Child vaccine communication practice in promoting child immunization in the Amhara region of Ethiopia

Abstract

BACKGROUND

Child vaccination plays a great role in preventing infectious diseases in children. While Ethiopia has emphasized child vaccination, its effectiveness largely depends on efficient communication between health practitioners and mothers/caregivers. Thus, sufficient communication contributes to promoting child immunization and in turn improving child health.

AIM

To examine child vaccine communication practices and strategies as well as their relationship with sociodemographic characteristics of respondents in the Amhara region of Ethiopia.

METHODS

A quantitative cross-sectional survey was conducted using a pretested Likert scale questionnaire and distributed to 123 health workers in primary healthcare centers between April 2024 and June 2024. The data were analyzed using both descriptive and inferential statistics.

RESULTS

The results indicated that the most common vaccine communication activities included education and communication (mean score = 24.1), vaccine data registration (mean score = 8.86), and information exchange (mean score = 8.3). A significant correlation was found between the implementation of interpersonal health communication principles and immunization communication training (F = 341.756, P = 0.000, P < 0.05). However, no significant correlations were observed between age, education, work experience, and vaccine communication practices. Additionally, the study found that the application of interpersonal communication principles was associated with the perceived relevance of immunization communication (F = 27.790, P = 0.000, P < 0.05).

CONCLUSION

Based on the findings the study concluded that communication practice in promoting child immunization is insufficient. To enhance vaccine acceptance, continuous immunization communication training for health workers is recommended.

Key Words: Child vaccine communication; Health workers; Health communication modes and strategies; Vaccine communication activities

Core Tip: This study presented an innovative approach to child vaccine communication in promoting child immunization in the Amhara region, Ethiopia using a quantitative research approach. We found that immunization communication training has a significant impact on child vaccine communication practice. This finding has a potential influence on showcasing the role that communication plays in primary healthcare service delivery, like immunization. Consequently, it will be used to improve the efficiency and adequacy of child immunization outcomes in the near future. Scholars in the area can study the determinants of effective child vaccine and vaccination communication.

INTRODUCTION

Immunization is the most cost-effective public health strategy for controlling infectious diseases[1,2]. As a crucial public health issue, vaccination emphasizes the necessity of health communication strategies in the social sciences[3]. As a result, Ethiopia has invested in a variety of vaccination programs, leading to notable progress in the prevention and control of infectious diseases[4]. Efforts have been made to improve regular vaccination rates and to lessen the burden of vaccine-preventable disease at all tiers[5,6]. Notwithstanding these initiatives, vaccination coverage has remained low, with recent declines noted[4,7]. For example, only 39.09% of Ethiopian children aged 12-23 months have received the complete set of recommended vaccinations[8].

Child health in the Amhara region improved between 2005 and 2016, especially in terms of preventing illness in children under 5 years[9]. Nevertheless, the region’s health status remains low, and many children still die from vaccine-preventable diseases. According to the regional Expanded Program on Immunization (EPI) 5-year report, low vaccination rates are a major contributing factor, with immunization coverage reported at 26.7%[10]. A lack of knowledge and targeted communication efforts may trigger this issue, reducing parental confidence in vaccine decisions and weakening trust in immunization programs[11]. In addition, it can be attributed to poor integration between communication initiatives and health extension activities as well as gaps in communication and social mobilization interventions[4].

Vaccination is often viewed through the lens of cost, accessibility, and clinical effectiveness in preventing and managing infectious diseases. This one-directional focus highlights the neglect of the communication aspect of vaccination programs[12,13]. Despite its potential to significantly improve child immunization rates, communication receives limited attention within the health sector. In particular, there is insufficient emphasis on promoting effective communication strategies to encourage acceptance of routine childhood vaccines[14]. This accentuates a broader issue: The lack of effective messaging about the importance of vaccines and the need to begin immunizing children at an early age[12,13].

Health communication serves as a crucial tool for raising awareness, shaping positive attitudes, and influencing vaccination-related behaviors. Since the introduction of the first vaccine, effective communication has played a key role in changing public perceptions and inspiring parents to immunize their children against various vaccine-preventable diseases[15,16]. One of the most significant factors affecting vaccine uptake is the quality of communication between parents and health service providers[17,18] and underlies that poor communication can negatively impact vaccine acceptance. In summary, poor communication may be a critical factor contributing to low childhood vaccination rates as inadequate messaging around vaccination can hinder immunization efforts and reduce vaccine acceptance[19-21].

