Coconstructing fishbone diagram to understand the barriers to immunization in an urban community in Mysuru, Karnataka: A brief report of a qualitative study

Background: Despite improvements in immunization coverage during the 1990s, full immunization coverage for 12–23 months according to National Family Health Survey 4 still remains low. To change the quality of care outcome within a system, quality improvement initiatives must first understand the causes contributing to the outcome and accordingly can administer the changes. Objectives: The objective of this study were as follows: (1) To understand the barriers to Routine Immunization among Caregivers and health personnel through participatory group discussions and (2) cocreation of a fishbone diagram illustrating the barriers, in an Urban Primary Health Center in Mysuru, Karnataka. Materials and Methods: The barriers to immunization were unveiled by participatory focus group discussions conducted among caregivers and health workers in an urban primary health center in Mysuru. A fishbone diagram depicting the root causes of delayed immunization/drop-outs was constructed with the participants. Results: The barriers include social factors, individual/family factors, barriers associated with private clinics, and problems in the public health system. The major cause was information system which did not reach the parents periodically by health workers, carelessness by the parents for delaying or skipping, migrating population, and non-accounting of child immunization in private clinics. Conclusion: Lack of timely administration and drop-outs of key childhood vaccines and improper functioning of the health system remains a major challenge in this area. An effective, regular, and universal monitoring of the sessions are necessary for appropriate action which is very much essential.