Enablers and barriers to older women's support of infant immunization timeliness and completion in selected urban slum communities of Ibadan, Nigeria

Abstract

Infant immunization coverage remains suboptimal in Nigeria, especially in the rural and urban slum areas. There have been efforts to improve immunization coverage, but the outcomes are not satisfactory. In many African families, older women significantly influence childcare decisions, and this influence may be channeled to improve infant vaccination. This study investigated the enablers and barriers to older women's support of infant immunization timeliness and completion in selected urban slum communities of Ibadan, Nigeria. An exploratory cross-sectional qualitative study was conducted in eight urban slum communities. Older women's opinions about their roles in infant immunization timeliness and completion were explored using focus group discussions (FGDs). Data were analyzed using content analysis based on the Theoretical Domains Framework. 175 women aged 35–80 years participated in 22 FGDs. Enablers of support for infant immunization include the older women's cognitive and interpersonal skills in supporting young mothers, their positive social influence on grandchildren's immunization, and their belief that complete immunization prevents childhood illnesses and death. Barriers included incomplete knowledge of vaccination schedules, vaccine stockouts, poorly behaved health workers, long waiting times at clinics, and adverse experiences following immunization. The role of older women in mentoring, educating, reminding, and supporting parents was recognized as critical for improving vaccination rates. The older women possessed valuable capabilities, opportunities, and motivations that can be leveraged to improve infant immunization. However, they need improvement in the knowledge of immunization schedules and the identified health system barriers should be addressed. • Bird's eye view. • The older women were already supporting infant immunization in different capacities. • Older women's cognitive skills and social influence enabled support for immunization. • Poor knowledge of vaccine schedules and workers' attitudes were identified barriers. • Importance of timeliness and completion of immunization were not known by some women.