Table 3 Example of using qualitative evidence to populate the evidence-to-decision framework criterion on gender, health equity and human rights impacts – ‘direct’ equity impacts

Communication interventions to inform and educate caregivers on routine childhood vaccination in the African Region – Face-to-face interventions and community-aimed interventions (World Health Organization Regional Office for Africa: Guidance on Communication Interventions to Inform and Educate Caregivers on Routine Childhood Vaccination in the African Region, forthcoming)

Existing synthesis [27]

Synthesis finding 6 – Parents who had migrated to a new country had difficulty negotiating the new health system and accessing and understanding vaccination information (low confidence in the evidence)

Synthesis finding 16 – Parents felt that the vaccination card was a potentially important source of vaccination information, for instance, about the names of the diseases, the names of the vaccines and the date for the next appointment. However, some parents and informal caregivers found it difficult to read and understand this information (moderate confidence in the evidence)

Synthesis finding 32 – Parents wanted information that was presented in an understandable way that avoided technical terms and jargon to facilitate their assessment of the content. Parents sometimes found medical terminology used in medical research or by their healthcare provider difficult to understand and evaluate. Misunderstanding and lack of access were further compounded when written information was presented to illiterate mothers, when the mother’s education level was not taken into account when providing information, or when health workers did not provide any information at all. Parents also wanted information communicated in a language that they could understand. Some parents also found presentations in the media unclear due to the mixing of anecdotal and scientific evidence to create an impression of balance. A clear presentation of information was important for parents to feel like they had understood the information they had received (moderate confidence in the evidence)

Certain circumstances may make it particularly difficult for people to understand vaccination information. These include:

• literacy level: parents who are illiterate or who have lower levels of education may find information difficult to access, particularly when information is presented in writing or includes technical terms and jargon

• unfamiliarity with the health system: parents who have migrated to a new country may have insufficient knowledge about how immunisation services and policies work in their new countries concerning, for example, schedules and appointments

• language: parents who speak languages other than those most commonly spoken within the health services or the setting in which they live may find information difficult to access