Strengthening Capacity for Tailored Immunization Programs Using Adult Learning Principles: A Case Study from Nigeria.

Area of Science:

• Public Health
• Health Systems Strengthening
• Adult Education

Background:

• Nigeria faces a high burden of unvaccinated children, exacerbated by ineffective traditional training methods for immunization program managers (PMs) and healthcare workers (HCWs).
• Conventional training-of-trainers (TOT) models do not align with adult learning principles (ALPs), hindering the success of immunization programs.
• There is a need for tailored immunization strategies that effectively engage communities using data.

Purpose of the Study:

• To incorporate ALPs into TOT for immunization PMs and HCWs in Nigeria.
• To enhance the capacity of PMs and HCWs to use data for community engagement and develop tailored immunization strategies.
• To evaluate the impact of ALP-integrated training on participant satisfaction, knowledge, competence, behavior, and immunization program results.

Main Methods:

• A training curriculum integrating ALPs and human-centered design for tailoring immunization programs (HCD-TIP) was developed and implemented in three LGAs in Nigeria's Federal Capital Territory.
• State PMs (n=10), LGA PMs (n=30), and HCWs (n=42) received training on HCD-TIP approaches using ALPs.
• Participant satisfaction, knowledge, competence, behavior changes, and results were assessed using interviews, surveys, and observations.

Main Results:

• High participant satisfaction was reported: 100% for LGA PMs, 91% for state PMs, and 85% for HCWs.
• Significant improvements in knowledge and competence were observed post-training (P<.001).
• Trained participants conducted HCD sessions, co-designed 24 prototype solutions, and achieved substantial increases in pentavalent vaccine coverage (1st dose: 54%, 3rd dose: 188%) across 12 communities.

Conclusions:

• Applying ALPs, HCD-TIP approaches, and supportive supervision effectively enhanced the capacity of PMs and HCWs for tailored immunization interventions.
• The study demonstrates the effectiveness of a holistic approach integrating adult learning and human-centered design in strengthening immunization programs.
• Adoption of these methods can improve equitable vaccine coverage and strengthen health systems in Nigeria and similar settings.