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Amref Institutional Repository
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HMD 311: Communication and Advocacy in Health (Sept-Dec 2025)
(2025-12) Department of Health Systems Management and Development
The Vaccine Trust Framework: mixed-method development of a tool for understanding and quantifying trust in health systems and vaccines
(Elsevier Ltd, 2025-09) Muhula PhD, S O; Osur PhD, J; et al...
Summary
Trust is a key component of vaccine demand; however, there is no consensus on how to define trust and a lack of actionable, contextually grounded measurement tools validated in low-income and middle-income countries.
Trust is a key component of vaccine demand; however, there is no consensus on how to define trust and a lack of actionable, contextually grounded measurement tools validated in low-income and middle-income countries.
Aim
To develop and validate a Vaccine Trust Framework and a trust measurement tool that can be used to leverage trust to drive resilient vaccine demand.
To develop and validate a Vaccine Trust Framework and a trust measurement tool that can be used to leverage trust to drive resilient vaccine demand.
Methods
An exploratory sequential mixed-methods study was conducted.
An exploratory sequential mixed-methods study was conducted.
- Ethnographic research in Nigeria, Kenya, and Pakistan to define trust in the context of childhood, HPV, and COVID-19 vaccines.
- Validation through a nationally representative survey of caregivers of adolescents in Kenya and Pakistan.
- Psychometric assessment using confirmatory factor analysis and logistic regression.
Findings
-
The Vaccine Trust Framework consists of
four interlinked domains and
15 measurable dimensions:
Health system promise, health system delivery, vaccine promise, and vaccine delivery. - Survey data were collected from 3670 participants in Kenya and 3734 participants in Pakistan.
- Trust influenced vaccine behaviour and intentions, supported by associations between quantitative trust scores and vaccination status.
- Regional variation in trust was observed within Kenya and Pakistan, aligning with qualitative perceptions of local vaccine and health systems.
Interpretation
The Vaccine Trust Framework provides a validated and contextually grounded tool for assessing trust in health systems and vaccines in low-income and middle-income countries.
It can be used as a:
The Vaccine Trust Framework provides a validated and contextually grounded tool for assessing trust in health systems and vaccines in low-income and middle-income countries.
It can be used as a:
- Prognostic tool to anticipate vaccine demand
- Intervention design aid to support trust-building strategies
- Trust measurement tool within intervention or monitoring studies
Digital tracking of girls exposed to community led alternative rites of passage to prevent female genital mutilation/cutting, and child, early and forced marriages in Kenya: a longitudinal study
(Frontiers in Reproductive Health, 2025-05) Kawai, David; Mbogo, Bernard; Opanga, Yvonne; Muhula, Samuel; Esho, Tammary C.; Conradi, Hilke; Rutto, Viola J.; Lugayo, Denge; Matanda, Dennis J
Introduction: Female genital mutilation/cutting (FGM/C) and child marriage (CEFM) are harmful practices that are a human rights violation. For decades, many interventions have been implemented to end these practices. One such intervention is the Alternative Rite of Passage (ARP), which allows girls to go through a meaningful rite of passage without the cut. The ARPs have come under scrutiny due to a lack of data to show how effective ARPs have been. This study aimed to establish the effect of the Community-Led Alternative Rite of Passage (CL-ARP) model on incidences of FGM/C, CEFM and keeping girls and young women in school.
Methods: The study adopted a longitudinal design where girls and young women were enrolled into the CL-ARP programme and later followed up for over three years to assess the effectiveness of the CL-ARP model in preventing incidences of FGM/C, CEFM and keeping girls in school. A total of 2,647 girls aged 10–23 years who resided in Kajiado County were recruited and followed up post-exposure to CL-ARP. Data analysis involved conducting descriptive and logistic regression analyses.
Results: The CL-ARP programme kept 98% of girls free of FGM/C, 99% free of CEFM and 98% kept in school. 41 cases of FGM/C, 12 cases of CEFM and 48 cases of school dropouts were reported three years post-exposure. Girls who underwent FGM/C had been kept free of FGM/C for an average of 39.5 months, those who experienced CEFM had been kept free of CEFM for an average of 40.2 months, and those who dropped out of school had been kept in school for an average of 38.5 months. Girls and young women who experienced instances of threats/violence were more likely to experience FGM/C, CEFM and drop out of school than those who had not.
Conclusions: The CL-ARP programme was successful in keeping the majority of girls and young women free of FGM/C and CEFM, and retained in school post-enrollment. Reported cases of FGM/C, CEFM and school dropouts underline the importance of considering other contextual factors such as gender-based violence that may continue to put girls and young women at risk despite embracing CL-ARP.