Notably, health workers should engage in a range of communication activities to enhance caregivers’ understanding of the importance of routine childhood vaccinations and to improve immunization rates[22]. Identifying the key communication activities that effectively promote child immunization is essential. Equally important is understanding which communication strategies are most commonly used to implement effective interventions and increase vaccine uptake[23]. This is crucial because different communication strategies can have varying impacts: Some may encourage vaccine acceptance, while others might inadvertently contribute to vaccine hesitancy[11,24].

With the aforementioned problems in mind, we conducted this study with the aim of addressing the existing knowledge gap by answering the following research questions: (1) What were the major communication activities that health workers have been doing to facilitate routine child vaccine uptake in Amhara Region? (2) What were the most frequently used communication strategies that have been used to communicate about child vaccines and vaccination? and (3) Was there a relationship between child vaccine communication and the sociodemographic characteristics of the respondents?

Theoretical framework

The study aimed to examine child routine vaccine communication practices in the Amhara region of Ethiopia. To achieve this social cognitive theory (SCT) was used as an analytical framework. Among the behavioral theories, SCT is pertinent for studies focused on health promotion and behavior change[25]. It provides a preventive framework for analyzing how health professionals deliver health education with the goal of influencing the behaviors of primary healthcare users[26]. The theory suggests success of health education and communication interventions in boosting parental confidence, and increasing vaccine uptake may depend on the strategies used to implement these interventions[27].

This theory is used to guide the study because by integrating the principles of SCT, healthcare providers can implement health interventions that utilize effective communication strategies to promote positive health behaviors and improve health outcomes. Specifically, SCT helps identify the communication activities undertaken by health professionals to enhance mothers’ and/caregivers’ knowledge, understanding, and intention to vaccinate their children and maintain their health. Furthermore, SCT helps to evaluate whether health professionals apply interpersonal health communication principles, recognizing that the way they educate mothers and/caregivers significantly impacts the effectiveness of the message. Additionally, the theory supports the researchers in identifying the most frequently used modes and strategies for communicating information about child vaccines and vaccination.

MATERIALS AND METHODS

Study design, site, and period

To achieve the objectives of the study, a quantitative research method was employed. This approach enables the generalization of findings by describing and characterizing phenomena through numerical data[28,29]. It is also a widely accepted method in health communication research[30]. Therefore, the researchers considered this design appropriate as the research questions align with the theoretical foundations that support the use of quantitative methods. Accordingly, a cross-sectional survey design was utilized to examine child vaccine communication practices between April 2024 and June 2024.

The study was conducted in the Amhara region, specifically within the Gondar and Woldia town administrations. Gondar town administartion has a total of 23 public health facilities, including one comprehensive specialized hospital, eight health centers, and fourteen health posts. In Woldia town administration, there are seven public health facilities, consisting of one general hospital, two health centers, and four health posts.

Area and participant sampling and participant recruitment

The selected study sites were purposively chosen based on vaccination coverage data from the EPI reports over the past 5 consecutive years. According to the EPI report from the Amhara region, both towns have consistently demonstrated low childhood immunization coverage compared with other areas in the region.

The study involved nurses and health extension workers who were providing vaccination services for children. In the study areas, a total of 136 health workers were involved in child immunization services, 26 from Woldia and 110 from Gondar. Of these 13 health workers participated in the pilot test and were excluded from the main study. Consequently, using a comprehensive sampling technique, the remaining 123 health workers were included in the study. This technique is appropriate when the total population is fewer than 200, making it manageable for a survey[31,32].

The participants were recruited from the two cities through face-to-face contact. Specifically, participants from Gondar were recruited on May 16, 2024, while those from Woldia were recruited on June 30, 2024. The authors did not have access to any information that could identify the participants of the study.

