The Republic of South Sudan
Ministry of Health
Module
Communicating with 7
caregivers about the malaria vaccine
1
Learning objectives
• At the end of the module, you will have learned to:
– Effectively engage with caregivers and communities
– Share messages on malaria and the malaria vaccine
– Encourage caregivers to return for next visit and build confidence about the
importance of completing all 4 doses
– Use motivational interviewing strategies to address concerns if they arise
• Duration
– 45’
2
Key issues to be addressed in this module
1
What are the best ways to communicate with
?caregivers
2
How can 'Triple A’ communication be used to
?remember the key messages
3 What are the key messages for stakeholders on
?malaria and malaria vaccination
4 How can motivational interviewing be used to
?promote vaccine uptake
3
Take time to interact with caregivers before vaccination
• Be positive about vaccination and respectful
• Inform the caregiver that child is due for malaria vaccination along with any other
vaccines or health services that may be missing, and provide information about why this
is important for their health
• Use simple words and avoid technical terms; make sure they have understood your key
messages
• Ask if they have questions and do your best to respond; pause to listen and address their
concerns
• Encourage caregivers to share information learned about the malaria vaccine in their
community
4
Good communication techniques
Good communication helps create and maintain respect and trust between health
workers, families and communities
It happens before, during and after vaccination sessions
BEFORE DURING AFTER
Make time Welcome Invite the Listen Acknowledge Ask questions Summarize
to give warmly and expression actively and address to check and request
personal praise for of thoughts to show concerns with understanding commitment
attention coming and feelings interest and empathy to vaccinate
respect
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Good communication techniques
When communicating with caregivers about the malaria vaccine:
• Share simple information about who will receive the vaccine and why (refer to "Triple A"
communication to delivery key messages)
• Show the caregiver how to use the child's home-based record to monitor vaccination status and other
health services due
• Use other visual aids available during the session (job aids developed)
• Acknowledge local challenges and show respect for community member experiences,
perspectives, customs and cultures
• Address any circulating misinformation or misunderstanding related to the malaria
vaccine with evidence-based and accurate information
• Encourage caregivers to share information learned about the malaria vaccine with other
community members
6
“Triple A” communication to deliver key messages to stakeholders
Advise Alert Arrange
on the vaccine given on possible side effects for the next
following immunization visit
and how to respond
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Advise: Malaria vaccine and schedule
• The malaria vaccine is safe and effective
• For best protection a child should receive all 4 doses:
• The first dose from 5 months of age
• The recommended schedule is 5months, 6months, 7months and 18months
• Remind caregivers about a 4th dose around 18 months to prolong protection
• Children who come late for doses should still receive their vaccine
• The malaria vaccine can safely be given with a minimum 4 weeks between any doses
• For a child that receives dose 3 late, ensure dose 4 is scheduled at least 6 months later to
prolong protection
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Advise about: Malaria disease
o Malaria is a serious disease that is spread to a person through mosquito bites
o Malaria disease is most dangerous to pregnant women and young children
o The early signs of malaria are fever, headaches, and muscle aches
o Any child with fever should be taken to a health facility immediately for a malaria test
o Malaria can be prevented: sleeping under a treated net, indoor residual spraying,
prompt diagnosis and anti malarial treatments for pregnant women and children
o Malaria vaccine offers children additional protection.
