Sociocultural and Behavioral Features of Anticipated COVID-19 Vaccine Acceptance in Papua New Guinea: Protocol for a Mixed Methods Study.

BACKGROUND: COVID-19 was characterized by the World Health Organization (WHO) as a pandemic in 2020. Papua New Guinea (PNG) has remained on high alert ever since, and its National Control Centre continues to coordinate national preparedness and response measures, guided by its Emergency Preparedness and Response Plan for COVID-19. As part of the WHO and the Global Alliance for Vaccines and Immunization's COVID-19 Vaccines Global Access (COVAX) program, PNG received several shipments of COVID-19 vaccine doses. A nationwide vaccine rollout for COVID-19 was initiated in PNG in May 2021. Despite the availability of vaccines and the capacity of health systems to vaccinate frontline workers and community members, including high-risk groups, there are still critical issues related to vaccine safety, confidence, and acceptance to ensure the effectiveness of the COVID-19 vaccination campaign. Evidence from studies on COVID-19 vaccine acceptance and demand in low- and middle-income countries (LMICs) suggests that sociocultural characteristics of the community and the behaviors of different vaccine stakeholders, including vaccine recipients, vaccine providers, and policymakers, determine the effectiveness of vaccination interventions or strategies. OBJECTIVE: This study will examine sociocultural determinants of anticipated acceptance of the COVID-19 vaccine in urban and rural areas of different regions in PNG and health care providers' views on vaccine acceptance. METHODS: The study design uses a mixed methods approach in PNG's coastal and highlands regions. The first research activity will use a qualitative methodology with an epistemological foundation based on constructivism. This design elicits and listens to community members' accounts of ways culture is a rich resource that provides meaning to the COVID-19 pandemic; the design also measures adherence to niupela pasin ("new normal" in Tok Pidgin) and vaccination acceptance. The second activity will be a cross-sectional survey to assess the distribution of features of vaccine acceptance, priorities, and practices. The third activity will be in-depth interviews of health care providers actively involved in either COVID-19 clinical management or public health-related pandemic control activities. RESULTS: The project proposal has been reviewed and approved by the Medical Research Advisory Committee of Papua New Guinea. Qualitative data collection started in December 2022, and the survey will begin in May 2023. The findings will be disseminated to the participating communities later this year, followed by publication. CONCLUSIONS: The proposed research on community views and experiences concerning sociocultural and behavioral features of acceptance of the vaccine will provide a better understanding of communication and education needs for vaccine action for COVID-19 control in PNG and other LMICs. The research also considers the influence of health care providers' and policy makers' roles in the awareness and use of the COVID-19 vaccine. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/44664.

The missing bit in the middle: Implementation of the Nationals Health Services Standards for Papua New Guinea.

OBJECTIVE: This case study examined implementation of the National Health Services Standards (NHSSs) as a continuous quality improvement (CQI) process at three church-based health facilities in Papua New Guinea. This process was designed to improve quality of care and accredit the level three health centers to level four as district hospitals to provide a higher level of care. The aims of the paper are to critically examine driving and restraining forces in CQI implementation and analyses how power influences agenda setting for change. METHODS: Semi-structured interviews were conducted with nine managers and eight health workers as well as three focus group discussions with health workers from three rural church-based health facilities in Morobe and Madang provinces. They included senior, mid-level and frontline managers and medical doctors, health extension officers, nursing officers and community health workers. Thematic analysis was used as an inductive and deductive process in which applied force field analysis, leadership-member exchange (LMX) theory and agenda setting was applied. RESULTS: Qualitative analysis showed how internal and external factors created urgency for change. The CQI process was designed as a collective process. Power relations operated at and between various levels: the facilities, which supported or undermined the change process; between management whereby the national management supported the quality improvement agenda, but the regional management exercised positional power in form of inaction. Theoretical analysis identified the 'missing bit in the middle' shaped by policy actors who exercise power over policy formulation and constrained financial and technical resources. Analysis revealed how to reduce restraining forces and build on driving forces to establish a new equilibrium. CONCLUSION: Multiple theories contributed to the analysis showing how to resolve problematic power relations by building high-quality, effective communication of senior leadership with mid-level management and reactivated broad collaborative processes at the health facilities. Addressing the 'missing bit in the middle' by agenda setting can improve implementation of the NHSSs as a quality improvement process. The paper concludes with learning for policy makers, managers and health workers by highlighting to pay close attention to institutional power dynamics and practices.