Data gathering tool

A questionnaire was used as the data collection tool for this study. It is a widely utilized instrument in the social sciences for measuring behavior and perceptions. Questionnaires are particularly effective for eliciting large amounts of information from a significant number of respondents within a short time frame and in a cost-effective manner[33,34]. The design of the questionnaire was guided by SCT, ensuring the inclusion of relevant items that addressed the behavioral, cognitive, and environmental components of child vaccination and vaccination communication interventions.

The researcher developed five-point Likert-type scales measuring agreement, frequency, and degree of trustworthiness, drawing on concepts adapted from various sources[35-38]. To ensure validity, an expert review technique was employed. This involved inviting professionals from the same field of study to assess the content and face validity of the questionnaire[39,40].

The reliability of the questionnaire was assessed through a pilot test. The results indicated that the tool was highly reliable, with a Cronbach’s alpha value of 0.89. Before the instrument was utilized to gather data for the main study, the appropriate adjustments were performed in light of the findings from the preliminary study.

Data analysis techniques and procedures

Following data collection, the responses were coded and entered into SPSS software, version 23. Data analysis was conducted using both descriptive and inferential statistical methods. Descriptive statistics, including means, frequencies, and percentages were used to summarize and present the characteristics of the sample respondents[41].

The researchers used inferential statistics to make inferences about the broader population based on the sample data. Specifically, the relationship between participants’ sociodemographic characteristics and vaccine communication practices was analyzed using a one-sample t-test, one-way analysis of variance (ANOVA), and Pearson correlation. These statistical methods correspond with the main tenets of the theoretical framework, SCT, which underscores the interconnected impact of cognitive, behavioral, and environmental factors.

As SCT corroborates, health education is a shared process between healthcare providers and service users. Thus, understanding the interactions among variables is essential for identifying the factors that influence the effectiveness of child immunization communication interventions. SCT further posits that examining the dynamic relationships among cognitive factors (e.g., knowledge about how to communicate), environmental factors (e.g., communication strategies used), and behavioral factors (e.g., the actual communication delivered to mothers) are critical to achieving successful child health outcomes.

Techniques applied to reduce measurement bias, participant bias, and data collection bias

To eliminate various types of bias, several techniques were implemented. First, measurement bias was addressed by conducting a pilot test, which helped refine the tool for greater clarity and effectiveness. Second, participant bias was minimized by selecting a diverse group of participants, ensuring variation in sex, age, educational status, and work experience. This approach helped reduce data collection bias. Furthermore, data collection bias was further mitigated by preparing a well-organized and pretested questionnaire that allowed respondents to answer objectively.

Ethical consideration

Ethical clearance for the study was obtained from the Institutional Review Board of Bahir Dar University (Protocol No. 14/IRB/24) in accordance with the Declaration of Helsinki standards for research involving human subjects. Based on this clearance the Amhara region Public Health Institute issued a support letter (Ref. No. APHIHRTT 03/2098) addressed to the health bureaus in the study sites.

Participants were fully informed about the purpose of the study, and it was clearly communicated that participation was voluntary, with the option to withdraw at any time without any consequences. All respondents provided informed written consent after agreeing that their data would remain anonymous and could be used for publication purposes. Through these measures all ethical considerations related to research involving human subjects were carefully addressed and upheld throughout the study.

RESULTS

Profiles of the respondents

Table 1 presents the sociodemographic characteristics of the respondents, providing a general overview of the sample population and serving as a basis for examining potential relationships with the study data. The majority of respondents were female, with 121 (98.4%) females and only 2 (1.6%) males. Most participants were between 26-35 years old (61.8%), followed by those aged 36-45 (22.8%). Respondents aged 18-25 accounted for 15 individuals (12.2%), while 4 respondents (3.2%) were in the 46-55 age group. The majority of participants (78.0%) held qualifications below a bachelor’s degree. Additionally, 19 respondents (15.5%) held a bachelor’s degree or higher, and 8 (6.5%) reported having a level 3 qualification. More than half of the respondents (51.2%) had 6-10 years of experience. This was followed by 30.9% with 11-15 years, 13% with 1-5 years, and 4.9% with 16 years or more. The majority of respondents (46.3%) reported having received the training once, while 17.1% received it twice, and 1.6% received it three or more times. Notably, 35.0% of the participants had not received any vaccine communication training. In terms of relevance, 35.8% of the respondents rated the importance of vaccine communication training as high, while 35.0% rated it as very high. Conversely, 1.6% rated its relevance as low, and 27.6% indicated that the relevance of such training was unknown to them.