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Advise: vaccines and health services that are due
• It is safe
• Inform them of other health services that are due such as
• MCV2 can be given with MV4 , for late vaccinations or missed vaccination
• Growth monitoring with MV1,MV2,MV3
• Vitamin A supplementation at 6 months with MV2
• Deworming
• MUAC screening
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Advise about the vaccine
Malaria vaccine is provided to children in routine vaccination
The vaccine is offered free of charge at health facilities
Malaria vaccine is safe and effective
Malaria vaccine reduces the number of times a child gets sick
A child who gets the malaria vaccine may still get malaria disease, so it is important to
continue other interventions to prevent malaria, including sleeping under a mosquito
net,
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Spotlight: Health worker’s role in Adverse Events
Following Immunization (AEFI) communication
Alert: side effects
Mild side effects are common and usually short in duration
If needed, reassure caregivers and explain:
• Common side effects are fever, irritability, • The vaccine is safe and reduces the number of times children
injection site pain and swelling gets sick from malaria
• The benefits outweigh the risks of potential side effects
• An uncommon side effect is febrile
• An AEFI may not necessarily be caused by the vaccine; there
convulsions, which can occur within 7 can be other causes
days after vaccination If the AEFI is serious:
• Show empathy to caregivers and community
• Remind caregivers to return to nearest
• Use provided messages; do not give incorrect/false information
health facility if they notice any adverse • Mention an investigation is being (or will be) done
events following vaccination (even those • Maintain contact with caregivers to share updates based on
not listed here) information available from your supervisor
As a vaccinator, do not speak to media about AEFI – refer to your
supervisor for the identified spokespersons
• If you hear concerns or rumors, alert your supervisor
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For more information, please refer to Module 4 on vaccine administration and Module 6 AEFI monitoring
The malaria vaccine schedule
• Complete malaria vaccination schedule=4 doses
• The malaria vaccine schedule is 5 months, 6 months, 7 months, and 18 months
• Any child who comes late for vaccination should complete the doses
5 months 6months 7months 18 months
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Alert: Malaria prevention
• The malaria vaccine reduces the number of times a child gets malaria and saves lives
• The vaccine is part of a recommended malaria prevention package, which includes other
preventive measures such as;
Insecticide treated nets
Seasonal malaria chemoprevention
Indoor residual spraying ,
• It is possible that a child who receives the vaccine may still become sick with malaria, so it
is important to seek prompt diagnosis and treatment for every fever in children <5 yrs
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Arrange: Next visit to make sure the 4-dose schedule
• On the child health card, write date of the next visit to receive the malaria vaccine along
with other vaccines and child health services:
• Next visit should be at least 4 weeks before administering the next malaria vaccine dose
• Ensure there is a vaccination session on the date (i.e. no public holiday, weekend, etc.)
• Remind the caregiver:
When to return with their child and the child health card
Visit the health facility monthly to have their child weighed and examined, and to receive all needed
vaccines and services
• To get the best protection children should receive all 4 malaria vaccine doses; specifically mention the
4th dose at 18 months of age
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Communicating with caregivers using motivational interviewing
What is motivational interviewing?
• A specific style of communication and interpersonal interaction
• Requires working together in a caring and respectful manner
• Aims to understand and address any questions or concerns about vaccination
Designed to move the caregiver to accept vaccination
May delay or
Declining Accepting
accept some
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Conversations with someone who is unsure?
• Start with a presumptive statement: “It’s time for malaria vaccine today.”
• If the caregiver is hesitant, use the following approaches:
1. Listen with empathy
• Find out about their questions and concerns I understand. It’s
I’m a bit okay to have
• Ask open-ended questions
worried about questions or need
• Acknowledge them and their experiences
the vaccine. more information.
2. Get personal
• Share your story
• Explore reasons for wanting to get vaccinated
• Encourage or recommend vaccination
3. Share knowledge and offer help
• Share trusted information
• Offer practical help within your capacity
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MOTIVATIONAL INTERVIEWING Is this 8-month old child eligible for malaria
Scenario: the unaware parent vaccination? What would you say to her mother?
Potential for vaccine acceptance • Yes, the child is eligible for dose 1. Start with a presumptive
statement: “It’s time for the malaria vaccine today”
An 8-month-old child is brought to
the clinic by her mother. The family • Use the ‘Triple A’ approach to share key messages about the
has been out of town. Upon malaria vaccine, benefits, any potential side effects
returning home, other parents • If there are no questions or concerns, proceed with vaccination
informed her of a new malaria • Advise the mother to come back in 4 weeks for the 2nd dose
vaccine; she would like to know • Write the date of the next visit in the home-based record, as well as
more about the malaria vaccine. any other vaccines and services due
• Show the caregiver how to monitor using the record
In reviewing the child’s child health
• Encourage continued use of other malaria prevention measures
card, you notice she has not yet
received any doses of the malaria • If questions or concerns, use motivational interviewing to
vaccine. understand her concerns and respond with empathy
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MOTIVATIONAL INTERVIEWING
Scenario: misinformation What would you say in response to the mother?
