Behavioral Insights from Vaccine Adoption in Nigeria: Cross-Sectional Survey Findings.

BACKGROUND: To generate behavioral insights for the development of effective vaccination interventions, we need approaches that combine rapid and inexpensive survey data collection with instruments based on easy-to-use behavior models. This study demonstrates how an inexpensive digital survey helped identify the drivers of COVID-19 vaccination in Nigeria. OBJECTIVE: This study aims to illustrate how behavioral insights can be generated through inexpensive digital surveys. METHODS: We designed and conducted a cross-sectional survey with multistage sampling. Data were collected from Nigerians (aged ≥18 years) from 120 strata based on age, sex, state, and urban or rural location. Respondents were recruited via advertisements on Meta platforms (Facebook and Instagram) using the Virtual Lab open-source tool. We used a Meta Messenger chatbot for data collection; participants were compensated with 400 naira (US $0.87 cents). Data collection took 2 weeks. In total, 957 respondents completed the survey, at an advertising cost of US $1.55 per respondent. An 18-item instrument measuring core motivators, ability barriers, sociodemographic characteristics, and respondents' vaccination status was pretested before data collection. We ran separate logistic regression models to examine the relationships between vaccine uptake and core motivators, ability barriers, and sociodemographic variables. A final model that predicted vaccine uptake included all 3 sets of variables. RESULTS: About 56% (n=540) of respondents reported that they had received at least 1 COVID-19 vaccination. Three core motivators were positively associated with vaccine uptake: the belief that the COVID-19 vaccine promised a better life (adjusted odds ratio [aOR] 3.51, 95% CI 2.23-5.52), the belief that the vaccine would allow respondents to do more things they enjoyed (aOR 1.97, 95% CI 1.33-2.93), and respondents' perception that their friends and family members accepted their decision to get vaccinated (aOR 1.62, 95% CI 1.06-2.48). Two ability barriers were negatively associated with vaccine uptake: cost- or income-related concerns lowered the odds of being vaccinated (aOR 0.35, 95% CI 0.24-0.50) and the lack of availability of vaccines at places respondents routinely visited also lowered their odds of being vaccinated (aOR 0.29, 95% CI 0.21-0.40). After adjusting for other variables, the perceived fear of getting COVID-19 and the hardship associated with the disease were no longer associated with vaccine uptake. CONCLUSIONS: These findings suggest that hope is more important for Nigerians than fear when it comes to vaccine adoption, enjoying life is more important than worrying about getting the disease, and approval from friends and family is more powerful than their disapproval. These findings suggest that emphasizing the benefits of leading a fuller life after being vaccinated is more likely to succeed than increasing Nigerians' fear of COVID-19. This study identifies a very different set of factors associated with COVID-19 vaccine adoption than previous Nigerian studies.

Determinants of Human Papillomavirus Vaccine Acceptance among Caregivers in Nigeria: A Fogg Behavior Model-Based Approach.

Human papillomavirus (HPV) vaccine uptake among adolescent girls is critical to reducing the burden of HPV-related cancers in Nigeria. This study assesses the factors influencing caregivers' acceptance of HPV vaccination for their charges, using the Fogg Behavior Model (FBM) as a theoretical framework. We analyzed cross-sectional data from 1429 caregivers of girls aged 9-17 in six Nigerian states, using a survey instrument based on the FBM. Participants were recruited via Facebook and Instagram advertisements and interviewed through Facebook Messenger in August and September 2023. The study received ethical clearance from Nigeria's National Health Research Ethics Committee. We applied bivariate and multivariate analyses to assess the relationships between the caregiver's perception of how likely their adolescent girl was to get vaccinated in the next 12 months and motivation, ability, social factors (such as discussions with family and friends), injunctive norms, previous COVID-19 vaccination, and respondents' sociodemographic characteristics. Adjusted odds ratios derived from logistic regression analyses revealed that caregivers' motivation and ability, as well as social factors, were significantly associated with their perception that the adolescent girl in their care would get vaccinated within the next 12 months. Our findings suggest that behavioral interventions tailored to enhance motivation, ability, and social support among caregivers could significantly increase HPV vaccine uptake among adolescent girls in Nigeria.

Outcomes of a social media campaign to promote COVID-19 vaccination in Nigeria.

The COVID-19 pandemic has been an historic challenge to public health and behavior change programs. In low -and middle-income countries (LMICs) such as Nigeria, there have been challenges in promoting vaccination. Vaccine hesitancy and social norms related to vaccination may be important factors in promoting or inhibiting not only COVID vaccination, but other routine vaccinations as well. The aim of this study was to conduct a national-level quasi-experimental evaluation of a social media based COVID-19 vaccination promotion campaign in Nigeria run in 2022. We followed a longitudinal cohort of Nigerians (at baseline) drawn from all 37 states in Nigeria over a 10-month period. This was done at 3 time points to evaluate psychosocial predictors of vaccination and vaccination outcomes following a theory of change based on Diffusion of Innovations, Social Norms Theory, and the Motivation, Opportunity, Ability (MOA) Framework. In a quasi-experimental design, participants in 6 Nigerian states where the social media campaign was run (treatment) were compared to participants from non-treatment states. This study highlights new social media-based data collection techniques. The study found that vaccination rates increased in treatment states compared to non-treatment states, and that these effects were strongest between baseline and first follow up (December 2021 to March 2022). We also found that more pro-vaccination social norms at one time point are associated with higher vaccination rates at a later time point. Social media campaigns are a promising approach to increasing vaccination at scale in LMICs, and social norms are an important factor in promoting vaccination, which is consistent with the Social Norms Theory. We describe implications for future vaccination campaigns and identify future research priorities in this area.