Table 1 The frequency distribution of the respondents’ sociodemographic characteristics.

Variables		n = 123	%
Sex	Male	2	1.6
	Female	121	98.4
Age	18-25	15	12.2
	26-35	76	61.8
	36-45	28	22.8
	46-55	4	3.2
Education level	Level 3	8	6.5
	Below bachelor’s degree	96	78.0
	Degree and above	19	15.5
Working experience	1-5 years	16	13.0
	6-10 years	63	51.2
	11-15 years	38	30.9
	16 and above	6	4.9
Vaccine communication training	No training taken	25	20.3
	Took once	75	61.0
	Took twice	21	17.1
	Took three or more times	2	1.6
Relevance of vaccine communication training	Low	2	1.6
	Unknown	23	18.7
	High	53	43.1
	Very high	45	36.6

Child vaccine communication activities

The mean score for each respondent was calculated based on their average responses to the items related to vaccine communication activities and was then compared with the test value (expected mean). As shown in Table 2, the sample mean score for health education and communication activities is 24.10, which is significantly higher than the test value (expected mean) of 18.00. Similarly, for the second key vaccine communication activity, registering vaccine data, the sample mean of 8.86 is notably higher than the expected mean of 6.00. Additionally, the t-test result for the activity of exchanging vaccine and vaccination information indicates that the calculated mean of 8.30 also significantly exceeds the expected mean of 6.00. As shown in Table 3, the t-test result for the implementation of interpersonal health communication principles is 22.90, which is significantly higher than the expected mean of 18.00.

Table 2 Mean comparison between the calculated and the expected.

	T	Df	Sample mean	Test value	P value	Mean difference	95%CI of the difference
							Lower	Upper
Health education and communication total	17.232	122	24.10	18.00	0.000	6.098	5.40	6.80
Registering information	26.680	122	8.86	6.00	0.000	2.862	2.65	3.07
Exchange information	20.139	122	8.30	6.00	0.000	2.301	2.07	2.53

CI: Confidence interval.

Table 3 Mean comparison (observed and expected).

	T	Df	Sample mean	Test value	P value	Mean difference	95%CI of the difference
							Lower	Upper
The implementation of interpersonal health communication principles	8.729	122	22.9	18	0.000	4.902	3.79	6.01

CI: Confidence interval.

The impact of sociodemographic variables on the child vaccine communication practice

An ANOVA was conducted to examine the impact of sociodemographic factors, specifically age group, educational level, and work experience, on vaccine communication activities and the implementation of interpersonal health communication principles.

The results of the one-way ANOVA presented in Table 4 indicated that there is no significant variation among age groups in their ratings of the three major vaccine communication activities, education and communication (F = 2.418, P = 0.070), registering data (F = 1.228, P = 0.303), and exchanging information (F = 1.955, P = 0.124).

Table 4 Analysis of variance between the sociodemographic variables and the vaccine communication activities.

Dependent variables	Independent variables	n	Mean square	F	P value
Education communication activity	Between age groups	123	35.982	2.418	0.700
	Between educational levels	123	18.003	1.172	0.313
	Between years of work experience	123	22.712	1.493	0.220
Register child vaccine and vaccination data	Between age groups	123	1.728	1.228	0.303
	Between educational levels	123	2.557	1.831	0.165
	Between years of work experience	123	2.321	1.667	0.178
Exchange vaccine and vaccination information	Between age groups	123	3.067	1.955	0.124
	Between educational levels	123	4.080	2.609	0.078
	Between years of work experience	123	1.006	0.621	0.603

Similarly, no significant differences were found based on educational level in the ratings of these activities: Education and communication (F = 1.172, P = 0.313), registering data (F = 1.831, P = 0.165), and exchanging information (F = 2.609, P = 0.078). As all P values were greater than 0.05, the differences were not statistically significant. In terms of work experience, the results also indicated no significant variation in how respondents rated the communication and education activities (F = 1.493, P = 0.220), registering data (F = 1.667, P = 0.178), and exchanging information (F = 0.621, P = 0.603).