• Use a participatory approach to identify and address concerns
Hesitant and unsure and help to understand the importance of vaccination
A 10-month-old child is brought to • Ask questions to discover any misinformation. Share facts and
stories to debunk myths and respond to concerns
the clinic by her mother. In
• Acknowledge risks and benefits of the malaria vaccine.
reviewing her home-based record,
you notice she has not yet received • Ask about vaccine perceptions and preferences; listen and respond
with empathy
any doses of the malaria vaccine.
• If the caregiver agrees and there are no further questions or
When asked, her caregiver says: concerns, proceed with vaccination of the child and:
“The women in my mothers' group • Advise to come back in 4 weeks for the 2nd dose; write date of next
said the vaccine can result in illness visit in the home-based record and show caregiver how to monitor
and that I should not let my child • Encourage continued use of other malaria prevention measures
take it. Is the vaccine safe?” • If a person remains hesitant, be respectful and provide
information to take home, encourage to consider vaccination
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Is Joseph’s son eligible for the malaria vaccine? Why or why not?
MOTIVATIONAL INTERVIEWING
Scenario: eligibility What would you say to Joseph?
Enthusiastic • Express appreciation for Joseph’s interest in keeping his son
healthy
Joseph brings his 2-month-old son
into the health clinic for a wellness • Explain that the guidelines indicate that a 1st dose of the malaria
check and his childhood vaccine is delivered from 5 months of age
vaccinations. • Discuss dates for any subsequent visits, including for the 1st dose of
the malaria vaccine
His neighbor recently vaccinated his • Show the father how to use and inteprete growth curve in the child
daughter against malaria, and he health card
would like to get the malaria • Inform if his son is due for any other vaccines or child health
vaccine for his son. services that can be provided today or at an upcoming visit
• Advise on other malaria preventive measures to use
• Remind to seek prompt diagnosis and treatment if his son
develops a fever
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Is the grandchild eligible for the malaria vaccine?
MOTIVATIONAL INTERVIEWING
Scenario: perception of risk What would you say to the grandmother?
Low motivation • Express appreciation for the grandmother’s interest in keeping
her grandchild healthy
A grandmother brings her 24-
month-old grandchild into the • Advise that vaccinated children remain vulnerable to malaria
health clinic. The health worker and children under 5 years of age can become very sick or even
notices the child has only received 3 die from malaria
malaria vaccine doses. • Explain that children should receive all 4 doses; the 4th dose is
needed to prolong protection from malaria
The grandmother says:
• If the grandmother agrees, proceed with vaccination and:
“It’s been a while since the prior • Reinforce importance to continue use of other malaria prevention
vaccinations. I’m not sure a 4th dose measures
is needed because my grandchild is • Inform if the child is due for any other vaccines or health services
older now and she has never been that can be provided today or at an upcoming scheduled visit
sick with malaria since she received • Remind to seek diagnosis and treatment if the child develops fever
the vaccine.” • If a person remains hesitant, be respectful and provide information to
take home, encourage to consider vaccination
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Can the child get malaria vaccine? What will you tell Mary?
MOTIVATIONAL INTERVIEWING
Scenario: Fear of side effects • Express appreciation for Mary’s interest in
keeping her child healthy
Hesitant
• Give information about common side effects of
Mary brings her 18 months child for growth the vaccine
monitoring. You noticed from the child health card • Advise that vaccinated children remain
the child never got any dose of malaria vaccine. vulnerable to malaria and children under 5
Her neighbor vaccinated her child with first dose of years of age can become very sick or even die
malaria vaccine two days ago and the child developed from malaria hence should get malaria vaccine
fever, diarrhoea and general body pain. Eventually she 1st dose
took the child to the health facility for check up. It was • If Mary agrees, proceed with vaccination
found that no malaria parasite. Because of this, Mary • If a person remains hesitant, be respectful and provide
refused her child to get malaria vaccine information to take home, encourage to consider
vaccination
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Keep in mind…
• Take time to interact with caregivers before, during, and after vaccination
• Be respectful – Listen to caregivers’ concerns and respond with empathy
• “Triple A” communication (Advise, Alert and Arrange) helps to convey the correct
messages on the vaccine as part of a malaria prevention strategy
• Motivational interviewing can be used to understand reasons for delayed acceptance and
to promote vaccine uptake. Your recommendation matters!
