Community-Based Participatory Research (CBPR) Approaches in Vaccination Promotion: A Scoping Review

"CBPR approaches are recommended for future vaccination promotion programmes, involving community stakeholders and research professionals, to ensure equitable access to vaccinations across diverse populations."

Community-based participatory research (CBPR) is a collaborative research approach that engages academic researchers and community stakeholders as equal partners in all research steps to address community concerns and achieve health equity. The CBPR approach has been widely used in vaccination promotion programmes. However, owing to the lack of unified theoretical guidance of CBPR approach in vaccination promotion, substantial discrepancy in practical application has emerged among various CBPR programmes. The purpose of this scoping review was to synthesise the elements and steps and to establish an implementation framework to guide the utilisation of CBPR approaches in vaccination promotion.

The researchers conducted a systematic search on a set of electronic databases and grey literature sources. They screened the retrieved articles according to the criteria of CBPR and vaccination promotion, extracted and recorded the data, used a narrative summary in categorising characteristics, and summarised the contents of the included studies through qualitative analysis.

A total of 8,557 publications were initially screened, and 23 articles were finally included in the review. The studies were conducted in the United States (n = 14),  Nigeria (n = 3), Pakistan (n = 2), Peru (n = 2), India (n = 1), and Kenya (n = 1). The studies were performed in various designs and included studies focused on multiple types of vaccines.

A widely used conceptual model of CBPR was used in the formulation of a CBPR-based implementation framework for vaccination promotion, which contained four domains: context, partnership dynamics, research, and intervention and outcome. As the studies included in the scoping review did not provide sufficient information about the context of vaccination promotion programmes, this scoping review only focused on the other three domains to summarise the application of CBPR approaches.

According to the CBPR conceptual model, the four components of the CBPR approach specifically for vaccination promotion included:
 

1. The establishment of community-academic partnership (CAPs) - A CAP was established between academic researchers or institutes and eight types of partners, including community-service-organisation-related non-government organisations (NGOs), health-service-institution-related NGOs, religious organisations, government agencies, educational institutions, media agencies, business agencies, and community representatives. The maintenance of CAP was achieved with four key strategies:  strengthening communication, forming management groups, sharing resources and information, and providing incentives.
2. Community capacity building by partner training vaccination knowledge, research literacy, and service abilities and skills - Table 2 in the paper summarises the contents of the training materials for community partners. The contents focused on four aspects: relevant knowledge of vaccination, research project introduction, research literacy and skills, and service capacities and skills.
3. Development and implementation of community-based intervention - Twelve studies provided comprehensive insights into the strategies employed for intervention development, utilising either quantitative surveys, qualitative methods, or a combination of both approaches. Table 3 in the paper shows the contents of the community-based interventions. The studies described seven strategies: Health service support was the most frequently used strategy (n = 19), followed by follow-ups and home visits (n = 15), health education activities (n = 12), social marketing campaigns and community mobilisation (n = 9), interactive discussions (n = 9), vaccination reminders (n = 7), and financial or material incentives (n = 5). The included studies adopted various approaches to deliver interventions; most interventions used a face-to-face delivery modality with various methods, such as group discussion and one-to-one interaction.
4. Outcome evaluation - Vaccination rate and the effectiveness of interventions were assessed. A considerable increase was observed in 95.7% of the included studies, and the highest increase (92.9%) was attained after the intervention. Nine studies highlighted the potential of CBPR-based interventions in mitigating immunisation disparities through improving vaccination rates or expanding coverage within the vaccinated population. Three of them explicitly stated the objective of reducing health disparities associated with vaccination among high-risk underserved populations.

Based on the three domains of the CBPR conceptual model, four components of the CBPR approach, and evidence summarised above, an implementation framework was developed (see Figure 4, above), which refines the elements and steps of a CBPR approach for vaccination promotion. 

In conclusion: "The results highlighted the success and potential of utilising CBPR for improving vaccination rates and indicated that researchers and community practitioners to further expand theoretical orientations and methodological toolkit associated with CBPR. The CBPR-based implementation framework, including CAP establishment, community capacity building, intervention development and implementation, and outcome evaluation, can serve as a framework for future vaccination promotion programmes involving community stakeholders and research professionals to facilitate equitable vaccination access for diverse populations."