The results presented in Table 5 showed that respondents’ ratings of the implementation of interpersonal health communication principles did not significantly vary by age (F = 0.009, P = 0.999), educational level (F = 52.115, P = 0.263), or work experience (F = 0.703, P = 0.552), as all P values were greater than 0.05. However, significant differences were found in ratings based on immunization communication training (F = 341.756, P = 0.000) and the relevance of such training (F = 27.790, P = 0.000), both of which yielded P values less than 0.05.

Table 5 One-way analysis of variance.

	Variables	n	Mean square	F	P value
The implementation of interpersonal health communication principles	Between age groups	123	0.358	0.009	0.999
	Between groups in terms of education level	123	52.115	52.115	0.263
	Between groups in terms of work experience	123	27.474	0.703	0.552
	Between groups based on immunization communication training	123	1413.544	341.756	0.000
	Between groups in terms of the perceived relevance of immunization communication training	123	649.931	27.790	0.000

Following these findings, a correlation analysis was conducted to further explore the relationship between immunization communication training, the relevance of the training, and the implementation of interpersonal health communication principles. As presented in Table 6, the correlation between immunization communication training and respondents’ scores on the implementation of interpersonal health communication principles was statistically significant, with a correlation coefficient of r = 0.734 and P = 0.00 (P < 0.01). Additionally, a significant positive correlation was found between respondents’ perceived relevance of immunization communication training and their scores on the implementation of interpersonal health communication principles, with r = 0.443 and P = 0.00 (P < 0.01).

Table 6 Correlation analysis.

Variables	Pearson correlation	P value	n
Immunization communication training	1.000	N/A	123
The implementation of interpersonal health communication principles	0.7341	0.000	123
The relevance of immunization communication training	1.000	N/A	123
The implementation of interpersonal health communication principles	0.4431	0.000	123

¹Correlation was significant at the 0.001 level. N/A: Not available.

The frequency of using different communication modes and strategies

To identify the most frequently used communication modes and strategies, the frequency of using each mode and strategy was computed. Table 7 indicates that the frequency of using audio, video, and brainstorming methods to educate and communicate about routine childhood vaccines is infrequent, with a mean score of 1.98. In contrast, oral communication or word-of-mouth is the most frequently used mode, with a mean score of 4.11, suggesting it is the most frequently used method employed by health workers when communicating with mothers and/caregivers.

Table 7 Frequency of modes of communication.

Item	n	Mean
Providing health education by using audio-visual aids and brainstorming modes	123	1.98
Providing health education by using oral/word of mouth/paper-based modes	123	4.11

As shown in Table 8, one-to-one communication was the most commonly used strategy, with a mean score of 3.50. This was followed by one-to-group communication, which had a mean score of 3.32. Door-to-door communication was also utilized, with a mean score of 3.17. In comparison peer-to-peer communication was the least frequently used strategy, with a mean score of 2.25. The results also indicated that community meetings were infrequently used to educate the public about child vaccination, with a mean score of 2.39. The use of community radio was reported to be very infrequent, with a mean score of 1.56. Additionally, using mobile to communicate about child vaccines and vaccination was of moderate frequency, with a mean score of 2.59.

Table 8 Frequency of communication strategies.

Items	n	Mean
One-to-one communication strategy	123	3.50
One-to-group communication strategy	123	3.32
Door-to-door communication strategy	123	3.17
Peer-to-peer communication strategy	123	2.25
Educate and communicate with the community at community meetings	123	2.39
Educate and discuss with mothers/caregivers through using community radio	123	1.56
Use mobile phone to communicate with mothers/caregivers about child vaccine and vaccination	123	2.59

DISCUSSION

Relevance of immunization communication training

The results indicated that the majority of respondents (70.8%) recognized the relevance of immunization communication training. Effective communication is a critical component of successful immunization service delivery, and its impact can be significantly enhanced through targeted training. The findings suggested that health workers who have received communication training demonstrated improved interactions with service users. However, despite this recognition a considerable proportion (35.0%) of immunization service providers reported not having received any communication training. This gap in training may hinder their ability to effectively engage with mothers and caregivers, thereby limiting the success of communication interventions aimed at promoting routine childhood vaccinations[42].

