Focus group discussion to know the reasons of not being vaccinated as per the schedule for KFD vaccination

Kyasanur forest disease (KFD) is a tick-borne viral disease characterised by sudden onset of fever and/or headache followed by hemorrhagic manifestations such as conjunctival congestion, bleeding gums, epistaxis, haemoptysis, haematemesis and malena [1-3]. The disease reported for the first time from Shimoga district of Karnataka, India, is localised in five districts (Shimoga, Chikamagalur, Uttar Kannada, Dakshina Kannada and Udupi) of Karnataka state and occurs as seasonal outbreaks during January to June when the nymphal activity in the forest is maximum. Immunization with this vaccine has remained the key strategy for prevention of KFD in Karnataka since 1990. The focal immunization strategy involves annual rounds of vaccination using formalin inactivated tissue-culture vaccine. These campaigns are conducted during the months of August-November in the areas that reported KFD activity (defined as laboratory evidence of confirmed case in monkeys/ humans or infected ticks) in the previous transmission years and surrounding villages within a radius of 5 Km [13]. Two doses of the vaccine are administered to individuals aged 7-65 years at an interval of one month. As the immunity conferred by the vaccination is short-lived, booster doses are recommended within 6-9 months after primary vaccination and repeated for five consecutive years after the last confirmed case in the area [13]. If cases of KFD are reported in the area in spite of vaccination during the pretransmission season, additional vaccination campaigns are conducted. As part of the KFD vaccination programme, information about the number of individuals eligible for vaccination as well as coverage of vaccine is compiled. Analysis of the KFD vaccination and surveillance data from the five KFD endemic districts of Karnataka for the period 2005-2010 to estimate the coverage and the effectiveness of the KFD vaccine in the region shows that About 52% of the eligible population did not receive any vaccine while 36% of the population received two doses and a booster dose. The remaining 12% of the population received one or two doses of the vaccine. Hence we decided to conduct focus group discussions among people who are not received KFD vaccination as per schedule to know the reasons for not being vaccinated durin first week of January 2013. We will conduct one focus group discussion each in following five villages

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Annexure -1
Information sheet for the participants of Focus Group discussion on the Reasons for not being vaccinated for KFD as per schedule in Shimoga district, Karnataka, India, 2012 Sir/Madam, Greetings, I am Dr.Gudadappa Kasabi Taluk health officer Bhadravathi and Working for the Department of health and family welfare government of Karnataka. KFD vaccine is the key preventive measure to control Kyasanur forest disease. In Shimoga district from the previous 5 years data on KFD vaccination we learned that more than half of the target population is not receiving the vaccine. The purpose of this study is to generate information on not being vaccinated for KFD The National Institute of Epidemiology, ICMR, Chennai, The District Health Administration and District Health & Family welfare Office of Shimoga District, Karnataka State are working together in this research study. This study is intended to describe reasons for not being vaccinated. By knowing this information the health department will be able take some more interventions to improve the vaccination coverage. In this regard we would like to collect the opinion of the people who are not received complete vaccination as per the schedule by conducting a Focus Group Discussion. The discussion will take about 30- 45 minutes of your time. Your participation in this discussion will help us to understand the issues related to not being fully vaccinated. We would therefore request you to participate in this Focus Group Discussion. Your participation is voluntary. No one else will know whether or not you participated. We would maintain confidentiality of your comments. No compensation will be paid to you for taking part in this discussion. You can choose not to take part also. You can choose not to opine a specific point of discussion. You can also stop opining a specific point of discussion at any time without having to provide a reason. This will not affect your rights to avail any services in any of the health care settings. There is no specific benefit for you if you take part in the Focus Group Discussion. However, your participation in the discussion may help in improving KFD vaccination coverage in the community. When the results are analyzed, a report will be shared with the local health officials concerned with public health, so that the right measures can be taken to provide better acceptable health services to the community. The information we will collect in this Focus Group Discussion will remain between you and the principal investigator. We will not write your name on this form. We will only use a code instead. Only the principal investigator will know the key to this code. It will be kept under lock and key. It will be destroyed after the project is over. If you wish to know more about this study before taking part, you can ask me all the questions you want either in person or over phone with Dr.Gudadappa Kasabi, Primary investigator of this study, through mobile phone no. 9483683754. You can also contact the district health officer Shimoga over phone 9449843063

