Table 2 Lessons learned from study on missed opportunities of vaccination in Dominican Republic (October 2012) and from other immunization surveys in Latin America (2010–2011)
Political support | -EPI should lead the study, even when international technical or financial support is available. |
-Cooperation among governmental agencies is required, particularly ministries of health, finance, and statistics. | |
-EPI should start ethics approval process as soon as possible to prevent delays. | |
Country adaptation of instruments | -Sampling procedure must be carefully determined, preferably with assistance from a government statistician. |
-Surveys must be adapted to take into account differences in culture, local language, and EPI schedules. | |
-Algorithms/syntaxes for determining missed opportunities must take into account replacement vaccines. A professional with expertise in computers and statistical programs should participate in the data analysis and address problems as they arise. | |
-Survey questions must be understandable to all people regardless of education level. | |
-Avoid technical language. | |
-Professionals in different disciplines, including those outside of healthcare, should review questionnaires. | |
-Pilot project or focal groups conducted prior to study implementation are key to adapting surveying instruments to local realities. | |
Implementation | -Role-play and the use of sample vaccination cards are useful tools in training interviewers to properly conduct interviews. |
-Explaining the study’s potential impact to interviewers promotes their interest in and commitment to the study. | |
-Request feedback on surveying tools from interviewers/supervisors (many are parents and provide useful feedback). | |
-EPI should notify health facilities that they have been selected for a survey 1–2 days before implementation. | |
-New technologies (e.g. Palm Pilots) may reduce paperwork and data entry errors and enable local decision makers to access to data more quickly. | |
-A polling company, if cost-effective, allows EPI professionals to focus on technical issues and provides an independent perspective and surveying expertise. | |
-Properly-trained supervisors are key to ensuring that the questionnaire is properly administered and to minimizing data-entry errors. | |
-Supervisors should seek to have health facility directors distribute the health worker survey at grand rounds or during shift changes. | |
Data analysis and design of Interventions | -EPI professionals at all levels--local, sub-national, national--should review results and be asked for suggestions to reduce MOVs. |
-To promote their involvement in the study and the design of local interventions, directors of evaluated health facilities should receive results. | |
-Results should be published to increase understanding on the causes of under vaccination, establish a baseline for progress, and advocate for funding. | |
-Reports should not be overly detailed. Too much information may obscure the study’s principal findings. | |
-Report should advocate that study be repeated once interventions are implemented so that progress can be measured. |