Major child vaccine communication activities

Based on the results three primary communication activities carried out by health professionals to support child immunization were identified and are discussed below.

Education and communication: To identify the major communication activities, respondents’ scores on items related to education and communication were aggregated, and a one-sample t-test was conducted to compare the observed mean with the expected mean. As shown in Table 2, the average mean score for education and communication activities was 24.10, which was significantly higher than the expected mean of 18.00. This indicated that health workers actively engaged in educating mothers and caregivers on key aspects of immunization. These activities included explaining the purpose and importance of vaccines, the different types of vaccines, possible side effects following immunization, methods for relieving post-vaccination discomfort, the importance of bringing vaccination cards to appointments, and reminders for upcoming vaccine schedules.

Educating parents about routine childhood vaccines is essential for increasing their awareness of the importance of immunization for their child’s health[43]. Adequate communication between health workers and mothers has been revealed to improve the timely acceptance of vaccines[44]. As emphasized in the literature, it is the responsibility of health service providers to actively educate and communicate with mothers and keep them well-informed about child vaccination. This informed approach permits parents to make positive and timely decisions regarding their children’s immunization[38].

Recording data: The recording of vaccine and vaccination data is another major vaccine communication activity, with the average mean score of 8.86. This score is significantly higher than the expected mean of 6.00. This finding suggested that health workers consistently engaged in recording vaccine information in the child’s vaccination card and in the official register book[44].

Exchange information: The third major vaccine communication activity that health workers carry out is information exchange. The average mean score for this activity was 8.30, which is significantly higher than the ideal mean of 6.00. This suggests that health workers engage in sharing information related to child vaccines and vaccination.

For instance, they share updates regarding newborns who have not yet begun vaccination or children who have started but not completed their immunization schedules. Additionally, they are responsible for compiling and submitting weekly and monthly reports to the appropriate health authorities. These findings are consistent with previous research indicating that health professionals routinely share information concerning child vaccination practices[44].

Impact of the sociodemographic variables on vaccine communication

To assess the impact of respondents’ sociodemographic characteristics on vaccine communication, a one-way ANOVA was conducted. As shown in Table 6, no statistically significant differences were observed in respondents’ ratings of communication activities based on age, education level, or work experience. Consequently, the researcher inferred that these demographic factors do not have a meaningful influence on child vaccine communication practices among the health professionals surveyed. However, this finding contrasts with previous studies which suggest that physicians’ age can influence their communication with patients[45]. Moreover, professional development and educational advancement among health workers have been linked to improved healthcare service delivery[46,47]. Whenever there is an educational status upgrade, there is a difference in the health care service provision[47].

Implementation of interpersonal health communication principles

The respondents were asked to indicate their level of agreement regarding the implementation of interpersonal health communication principles. To analyze this, individual scores on the related items were summed, and the average mean score was calculated using a one-sample t-test. As shown in Table 4, the average mean score was 22.90, which is significantly higher than the expected mean value of 18.00. This finding suggested that health workers are actively applying interpersonal communication principles in their interactions with caregivers. This result aligns with existing literature, which highlights that effective interpersonal communication in healthcare is grounded in practices such as the use of clear and simple language, active listening, demonstrating empathy, encouraging patient questions, and providing appropriate responses[48,49].

A one-way ANOVA was conducted to assess the impact of immunization communication training and its relevance on the implementation of interpersonal communication principles. As presented in Table 5, there were significant differences in implementation ratings among respondents based on whether they had received immunization communication training (F = 341.756, P < 0.001) and their perception of the relevance of the training (F = 27.790, P < 0.001). Specifically, health workers who had received the training were significantly more likely to report implementing interpersonal communication principles compared with those who had not. Similarly, respondents who rated the relevance of the training as high or very high reported greater implementation of these principles than those who perceived it as low or unknown. These findings suggest that both participation in training and the perceived importance of the training are positively associated with the application of interpersonal health communication principles.