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Annexure -2 Written informed Consent

(For participant of Focus Group Discussion) I have read the foregoing information in the Kannada language version. I have had the opportunity to ask questions about it and any questions I have asked have been answered to my satisfaction. I consent voluntarily to participate as a participant in this Focus Group Discussion and understand that I have the right to withdraw from the discussion at any time without in any way it affecting my further medical care. I have received a copy of the information sheet and consent form.

Name of the participant

Signature of the participant

Name of the Principal Investigator

Signature of principal Investigator

Date:

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Annexure -3 Focus group discussion guide

Place: Date (including day of week): Time of Day: Primary Investigator: Dr.Gudadappa Kasabi Focus group discussion for Reasons for not being vaccinated for KFD as per schedule in Shimoga district, Karnataka, India, 2012 The aim of the focus group discussion is to encourage the general public to describe their opinion about not being vaccinated as per schedule. While facilitating this focus group we will try to learn as much as possible about the peoples opinion and reasons for not vaccinated as per schedule. STRUCTURE The focus group is split into two sections: 1. Introduction: explanation of the aims and objectives of the focus group 2. Activity: .Discussion about the topic. The focus group will take about 40-50 minutes to complete the discussion. RESOURCES We will need six to eight people who received one or two doses of KFD vaccine and then discontinued in Shimoga district of Karnataka as participant. Consent forms Refreshments for participants Voice recorder. Paper and pen for writing notes during the focus group discussion by the recorder.

1 INTRODUCTION: Facilitator instructions: After all the participants read the consent form they have to sign it. When all will finish, Facilitator starts the introduction. Facilitator suggested text: Thank you for taking the time to come and meet with us today. I am Dr.Gudadappa Kasabi Taluka health officer, Bhadravathi, we are conducting a project on reasons for not being vaccinated as per schedule in Shimoga district. Everything you say is confidential, so lets begin by introducing ourselves.

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2. ACTIVITIES Points of Discussion 1. Health seeking behaviors Where do you go for treatment if you are sick? What are the reasons to go there? 2. Awareness about Kyasanur forest disease (KFD). What do you know about Kyasanur forest disease? What are the symptoms of KFD? How it transmits What are the preventive measures? Belief about the KFD vaccine 3. What are the reasons for not being vaccinated as per schedule for KFD? Not aware of need Unaware of session site Non cooperative health worker Non availability of vaccines and logistics Painful/ fear of AEFI Out of village on the session day Busy with occupation Other reasons 4. Expectations of people towards prevention of Kyasanur forest disease Facilitator instructions: When discussion is complete, for confirmation and verification of the information anything not clear should be clarified with participants before ending the exercise. CONCLUSION - Facilitator suggested text: Thank you all for coming here today to discuss with us.

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Annexure -4 Focal group discussion Recording

Topic of Discussion: Reasons for not being vaccinated for KFD as per schedule in Shimoga district, Karnataka, India, 2012 Place: Date: ----------------Day: --------------Time: ----------Primary Investigator: Dr.Gudadappa Kasabi, Taluka health officer Bhadavathi The sitting arrangement was made in U shape to facilitate face to face discussion. The Facilitator will welcome all participants and gave a brief introduction about the topic to be discussed with the help of a information sheet and consent in writing was taken. All the participants were treated with light refreshments. Though all the participants knew each other well since they are living within the same village, formally Facilitator introduced himself and later Observer and Recorder introduced to all the participants and Participants introduced one by one as mentioned in the participants list. To record as fast as possible in pace with discussion by participants each of the participants has been given Serial No. (P1 to P10) as mentioned in the participants list and facilitator has coded as F and participants as p1 to p10.

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