Community Trust Barriers to Vaccine Uptake During Disease Resurgence: A Qualitative Descriptive Study
DOI:
https://doi.org/10.61919/xzmstw81Keywords:
family planning; qualitative research; community health workers; Marvi workers; contraceptive access; Sindh; thematic analysis; reproductive health.Abstract
Background: Family planning access in rural Sindh is shaped not only by service availability but also by gendered decision-making, household authority, contraceptive myths, privacy concerns, mobility restrictions, provider trust, and continuity of commodities. Qualitative evidence is needed to understand how women, men, frontline workers, and programme personnel perceive community-based family planning models and the conditions required for their acceptability and sustainability. Objective: To explore endline perceptions of a community-based family planning model involving Marvi workers, Marvi Markaz service points, and BiB-linked commodity access, with emphasis on barriers, facilitators, acceptability, and sustainability. Methods: An interpretative qualitative endline evaluation was conducted in selected intervention districts and villages of Sindh from 18 to 22 November 2024. Data were collected through in-depth interviews and focus group discussions with married women of reproductive age, men, Marvi workers, and district-level programme personnel. Transcripts and field notes were analyzed using thematic analysis, with attention to participant-group contrasts, implementation mechanisms, and trustworthiness through triangulation, reflexive memoing, audit trail, and direct quotation linkage. Results: The analysis identified interrelated themes around trust in Marvi workers, door-to-door counselling, Marvi Markaz as a safe and familiar service point, commodity availability, myths and fear of side effects, gendered household decision-making, elder influence, privacy and mobility constraints, worker capacity, and supervision/MIS for sustainability. Perceived acceptability was strongest when women experienced respectful counselling, confidentiality, safe access, and reliable commodities. Persistent barriers included misinformation, side-effect concerns, male or elder gatekeeping, restricted mobility, and dependence on continued worker support and supply-chain reliability. Conclusion: The model was perceived as acceptable through mechanisms of trust, proximity, privacy, and commodity access. Sustainability requires refresher training for Marvi workers, structured male engagement, privacy-sensitive service arrangements, reliable supplies, supportive supervision, and district-level ownership.
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Copyright (c) 2026 Li Ding, Santy Deasy Siregar, Elviyanti Br Tarigan (Author)
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