Key messages for communicating with caregivers
• The malaria vaccine is safe and reduces severe malaria
• 4 malaria vaccine doses provide the best protection
• Specifically mention the 4th dose is given at 18 months of age
• Visit monthly to have their child weighed and examined, and to receive all needed
vaccines and child health services
• Some common side effects include fever and injection site pain and swelling, but these
are typically short in duration
• Report to the nearest health facility should there be any concerns following vaccination
• Even after vaccination, a child can still become sick with malaria: seek prompt diagnosis
and treatment for a child with fever
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1
Ask open-ended questions
Open questions using “what”, “why”, “how”, “tell me…”
to explore reasons behind hesitancy
Close ended questions Open ended questions
Answer is only a yes or no Answer goes beyond a simple yes or no
Do you agree? What do you think?
Did you understand? What did you understand?
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1 2
Reflect and respond
Simple reflection: directly repeating what the person says
Complex reflection: repeating what you think the person means
Caregiver: “I know vaccinating will help my child but I am afraid.”
• Simple reflection: “I understand that you are afraid.”
• Complex reflection: “You want to make the best choice for your child but you are nervous.”
Use both types of statements to acknowledge concerns
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Responding to vaccine hesitancy with empathy: examples
Health worker: “I understand that you want to make the
"I know vaccinating will help my child, but I am best choice for your child. What side-effects are you
afraid of side-effects." concerned about?”
Health worker: "I can see you are questioning vaccines.
"I don’t know what to do. My husband objects to How do others you know deal with vaccination? Do you
vaccines." know what your husband is concerned about?
Health worker: “Social media and websites can spread
"I read rumours about malaria vaccine online. I do false information. You can get the latest information on
not know what to believe.” malaria vaccine from the source I trust at MoH,WHO and
UNICEF. I am also here to answer your questions.”
“I am not convinced about vaccines, so it seems like Health worker: “Vaccination may be difficult to consider.
too much effort to come all the way to get them.” Could I offer you some information on why we vaccinate?
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1 2 3
Affirm the strengths
“It is great that you are starting to think about vaccines.”
Validate concerns
“The health of your child is important to you.”
“Protecting yourself from illness is important for you and the health of your community.”
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1 2 3 4
Ask-Provide-Verify
As the conversation evolves, explore the concerns further:
Verify
Ask
Provide Verify what they have
Ask information on
Share information on understood and what they
what the caregiver
vaccines will do with this
knows about vaccines
information
“So, what do you already “Could I provide you with some “Given our discussion, how do you view
know about vaccination?” information, based on what you the decision now? I am here to help talk
just shared?” through any concerns you may have.”
Please note: Be careful not to add potential concerns by
mentioning issues not raised by the caregiver
1 2 3 4 5
Summarize the interaction
“The reason that’s important is…”
“What that means to you is…”
“The main point to remember is….”
1 2 3 4 5
Determine the action
IF YES: Vaccinate the child and offer praise to the caregiver to affirm the positive decision
IF FOR FOLLOW-UP (if possible): Refer caregiver to a specialist/community advocate or
schedule a new discussion:
“Let’s revisit this once you have had a chance to think more about vaccination.
When could you come back?”
IF REFUSAL: Do not debate. Leave the door open:
“I understand. Please know that if you change your mind and want to talk about
vaccinating, we are always available.”
Next modules about the malaria vaccine
Gender and malaria vaccine introduction
Missed opportunities for vaccination and other child health
interventions
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End of module
Thank you for your
attention!
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References
• Immunization in practice: a practical guide for health staff. Module 7: Partnering with communities. WHO.
2015.
https://www.who.int/publications/i/item/immunization-in-practice-a-practical-guide-for-health-staff
• Interpersonal communication for immunization: transforming immunization dialogue https://
www.unicef.org/eca/media/8576/file/interpersonal-communication-participant.pdf
• Demand for health services field guide: a human-centred approach
https://www.unicef.org/innovation/reports/demand-health-services
• Vaccine safety events: managing the communications response. Copenhagen: WHO Regional Office for
Europe; 2013 (https://www.who.int/europe/publications/i/item/9789289054935
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Questions / comments?
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