Formative qualitative assessment of caregiver barriers to childhood immunization in a Peri-urban District in Ghana

Abstract Background While access and quality issues in immunization services are well documented, determinants related to social norms and the roles of male and female caregivers remain underexplored in Ghana. This study examined social and behavioral barriers to childhood immunization to inform a family-based intervention to strengthen household engagement in immunization decision-making and improve childhood immunization. Methods A qualitative study was conducted in the Kpone Katamanso district of the Greater Accra Region, Ghana, in April 2023. Data was collected in English, Ga, and Twi through 10 key informant interviews with healthcare workers, 10 in-depth interviews with mothers of fully and under-vaccinated children, and eight focus group discussions with mothers ( n =30) and fathers ( n =24) of children under two years. Transcripts were coded and analyzed inductively to identify major themes. Results Six themes emerged: (1) diverse household immunization decision-making structures; (2) mothers as the primary actors in vaccination; (3) contrasting perceptions of fathers’ versus mothers’ availability; (4) potential to increase fathers’ engagement through improved knowledge and community influencers; (5) differing interpersonal communication experiences with healthcare workers; and (6) health system barriers disproportionately affecting mothers. Social norms and limited male involvement constrained mothers’ time, autonomy, and support, while healthcare barriers, such as staff shortages, indirect costs, and vaccine stockouts, further impeded access. Conclusion Findings highlight both demand- and supply-side barriers to childhood immunization. The differential valuation of mothers’ versus fathers’ time emerged as a key structural barrier. Promoting male engagement, strengthening interpersonal communication between caregivers and health workers, and addressing health system barriers may improve immunization uptake and advance family-centered immunization strategies in Ghana.