Table 5.

Patient Health Education

Subtheme	Quote
HCP Perspective
Effects of myths and misconceptions (“Rumor mill’)	“We recently had a challenge with polio and other vaccines that were being said to bring infertility. Those who do not get a chance to talk to a healthcare professional to enlighten them about these myths end up believing what they are told out there. The public sector has these challenges.” “For example, sometimes back, there was a serious debate between the ministry of health and Catholic church. The church was against the tetanus toxoid. The catholic church argued that the vaccine was meant to sterilize female populations. The issue was all over the internet and social applications. I think vaccination efforts did not reach their targets. There are some who also complicated the issue justly to scare more people away from vaccination.”
Education as a tool for demand creation and reinforcing/ building trust	“When communicating to them we need to tell them about the importance of vaccines and insist for them to receive. If you do not tell them about the importance, then they will not take. As you know that the patients normally believe in doctors and they will do whatever the health care provider suggest to them to do.” “We should have somebody at the triage, one in the child welfare clinic, one in the ANC clinic, one in the family planning clinic and one in the PMTCT. This would help us give mothers time to ask questions and also give as time to address them. This will also make the mothers to be comfortable with us since I will not be rushing through but will have adequate time to give the mother’s health information. Pregnant mothers need a lot of information and especially first time mothers who could be having wrong or outdated information” “There are pamphlets with pictorials about the effects of tetanus infection. When we show women such pictures, they understand the importance of tetanus vaccine and accept vaccination. You realize that TT uptake is increased. They are confident with what we tell them and we are also confident that their attitude is positive. This is evident in the fact that they come in numbers for the vaccines. In some cases, they come from other hospitals. They trust us.” “The first thing, which I appreciate about health information given to the mothers; is that at least they know that there is an antigen which they should be given and they appreciate about that antigen. Secondly, they know the importance of attending the ANC clinic because if you ask them why they always come to the clinic, they will tell you that “I come because I need to be given tetanus” so basically, the message you give them has a positive impact.” “Barriers. Mostly because most of the issues that normally come up are always myths, we try to debunk them by trying to tell them the facts. Like somebody believing that when they are pregnant they can’t get injected, you talk to them, you tell them the importance and we also expose them to know the side effects though in most cases the side effects are always very minor and I have never met an adverse reaction with the vaccines. So we always try to talk to them. We let them know the facts so that they make an informed decision. Some come when they have bad opinion about vaccines but they end up getting it, having been given the facts.” “Basically, it is the health information. We give them a group health talk outside then when they come in, we have one on one health talk. However short it is we make sure we tell them the importance. By the way, I have realized they know the importance of tetanus. Once we give them the information on the importance of the vaccine so we do not expect refusals.”
Community buy-in	“More publicity. These can be done by women who have received vaccination telling fellow women, pregnant and non-pregnant alike about the importance of vaccines. Government officials like chiefs and village elders can also play their part by organizing barazas-(Gatherings/meetings organized by the local chiefs to address issues) for all women where they will be educated on vaccines.” “They should also have the information because one mother will tell another and that is how information flows.” “The moment they know what we are doing, they become our ambassadors in most cases. They take that message home. When you do something right to one patient, you will help like five of them because when she goes out there, most of them share their experiences.”
Pregnant women perspective
Effects of myths and misconceptions	“I: Why do other people refuse vaccines? P: Others just take it lightly, others because of religion and others think it is wasting time.” “I: Have you ever refused vaccine for yourself before? P: Yes. There was one that brought lots disagreements. You know I am a Catholic … It was also in church but when we saw our leaders arguing with the government saying the vaccine is not good that it has other things. I rejected that one. By that time if you went to the clinic you could be asked to be given the vaccine but I refused.
Importance of education on vaccine acceptance	“Yes, the information on children’s vaccines was helpful. When the healthcare providers came administering the measles vaccine, a measles outbreak had just occurred. The healthcare providers informed us that those who will get the vaccine before contracting measles will be safe. And because of this information, even those who had never been vaccinated before came for vaccination.” “Why I received the tetanus vaccine was, it was well publicized, the information that came with it was okay, those people who were also giving it out, I believe they were professionals because they also had tags. Before they give you the vaccine, they had to explain what would also be compared with the information we had before; to me that was okay, I did not even need a second thought about it, yes.” “Mothers should be educated on vaccines first and then they can choose. As I told you earlier, some mothers refuse vaccines because of some misconceptions they hear about vaccines. There was a time everyone thought that polio vaccines would kill a child. I do not think the government can kill all the children in Kenya, I believe there have a conscious too.” “They said that children will be prevented from serious physical handicaps and polio. Since I do not have more knowledge than doctors, I accept to have my kids vaccinated.” “I : Let us say she refuses and the child happens to be infected by the disease that would have been prevented and remember the child has no capacity to take her/himself to the facility for the services, so what do you suggest to be done to such a parent? P : Just give her good pieces of advice.”
Desire for health education	“I come here because of the services they provide but mostly I like the guidance and counseling they provide.” “AMREF together with the nurses usually go round the villages to vaccinate the children so I ask them about it that is where I learnt from. I have to ask because I will find myself in that situation where my child has to be vaccinated so I need to know.” “I think you should put more advertisements on radio and television. There should also be caregivers to teach us when we come here in the morning. But you find that when you come to the clinic, you might sit at the reception for even an hour without anybody attending to you. When they finally attend to you, you just go home. Ever since I started coming here, we have only been educated once. Maybe it is me who comes early and they do it later.” “For example, I went to a private hospital but I was not given any vaccine or advice as a pregnant woman. I was also not asked any question as a pregnant woman. They only tested me and filled the form and by that time I was in great pain. That is all they did. So I thought that if I come to Mbagathi Hospitals, I will get vaccinated and get advised. Like today I have been advised to start preparing for the delivery of my baby. I have been told to have a razor blade, string and money. I have received advised which I would not have received in private hospital. I have also been told that I need to eat well as a pregnant mother and to also use folic tablets for me to have enough blood in the body. I would not have received such advice in a private clinic.” “ I : Between government hospitals and private hospitals, where would you prefer to be vaccinated? P : Government hospitals because they educate a lot on vaccines.”
Fear of reproach	“There are some doctors that when you ask them questions, they will also ask you, if you came to be treated or for questions; it becomes difficult to interact with such ones.”
Time constraints	“I do not ask because I find many women on the queue. You do not have the time to ask why do you so you just agree to be injected so that you go home.”