Exploring Patterns of Non-Participation Across Multiple Health Campaigns

Research question

1. In areas with low coverage of MDA or a history of never treatment, low coverage for Expanded Programme on Immunization (EPI) vaccines, and/or high malaria prevalence in Ambon City and in Volta Region, Ghana, is never treatment/zero dose a household phenomenon that spans more than one health domain (e.g., neglected tropical diseases, vaccines, insecticide-treated bed net use)?

2. What are the features/traits of households or individuals who miss more than one public health intervention?

3. Does never treatment / zero dose / non-participation vary between public health interventions?


Through transect walks, focus groups, and interviews in Ghana and Indonesia, researchers explored rationales for non-participation in health campaigns, including childhood immunizations, COVID-19 vaccination, mass drug administration, and insecticide-treated net distribution. The findings indicate that although rationales may vary by campaign at the individual level, reasons for non-participation are similar across campaigns.

  • Reasons for non-participation represented four broad categories:

    • Health system-related reasons (e.g., low vaccine availability)
    • Intervention-related reasons (e.g., fear of receiving injections)
    • Personal reasons (e.g., religious or cultural beliefs)
    • Biological reasons (e.g., pregnancy or comorbidity)
  • Individuals often cited multiple rationale types when explaining why they did not participate in a campaign.
  • Non-participation occurred intentionally for a variety of reasons, such as distrust in the interventions or the health care workers. Failure to participate was sometimes unintentional; for example, the individual may have been absent during the campaign.
  • Rumors often led to misconceptions about health interventions, which dissuaded individuals from uptake of the intervention. This influence was not as prevalent with bed net campaigns.
  • Distrust in health care workers due to previous negative experiences was a commonly cited factor in non-participation.
  • Among non-participating individuals, health literacy was generally low.
  • Knowledge about an intervention’s benefits did not necessarily predict uptake of that intervention. Other factors were stronger indicators of participation.
  • Resistance to COVID-19 vaccination was common among the study participants.
  • Gender roles and expectations influenced the uptake of interventions. At the household level, men often decided whether the family would participate in a campaign. Women were responsible for coordinating the household’s receipt of the intervention.

See full coverage of the study at: https://campaigneffectiveness.org/research_project/exploring-patterns-of-non-participation-across-multiple-health-campaigns/