Correlation analysis (Table 6) further revealed a significant positive relationship between immunization communication training, its relevance, and the implementation of interpersonal health communication principles. This suggested that health workers who received immunization communication training were more effective in applying these principles. Likewise, those who perceived the training as relevant demonstrated higher levels of implementation. These findings reinforce the importance of both training and its value in enhancing the application of interpersonal communication strategies in immunization contexts. Emphasizing the relevance of health communication training, previous research highlighted its critical role in strengthening health professional–client interactions and improving healthcare outcomes by enhancing the efficiency of public health decision-making processes[50].

Most frequently used communication modes and strategies

To identify the most frequently used modes and strategies of vaccine communication, the frequencies and percentages of respondents’ ratings were calculated. The results are presented above and discussed accordingly.

Most frequently used modes of health communication: The results presented in Table 8 indicated that the mean score for the use of audio-visual and brainstorming communication modes in conveying information about child vaccination was relatively low (M = 1.98). This suggested that such modes are not commonly utilized by health workers. In contrast oral and/or paper-based communication received a higher mean score (M = 4.11), indicating that these were the most frequently employed modes of communication. This preference may be attributed to limited access to resources required for alternative methods. Consistent with this finding previous studies have reported that health service providers primarily rely on verbal and written materials to educate patients about their health[51].

Despite the current findings existing literature strongly supports the use of audio-visual aids in health education and promotion. These tools are essential for fostering interactive discussions and enhancing comprehension of health-related information. Audio-visual communication has been shown to improve both understanding and recall, thereby encouraging healthier behaviors among patients[52,53]. For example, research indicated that participants preferred real-life photographs in immunization messaging as these visuals helped them relate to and retain the information more effectively[54,52]. Similarly, another study found that housewives who received HIV/AIDS prevention education through audio-visual materials significantly increased their knowledge and ability to protect themselves[55].

Furthermore, flipcharts and booklets have been found to positively influence communication in primary healthcare settings[56]. Compared with written materials, visual aids are more effective in capturing patients’ attention and conveying health information clearly and memorably[54]. Collectively, these studies affirmed the significant role of audio-visual aids in enhancing effective interpersonal communication regarding health issues.

Therefore, we recommends that rather than relying solely on oral and paper-based communication methods health centers should expand their health education and communication services for mothers, caregivers, and the broader community by incorporating audio-visual media such as flipcharts, graphs, posters, and brainstorming techniques alongside traditional methods. This strategy can improve continuous communication and help sustain the demand for and adoption of childhood vaccines that should be taken regularly. Furthermore, the heavy reliance on oral and paper-based methods may be partly attributed to a lack of adequate communication and educational materials.

Most frequently used communication strategies: As indicated in the results section, the mean scores for the use of various communication strategies to educate and communicate with mothers and caregivers were calculated. To identify the most frequently used strategies, a mean score of 3.00 was set as the cutoff point. Communication methods with a mean score of 3.00 or higher were considered frequently used, while a score below three was interpreted as infrequently utilized[57].

As presented in the results section, one-to-one communication had the highest mean score (M = 3.50), followed by one-to-group communication (M = 3.32) and door-to-door communication (M = 3.17) methods. This underlined that one-to-one, one-to-group, and door-to-door communication methods are the methods that health workers mostly used to educate and communicate with mothers and caregivers about child vaccines and vaccination.

One-to-one communication is a crucial method for effective interpersonal communication and allows health workers to frame messages according to the specific needs of individual mothers and caregivers[23]. It creates an interactive platform for dialogue with parents, addressing key questions related to the why, where, when, and how of child vaccination in a form of face-to-face educational intervention[58]. It is evident that the method plays a crucial role in facilitating maternal and child healthcare, such as promoting vaccination and family planning[59].

One-to-group communication involves educating the community, including mothers and caregivers through meetings or conferences. This method allows health workers to meet with many caregivers at once, making it a manageable approach in terms of time and resource utilization. It is always employed in the form of lectures to inform people about a specific health issue. Correspondingly, previous research findings have revealed that health experts often use the group communication method, particularly open lectures, to ease dialogue among participants[60].

Door-to-door communication is a method that is always used to promote child vaccines and vaccination in the Amhara region. This approach is a proactive and tailored method of interacting with mothers and other family members through household home visiting. It is germane to inform mothers about their concerns related to child vaccines and vaccination and to build trust and understanding at the family level. Literature has demonstrated that health service providers educate families on disease prevention and health promotion through door-to-door visits[61]. This strategy was found to be effective in enhancing children’s nutritional status[62].

