From Information to Vaccination: A Conceptual Framework for Understanding Community Participation in Catch-Up Vaccination for Children in Abidjan, Côte d'Ivoire.

Abstract

Background/Objectives: Catch-up vaccination is essential for reaching zero-dose and under-vaccinated children. However, community participation depends on several factors whose interactions remain insufficiently understood. This study aimed to analyze the dimensions structuring community participation in catch-up vaccination and to develop a conceptual framework describing their relationships. Methods: An analytical qualitative study was conducted between July and November 2025 in the health districts of Abobo and Yopougon, Abidjan, Côte d'Ivoire. Data were gathered from 106 participants through 26 semi-structured individual interviews and eight focus group discussions involving 80 parents or caregivers of children aged 0-59 months. Interviews and focus group discussions were transcribed in French, and thematic analysis was conducted using NVivo 14 (Lumivero, Denver, CO, USA). A standardized thematic codebook with operational definitions was used by three coders to ensure consistent coding across transcripts. Results: Thematic analysis across participant groups identified seven components shaping community participation: exposure to information, understanding of the message, trust in actors and services, social acceptance, parents' availability and capacity, participation in the activity, and effective vaccination of the child. Five cross-cutting factors influenced progression along this pathway. Participation could break down when information was insufficient or unclear, trust was undermined by perceived costs or rumors, social acceptance was constrained, or parents faced competing work and time demands. These interactions informed the Community Participation Pathway for Catch-up Vaccination (CPP-CV), which identifies potential disruption points between information exposure and effective vaccination and highlights that non-participation may result from the interaction of informational, social, individual, structural, and organizational factors rather than vaccine hesitancy alone. Conclusions: The findings suggest that participation in catch-up vaccination goes beyond information alone and results from the interaction between community and organizational factors. Non-participation should not be treated as a single problem or assumed to reflect vaccine hesitancy. The CPP-CV provides a programmatically oriented framework for identifying where the pathway from information to vaccination breaks down and for tailoring catch-up strategies accordingly.