Identifying and understanding challenges to inform new approaches to improve vaccination rates: A qualitative study in Indonesia

Authors: Joko Gunawan PhD, RN, Yupin Aungsuroch PhD, RN, Mary L. Fisher PhD, RN, Colleen Marzilli PhD, DNP, MBA, RN-BC, CCM, PHNA-BC, CNE, NEA-BC,   Nazliansyah MNS, RN, Ade Sukarna MNS, RN



This study aimed to identify and understand challenges to inform new strategies to increase the COVID-19 vaccination rate according to involved vaccinators’ perspectives in Belitung, Indonesia.


A qualitative descriptive study design was used.


Online interviews and chatting were done among 11 vaccinators for data collection between August 2021 and January 2022. Data were analyzed using a content analysis model.


Four main themes emerged, including (1) communication strategies (evidence-based, electronic-based, and culturally based communication), (2) cross-sectoral strategies (collaboration with police, religious leaders, customary leaders, heads of village divisions, and non-governmental organizations), (3) “picking-up the ball” system (home visits for elderly and people with disability and school visits for children), and (4) setting-up priorities (between mandatory vaccines and boosters).


Despite making vaccination mandatory, the roles of communication, cross-sectoral innovations, “picking-up the ball” system, and priority setting may have useful potential to improve vaccination rates.

Clinical Relevance

The findings may serve as an input to overcome challenges and accelerate the vaccination coverage in Indonesia and beyond. However, further research is needed.

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