Decolonising global health evaluation: Synthesis from a scoping review.

As decolonisation awareness and activism amplifies in the mainstream masses and within academic realms across a variety of fields, the time is right to converge parallel movements to decolonise the fields of global health and evaluation by restructuring relations of dependency and domination reified through the "foreign gaze"1 or "white gaze." We conducted a review of relevant records with the following inclusion criteria-they define or advocate for the decolonisation of global health evaluation or explicate methods, policies or interventions to decolonise global health evaluation published by advocates of the decolonisation movement from both fields. These records were derived following a systematic article search by the lead autthor on Google, Google Scholar, NewsBank, and PubMed using the following keywords: "decolonising" and "global health," "evaluation," or "global health evaluation" replicating a digital search strategy utilized by scoping reviews across a variety of topics. Because the topic of interest is nascent and still emerging, the date range was not restricted. The lead author screened abstracts retrieved from the search. In total, 57 records, ranging in publication date from 1994 to 2020, were selected and charted for this review. We reviewed these records to identify socio-ecological factors that influence the decolonisation of global health evaluation, such as decolonising minds; reorienting funders and reforming funding mechanisms; and investing in sustainable capacity exchange. In doing so, we reflected on our positionality as well as our internalisation and potential reinforcement of colonial relations in the process of reporting our results. In the context of turmoil and transition due to the COVID-19 pandemic, our scoping review offers a starting point to embark on a journey first to transform and decolonise global health evaluation and then to achieve the greater goal of equity and justice.

COVID-19 calls for health systems strengthening in Africa: A case of Nigeria.

The COVID-19 pandemic has proven the need for countries worldwide to implement strategies that promote health systems strengthening and ensure epidemic preparedness. Many African countries are burdened by fragile healthcare systems, hence, this paper emphasises the need for African policymakers to improve healthcare quality in their countries. Through a brief review of various online literatures concerning health systems strengthening in Africa, this paper focuses on the nature of healthcare in Nigeria amidst the COVID-19 pandemic. The major stress areas include COVID-19 testing capacity, health workforce, infection prevention and control, health information and surveillance systems, health insurance, public-private partnerships, and governance. The COVID-19 pandemic has amplified several challenges ravaging Africa's already fragile healthcare systems, leaving the health sectors of most African countries ill-prepared to deal with the pandemic. If Nigeria and many other African countries had invested sufficiently in strengthening their healthcare systems prior to COVID-19, their pandemic response efforts would have been more effective. Health systems strengthening is necessary to ensure steady progress toward universal health coverage and global health security. Through health systems strengthening, Nigeria and other African countries can greatly improve their infection prevention and control measures.

Sub-Saharan Africa Tackles COVID-19: Challenges and Opportunities.

As of May 2020, the global COVID-19 pandemic had reached 187 countries with more than 3.7 million confirmed cases and 263,000 deaths. While sub-Saharan Africa (SSA) has not been spared, the extent of disease is currently far less than in Europe or North America leading some to posit that climatic, genetic or other conditions will self-limit disease in this location. Nonetheless, infections in tropical Africa continue to rise at an alarming pace with the potential to soon exceed health resource availability and to exhaust a health care workforce that is already grossly under supported and ill-equipped. This perspective outlines the context of COVID-19 disease in Africa with a focus on the distinctive challenges faced by African nations and a potential best path forward.

[Evaluation on implementation of the African programme for onchocerciasis control in Nigeria].

OBJECTIVE: To investigate the progress and challenges of the implementation of the global programme in Taraba State, Nigeria. METHODS: The African Programme for Onchocerciasis Control (APOC) as the first neglected tropical diseases (NTD) control initiative in Africa had been introduced to Nigeria since 1997. Community-directed distributors of community-directed treatment with ivermectin had been adopted as its main strategy. As a qualitative study, in-depth interview and focus group discussion were used as data collection methods. The thematic framework method was used as a data analysis method. RESULTS: The community reported that they had benefited from the programme. The study findings showed that the health education on NTDs remained very poor, and the community had not fully realized its responsibility for the drug distribution and NTDs control, and the community drug distributor (CDDs) had not been developed as a substantial team working for other projects. CONCLUSION: The goals of community-directed treatment with ivermectin (CDTI) only have been achieved partly. China should learn from the experience.