Availability, utilization, and contribution of interpersonal communication job aids for immunization among frontline health workers in Ethiopia: a qualitative study

Interpersonal communication can mean the difference between a children being fully immunized or not at all. Interpersonal Communication (IPC) job aids help health workers value, acquire, and consistently use the knowledge, skills, and attitudes needed to communicate effectively with mothers/caregivers about childhood immunization. Thus, this study explored the role of interpersonal communication job aids in enhancing health workers’ interpersonal communication skills for immunization in Ethiopia. A descriptive qualitative study was conducted in Oromia, Amhara and Afar regions of Ethiopia from January 01 to February 28, 2020. Participants were purposively selected to include Expanded Programme of Immunization (EPI) focal persons, health workers, health extension workers (HEWs), and mothers/caregivers. Twenty five in-depth interviews (IDIs), 17 Key informant interviews (KIIs), six Focused Group Discussions (FGDs) and observations were conducted were used to see the practical application of the Immunization IPC job aids. Data were transcribed edited verbatim and translated from Amharic. Oromo, and Afar languages to English language. ATLAS.ti was used for coding and analysis. The data were analyzed through thematic analysis approach. The findings were presented in narratives using the respondents’ own words as illustrations. The analysis identified four key themes: the availability and distribution of IPC job aids, the utilization IPC job aids in immunization practices, the effect of IPC job aids on health workers’ performance, and suggestions for the improvement of future IPC job aids. The IPC job aids for immunization were not adequately available in the health facilities and the supply of these aids was not maintained. Health workers have been employing the job aids to complement immunization counselling and health education sessions. The job aids enhanced health professionals’ knowledge, confidence, and teaching skills, leading to improved immunization counseling which ultimately increased routine immunization coverage for children. Inconsistent supply, language limitations, insufficient training, logistical issues, and high staff turnover were barriers to the effective use of IPC job aids. The IPC job aids improved the interpersonal communication skills of frontline health workers and thereby increased routine immunization service utilization. Despite their potential to improve counseling quality, foster clear communication, and strengthen relationships with clients, significant challenges persist in their availability, distribution, and utilization across regions. Health systems must prioritize consistent availability and equitable distribution of IPC job aids across all health facilities. On-site supervision, follow-up after distribution, quality evaluations of IPC job aids, and skill training are essential for effectiveness of IPC job aids sustained improvements in immunization coverage.