BACKGROUND Vaccination coverage in Bosnia and Herzegovina has been declining over recent years. A World Health Organization Tailoring Immunization Programmes (TIP) project is underway to gain insights into the underlying reasons for this, to develop tailored interventions. As part of TIP, this study aimed to investigate the views of health workers on their barriers and drivers to positive childhood vaccination practices. METHODS Face-to-face qualitative interviews explored 38 health workers' views on vaccination coverage, their vaccination attitudes, and system, programme and institutional influences on their vaccination practices. The data were analysed using content analysis and organised by the COM (Capability, Opportunity and Motivation) factors. FINDINGS Very few differences in barriers and drivers were evident between high and low coverage primary care centres or across different professional roles. Capability: Drivers included awareness of the risks of low vaccination coverage, regular use of the Rulebook and Order, knowledge of how to advise parents on mild side effects and recognition of the importance of good communication with parents. Key barriers were the use of false contraindications to postpone vacination and poor skills in tailoring communication with parents. Opportunity: Drivers were sufficient time for adminstering vaccination and good availability of vaccines. Several barriers were evident: lack of implementation of mandatory vaccination, no uniform recall and reminder system or system for detecting under-vaccinated children, staff shortages and lack of time to discuss vaccination with parents. MOTIVATION Drivers were a belief in the value, safety and effectiveness of vaccination and seeing that they have an important role to play. Barriers were a tendency to blame external factors e.g. anti-vax movement and a fear of being blamed for adverse events. CONCLUSIONS The study identified complex and inter-related barriers and drivers to health worker positive vaccination practices. These insights will now inform a process to identify and prioritize interventions.

中文翻译：

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确定疫苗接种的障碍和驱动因素：对波斯尼亚和黑塞哥维那联邦卫生工作者的定性访谈研究。

背景技术近年来，波斯尼亚和黑塞哥维那的疫苗接种率一直在下降。世界卫生组织定制免疫计划（TIP）项目正在进行中，目的是深入了解造成这种现象的根本原因，并制定针对性的干预措施。作为TIP的一部分，本研究旨在调查卫生工作者对其积极的儿童疫苗接种实践的障碍和驱动因素的看法。方法面对面的定性访谈探讨了38名卫生工作者对疫苗接种覆盖率，他们的疫苗接种态度以及系统，项目和机构对他们的疫苗接种实践的影响的观点。使用内容分析对数据进行分析，并按COM（能力，机会和动机）因素进行整理。研究结果在高覆盖率和低覆盖率的初级保健中心之间或在不同的专业角色之间，障碍和驱动因素之间几乎没有明显差异。能力：驾驶员包括对疫苗接种率低的风险的意识，定期使用《规则手册》，了解如何为父母提供轻微副作用方面的知识以及对与父母进行良好沟通的重要性的认识。关键的障碍是使用错误的禁忌症来推迟接种疫苗，以及在与父母沟通时缺乏技巧。机会：驾驶员有足够的时间进行疫苗接种和良好的疫苗供应。显然有几个障碍：缺乏强制性疫苗的实施，没有统一的召回和提醒系统或检测未接种疫苗的儿童的系统，工作人员短缺，缺乏与父母讨论疫苗接种的时间。动机驾驶员坚信疫苗的价值，安全性和有效性，并意识到自己可以发挥重要作用。障碍往往归咎于外部因素，例如抗vax运动，以及害怕因不良事件而受到谴责。结论该研究确定了卫生工作者积极接种疫苗的复杂且相互关联的障碍和驱动因素。这些洞察力现在将为确定和确定干预措施的优先顺序提供信息。结论该研究确定了卫生工作者积极接种疫苗的复杂且相互关联的障碍和驱动因素。这些洞察力现在将为确定和确定干预措施的优先顺序提供信息。结论该研究确定了卫生工作者积极接种疫苗的复杂且相互关联的障碍和驱动因素。这些洞察力现在将为确定和确定干预措施的优先顺序提供信息。