Is the choice to vaccinate informed? : A qualitative study on information exchange in the vaccination encounter in Dhaka, Bangladesh

Abstract

Vaccination is a globally accepted public health initiative. Recently, there has been a new push to vaccinate children to meet the millennium development goal four. This push for mass vaccination has undeniable benefits however, it is unclear if ethical and human rights standards are being met concerning guardian access to information and consent. In some countries where vaccination is voluntary express informed consent procedures have been implemented to protect the autonomy of those involved. Bangladesh has a voluntary immunization program without a consent policy. Vaccination levels are low and many studies link these low rates to a lack of vaccination information and a lack of communication inside the vaccination clinic. The first objective of this study is to explore the vaccination encounter in two Bengali vaccination clinics with a focus on information exchange and communication. The second objective is to identify the decision making process of guardians around vaccination and to see if they feel their decision to vaccinate is informed. This was a qualitative study. Observations were done in the vaccination clinics during the vaccination encounter. Interviews were done with eight vaccinators and twenty-two guardians. Six workshops were done at the International Centre for Diarrhoeal Disease Research, Bangladesh to gain further insight into the perceptions of vaccinators. Finally, material analysis was done on five group vaccination talks and vaccination teaching aids. Four main factors were found to effect communication and information exchange during the vaccination encounter. These were the environment of the vaccination clinic, the job satisfaction of the vaccinators, the source from which guardians received their information, and power, trust and respect during the vaccination encounter. The majority of parents wanted more information about vaccination before making their decision. In conclusion, various ethical and human rights standards in vaccination have yet to be achieved in Bangladesh. The implementation of informed decision making and informed consent during the vaccination encounter would help to increase communication and information exchange leading to a more informed decision on the part of the guardian.