Conversely, with mean scores of 2.25, 2.39, 1.56, and 2.59 respectively, peer-to-peer communication, community meetings, community radio, and mobile communication were among the least frequently used strategies. The low mean score for peer-to-peer communication suggests that mothers and caregivers do not often share vaccine and vaccination information and knowledge among themselves. This may be a lack of health professionals’ initiatives to empower and encourage mothers to engage in reciprocated learning and experience-sharing regarding child vaccines and vaccination. Peer communication is an influential method of communication which helps mothers and caregivers to communicate easily and openly with one another from their surroundings. Enhancing the use of this strategy could increase the integrity and acceptance of vaccine and vaccination information by placing greater trust in those who know each other personally[63].

Nonetheless, using peer education requires peers to be successfully trained, knowledgeable about the health issue, and openly interested in informing and dealing with others. In particular, they must have facilitation and communication skills to convey health messages effectively[64]. Therefore, the infrequent use of peer-to-peer communication in sharing vaccine information among mothers may be attributed to a lack of trained and empowered caregivers who are capable to educate their peers.

Promoting the use of community meetings as a health education strategy could significantly enhance community involvement and strengthen the linkage between the community and health facilities[65]. Community meetings serve as a platform to inform the public, raise awareness, and encourage active participation in child disease prevention efforts, thereby promoting routine immunization[66].

Furthermore, to expand the reach and impact of health education and communication, increase awareness and ensure behavioral changes regarding child vaccination, using community radio is a recommended strategy. It serves as an effective medium for promoting other essential health interventions, such as nutrition, which are crucial for ensuring child health[67].

Scholarly evidence also supports the use of mobile phones as an effective tool for health promotion. For example, studies have shown that using mobile phones to send text messages and voice calls increases contact with health service users, overcoming the limitations of time and place[68]. Additionally, mobile phones enable health promotion activities to be carried out with limited human resources, making them a cost-effective solution for reaching a wider audience[69].

In summary, the data revealed a strong reliance on oral and face-to-face interpersonal communication methods, while highlighting the underutilization of audiovisual communication materials, such as PowerPoint presentations, photographs, pictures, videos, and community-based strategies (e.g., community meetings and community radio). Expanding the use of diverse communication methods, including communication technologies (such as mobile phones) and increased community engagement, could significantly enhance the overall effectiveness of immunization education and communication efforts[70].

Limitation of the study

The study had some limitations including using only one research design, the quantitative design. If a mixed-methods design was used, the findings of the study could have incorporated the different lenses of child vaccine communication practice, including providing understanding of the communication strategies used, the underlying reasons for their frequent or infrequent utilization, and their effectiveness or limitations.

CONCLUSION

Based on the findings the researchers concluded that child vaccine communication practices in the region are insufficient. Though the literature supports the frequent utilization of the different communication strategies for a positive child health promotion and outcome, most of the communication strategies are not frequently employed. Additionally, the inadequacy of the practice may result from a lack of immunization communication training for health professionals. The provision of healthcare services regardless of taking appropriate communication training repeatedly places the critical role that communication can play at risk.

Accordingly, the researcher suggested that health professionals should take immunization communication training by virtue of its importance in effectively educating and communicating with mothers and caregivers. Additionally, the use of audio-visual aids should be prioritized, as it enhances understanding of information related to child vaccination. Given the infrequent use of audio-visual communication, which is likely because of resource shortages, health facilities should ensure the availability of the necessary tools for the sufficient provision of child vaccine education and communication services.

Moreover, peer-to-peer education promotes community participation in child immunization initiatives. Consequently, the utilization of this strategy can be enhanced by providing training on child vaccination to mothers and caregivers. The authors corroborated that promoting mothers to educate and communicate with each other can be an effective strategy to address the human resource gap. Similarly, promoting the regular utilization of community radio and community meetings can allow for improving community involvement in promoting child vaccines and vaccination. Lastly, fostering the use of mobile phones for immunization communication is essential, especially in urban areas of the Amhara region as mobile phones are influential tools for communicating about health.