Content and Factors Influencing Health Education in Immunisation Clinics in Nigeria

BACKGROUND: Most parents in Nigeria receive childhood vaccine education in a group clinic setting. These health talks are not standardised, and little is known about the topics addressed, how these topics are chosen, and how parents experience these talks. This study aimed to fill this knowledge gap. METHOD: We conducted a qualitative study in eight immunisation clinics across rural and urban sites in Borno and Cross River State, Nigeria. We audio-recorded two health education talks at each clinic-one with the health worker unaware of being recorded. We interviewed 40 parents and 16 health workers to gather insights. Content analysis identified topics covered, while thematic analysis explored motivations for the health education content from health workers' and parents' perspectives on the talks. RESULTS: The content and delivery method of the recorded health talks varied considerably within and between different health workers. Of the 16 analysed talks, 6 (37.5%) contained non-vaccine-related topics such as breastfeeding and family planning. The content of health talks was based on a clinic topic schedule, prevailing interests such as ongoing disease outbreaks, or the health workers' feelings and moods. Health workers mentioned they receive little to no formal training on the content and delivery of vaccine education. Current competency was primarily based on training received during formal schooling, embedded within other health programs or media outlets aimed at the general population. Parents generally perceived the educational sessions to be informative and important. However, short health talks, long clinic sessions and a lack of courtesy were barriers to a positive clinic experience. CONCLUSION: Inadequate and inconsistent health education on immunisation is prevalent at group-setting vaccine clinics in Nigeria and is driven by a lack of health worker training. Research and policy changes are critically needed to improve the quality of vaccine health education.