TIP Tailoring Immunization Programmes

"Social and behavoural insights studies and engagement of stakeholders can help in first understanding the problems and then designing immunization programme solutions tailored to the local barriers to vaccination."

As outlined in the first TIP document published in 2013 (see Related Summaries, below), the World Health Organization (WHO) Regional Office for Europe developed the Tailoring Immunization Programmes (TIP) approach to provide immunisation stakeholders with tools to identify suboptimally vaccinated populations, determine barriers and drivers, and design interventions.

The document is grounded in evidence and country experience from its application in 12 countries within and outside the European Region during 2013-2019. The new TIP approach also follows the guidance and recommendations of an external review of the first TIP approach, conducted in 2017 by a team of global experts.

TIP is based on convictions that:

• "Making vaccination accessible, acceptable, convenient and attractive for people requires insights into both individual behavioural factors and the contextual, social and societal mechanisms which support the behaviour."
• "The framework proposes that the encounter between the patient /caregiver and the health worker is a critical moment in vaccination decisionmaking..."
• "Equitable vaccination uptake can be achieved through considering and addressing differences, inequities and structural disadvantages and through ensuring vaccination services are tailored to meet the needs of patients and caregivers. It does not mean treating all people the same."
• "The TIP approach builds on the principles of global, regional and national plans and strategies."

A TIP process may be initiated when:

• Lower-than-target vaccination uptake or high susceptibility to vaccine-preventable diseases (VPDs) has been identified in specific population groups; and/or
• There is concern about declining uptake, nationally or in specific population groups or geographical areas.

To inform people wishing to implement a TIP process, Section 1 of the resource offers an introduction to:

• Key immunisation-related goals and plans and how the TIP approach relates to these;
• The three pillars of the TIP approach:
  1. Six TIP values and principles: people-centred; equity; participatory; health goals; evidence; and comprehensive;
  2. TIP theoretical model and pathway: based on the COM-B model and the Behaviour Change Wheel framework, developed by a team of researchers drawing on 19 frameworks of behaviour change; and
  3. TIP process:
     • Pre-TIP: planning
     • Phase 1: situation analysis (review data, existing studies; engage stakeholders)
     • Phase 2: research (priortise intended groups; plan research; conduct research; summarise research findings)
     • Phase 3: intervention design (translate outcomes into intervention; engage stakeholders and advocate for the intervention; design and plan intervention in detail; develop monitoring and evaluation (M&E) framework)
     • Post-TIP: implementation (implement; monitor; evaluate; adjust; scale up)

To help implementers structure the TIP process, Section 2 sets out a detailed description of the TIP phases and steps, including:

• exercises to help structure findings, guide discussions, and suggest criteria for decisions;
• inspiration boxes and advice to inform and inspire TIP processes; and
• links to other relevant guidance documents.