with the Measurement, Adaptive Learning, and Knowledge Management Lab (MAKLab) to identify common barriers to and best practices for resource implementation. This article describes the process that the MOMENTUM projects followed to extract relevant findings for use in practice and the key learnings generated through this process.

The activity team consisted of 5 individuals from MAKLab, who led information collection and analysis, and 2 individuals from the MOMENTUM Routine Immunization Transformation and Equity Project, who provided expert input. They conducted a targeted narrative review and synthesis and key informant interviews to identify practice-based learning, including the characteristics and factors that promote uptake and use of immunisation-related resources in low- and middle-income countries (LMICs) and practical strategies to evaluate existing resources and promote resource use.

Fifteen characteristics or factors to consider when designing, choosing, or implementing a resource were identified through the narrative review and interviews. Characteristics of the resource associated with improved uptake and use include ease of use, value added, effectiveness, and adaptability. For example, resources should not only be in a language familiar to the end user but also include simple, concise, and clear wording to improve retention and understanding of the resource. Review findings also suggest resources should be designed to be adaptable with local input so end users can modify information based on their level of knowledge, experience, needs, and environments. For example, a feasibility study of the World Health Organization antimicrobial stewardship resource found that the ability to adapt the resource to reflect local antimicrobial resistance surveillance data patterns and the local context supported implementation of the resource.

Factors that may support resource implementation include training, buy-in, messaging and communication, human resources, funding, infrastructure, team culture, leadership support, data systems, political commitment, and partnerships. For instance, the review revealed that effective communication about the resource is critical to ensure user buy-in, promote a positive team culture, and secure finances to support resource use. Thus, to promote uptake and use, it may be helpful to include additional information related to communication - including key messages for different audiences - within the resource. Findings suggest that creating linkages between communities, private sector organisations, and local nonprofit organisations can help support essential components of resource implementation, such as gaining community buy-in for routine immunisation programmes.

Findings were generated using primarily immunisation-related resources, but, per the researchers, lessons may be applicable in other sectors within global and public health that use resources. The literature suggests a need for improved resource implementation beyond the immunisation sphere.

In conclusion: "Global health practitioners who use toolkits, guidance, and other capacity-building materials to support programmatic goals should consider whether the resource or the context in which it is being implemented supports its uptake and use."