Effectiveness of Interventions to Improve Vaccination Coverage in India: A Systematic Review and Meta-Synthesis of Qualitative Studies.

Abstract

This is a systematic review and meta-synthesis of qualitative studies to identify the facilitators and barriers of interventions aimed at improving vaccination coverage in India, along with exploring the beliefs and practices regarding vaccination. The focus was on interventions targeting beneficiaries, healthcare providers, and the health system via recipient-focused methods, provider-oriented training, and health system reforms to increase vaccination coverage. Search terms were adapted from database scoping and title, abstract, and index term analysis, and a thorough literature search was conducted in PubMed, Scopus, and Crossref databases for studies published in English on the topic of research between January 2013 and December 2024. Among the 12 articles selected for the study, four were mixed-method studies, and five were conducted among stakeholders in the community providing the vaccination. The quantitative synthesis revealed several key themes: beneficiary-related (improved vaccine acceptance), community-related (mobilization, awareness, ownership, and leadership), and healthcare provider-related (better stock management, endorsement, and engagement). Additional themes included local advocacy and the integration of family planning with infant vaccination. Barriers were categorized as system-related (e.g., accessibility issues, coercive strategies), information-related (misinformation, lack of awareness), and logistic-related (limited resources, indirect costs). Effective interventions were found to leverage community engagement, improve healthcare provider practices, and enhance vaccine acceptance among beneficiaries. However, significant barriers persist, including systemic challenges, information gaps, and logistical constraints. Social norms, health attitudes, and trust in healthcare systems have emerged as critical factors affecting vaccination uptake. These findings underscore the need for multifaceted, culturally sensitive approaches to improve vaccine coverage in India. Future interventions should address identified barriers while building upon successful strategies to ensure more comprehensive and sustainable vaccination programs.