"Fear of the unknown": Health, disability, and stakeholder perspectives on the behavioral and social drivers of vaccination in children with disability in Fiji

Rosalie Power; Unise Vakaloloma; Israt Jahan; Sureni Perera; Ilisapeci Tuibeqa; Rachel Devi; Litiana Volavola; William May; Donald Wilson; Lanieta Tuimabu; Gulam Khandaker; Meru Sheel; Australian Immunisation and Disability Investigators

doi:10.1371/journal.pgph.0004132

"Fear of the unknown": Health, disability, and stakeholder perspectives on the behavioral and social drivers of vaccination in children with disability in Fiji

PLOS Glob Public Health. 2025 Jan 8;5(1):e0004132. doi: 10.1371/journal.pgph.0004132. eCollection 2025.

Affiliations

¹ Translational Health Research Institute, Western Sydney University, New South Wales, Australia.
² Fiji Institute of Pacific Health Research, College of Medicine, Nursing & Health Sciences, Fiji National University, Suva, Fiji.
³ Central Queensland University, Queensland, Australia.
⁴ Frank Hilton Organization, Suva, Fiji.
⁵ Colonial War Memorial Hospital, Ministry of Health and Medical Services, Suva, Fiji.
⁶ Family Health, Ministry of Health and Medical Services, Suva, Fiji.
⁷ School of Medical Sciences, College of Medicine, Nursing & Health Sciences, Fiji National University, Suva, Fiji.
⁸ Fiji Disabled People's Federation, Suva, Fiji.
⁹ Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Queensland, Australia.
¹⁰ Sydney School of Public Health, The University of Sydney, New South Wales, Australia.
¹¹ Sydney Infectious Diseases Institute, Faculty of Medicine and Health, The University of Health, New South Wales, Australia.

Abstract

Vaccinating children with disability in low- and middle-income countries, such as Fiji, is a key priority for equity. This study aimed to understand the social and behavioral drivers of vaccine uptake among children with disability in Fiji, from the perspectives of health, disability, and community stakeholders. Five qualitative focus groups were conducted with 22 stakeholders, including healthcare workers, disability service providers and advocates, and community and faith leaders (female n = 17, 77%). Data were collected and analyzed using reflexive thematic analysis and applied the World Health Organization's Behavioral and Social Drivers of Vaccination framework. Numerous drivers were reported to impact vaccination for children with disability. These included (1) Thinking and feeling: lack of reliable information about vaccine benefits and safety for children with disability; (2) Social processes: disability stigma and discrimination impacted families of children with disability engaging with healthcare services; lack of tailored vaccination communication and engagement strategies; and, need for improved disability and health service collaboration; (3) Motivation: lack of awareness and support for parents of children with disability to have their children vaccinated, and religious beliefs negatively impacted motivation; (4) Practical issues: long waiting times and lack of suitable waiting areas for children with disability; financial and time barriers; and, lack of healthcare worker knowledge and confidence in providing vaccines to children with disability, impacted patient-provider trust. The findings from this study can inform strategic actions to overcome barriers to vaccination for children with disability, including strengthening existing vaccination programs, promoting greater equity in vaccination for children with disability in Fiji. This will reduce the burden of vaccine-preventable diseases in this priority group.

Copyright: © 2025 Power et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

This study was funded by the Australian Government Department of Foreign Affairs and Trade (G207535) under the Australian Regional Immunisation Alliance - Regional Immunisation Support and Engagement (ARIA-RISE) scheme. IJ is supported by the early career researcher grant of the Cerebral Palsy Alliance Research Foundation (ERG02021 and ERG05123). GK is supported by the NHMRC Investigator Grant (APP2009873). MS was supported by a Westpac Research Fellowship in 2022-2023. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.