This section will be a short paragraph that summarises the intent of the project. It should include: • The purpose and/or the desired outcome of the project • Timeframes for completion • Budget required (estimated) For example: “This project aims to increase the capacity of University of the Sunshine Coast (USC) staff and students to access health and wellbeing services by instituting a Health Promoting University Policy. The project is intended to be completed within 2 years, within a budget of $15 000.”
Immunisation project in the Sunshine Coast
The following project plan addresses the low rates of immunisation during childhood in the Sunshine Coast region.1
Immunisation is described by the World Health organisation (WHO) as “the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine”.2 During the 1990’s, Australia was facing a decrease in childhood immunisation and a rise in communicable diseases that could have been prevented with vaccinations.3
2.1 Justification of health issue
Based on the article of Canham-Chervak et al.4, six prioritisation criteria have been identified to justify the choice of the immunisation project in the Sunshine Coast.
The most important criteria to justify the development of a project based on immunisation is the preventability of the problem. It is proven that immunization is the most effective medical intervention to reduce mortality and morbidity associated with communicable disease.5 For example, smallpox, an infectious disease has been fully eradicated following immunisation coverage.6
Vaccination plays an important role to reduce child mortality in developing countries in order to achieve the Millenium Development Goals established by the United Nations.7 Developed countries can participate to help to reach this goal by having a high immunity level in all parts of the world to potentially eradicate communicable diseases in the future. By reducing mortality and morbidity worldwide, vaccination has the advantage of helping the economic growth as it is a very cost-effective intervention. Furthermore, immunisation is also increasing equity in health.6
Timeliness needs to be address for this health issue as there is a concern regarding Indigenous children in Australia with a delay in immunisation compared to the Non-Indigenous at 12 months.8 Overall, immunisation coverage has increased in Australia; however, the timeliness has shown little improvement in the last decade and will become the next goal once the herd immunity target will be reached.9 Delays in immunisation can have significant impacts especially with vaccine requiring multiple doses.8
It is indicated that rates of immunisation needs to exceed 90% of coverage to attain herd immunity in order to truly protect againts communicable diseases with vaccination.8 Increasing vaccination coverage is feasible as Australia has shown huge improvement during the 1990’s (Figure 1).10 Eradication of measles in America secondary to immunisation is another example of the feasibility of the project.6
Figure 1: Immunisation coverage based on the ACIR from 1997 to 2007 in Australia
In Australia, immunisation coverage data for children aged under seven years are easily accessible with the Australian Childhood Immunisation Register (ACIR).11 Therefore, the register allows the government to easily evaluate the improvement of the immunisation program by comparing the annual report from one year to the other. Australia already has an immunisation handbook policy available to the population12.
Overall, the project shows a consistency with the mission of the Australian Government regarding immunisation coverage.3 (374 words)
3. Health issue analysis
4.1 Primary stakeholders: those directly impacted by the issue
- children aged one, two and five years old and living in the Sunshine Coast
4.2 Secondary stakeholders: those that have an interest in the project
- parents of the primary co-activists, living in the Sunshine Coast
- health professionals, nurses and General Practitioners (GPs)
- Queensland Health
- community of the Sunshine Coast
5. Project goal, objectives, sub objectives
7. Justification for goal, objectives, sub-objectives, outcome and impact evaluation indicators and methods
The Sunshine Coast region has one of the lowest rates of immunisation in Australia, with 90% at 1 year old, 89% at 2 years old and 87% at 5 years old.1 At the National level, it is recommended to reach an immunity of at least 90% of the population.3
7.1 Justification for risk markers, immediate and contributing determinants
Risk markers were clearly identified by the use of publications from the Government based on current Australian statistics.1,3 The literature review for the identification of the health determinants was mainly international, peer-reviewed and recent.15-24 The determinants of health chosen for the report were the ones that were the most applicable to Australia and the most commons ones across the literature15-24. The choice of health determinants was based on a broad range that includes children16-17, parents15,19,22-24 and health professionals18-21 behaviours and socio-environmental factors15,19,22-24. The articles from developing countries and articles not involving children immunisation were excluded to ensure the relevance of the studies to Australia and all the articles not including children.
7.2 Measure of change limitation
The goal of the project is based on the requirement of the Australian Government regarding immunisation coverage.3 It is important to mention that the goal to increase the vaccination rates is the only measure of change that was found in the literature. In fact, most studies primarily calculate the impact of an intervention by the surveillance of the immunisation coverage.23-25 The benchmarks for the objectives and sub-objectives measures of change were established by aspirational figures only. There was a gap in the literature in terms of measurable objectives and sub-objectives, therefore professional judgement was used to set up achievable and realistic benchmarks.
7.3 Timeframe limitation
The sub-objectives were set up for immediate implementation over an extended period of two years. By achieving the sub-objectives, the objectives should be realistically attainable by 2016 and by 2018 the immunisation rates in the Sunshine Coast are predicted to be 90% for children aged of 1 and 2 and close to 100% for children aged of 5 years old. Although, the Australian Government doubts to achieve the 100% goal at 5 years of age due to parent’s refusal to vaccine.3 The Government is not setting a timeframe to reach the goal but Australia has shown significant improvements of the immunisation coverage in the past, which makes this target feasible.10,25 The outcome of the project will be easily evaluated with the ACIR.11 Assumptions regarding reasonable timeframe are also relying on professional judgement for the objectives and sub-objectives. Overall, the measure of change and the timeframe should be used with caution as it is an important limitation of the project.
7.4 Objective 1 and sub-objective 1.1 and impact evaluation indicators and methods
The objective and the sub-objectives are based on an evidence-based clinical practice guideline and a cross-sectional survey on the prevalence of non-immunisation compliance due to needle fears. There was a lack of literature that were assessing program on distress and needle fears in children.16,17 The survey was useful to determine a methodology to carry out the impact evaluation for these two determinants.17
7.5 Objective 2 and sub-objectives 2.1, 2.2 and impact evaluation indicators and methods
The objective and the sub-objectives are focusing on the confidence of the health professionals’ recommendations that can be improved by reducing their gap in knowledge and enhancing their communication with parents of children18-21. Professionals’ knowledge on immunisation shows a disparity between the different school programs at the National level. Only practical advice was given to adapt the existing curriculum to decrease the gap in knowledge in health care professionals.19 The methodology of the studies, such as a computer assisted telephone interviews18 and a web-based self-administered questionnaire19, were chosen to evaluate the impact of future interventions.18-19 Poor communication between secondary and primary co-activists are based on two peer-reviewed articles suggesting the use of a communication framework and taxonomy of communication as a strategy to play on this determinant. Then again, the efficiency of these communication tools was not tested by the authors20-21. The data collection method from Leask et al.20, which was to seek feedback from health professionals with a short web-based questionnaire, was valuable to find an appropriate way to evaluate the impact of the communication tools.
7.6 Objective 3 and sub-objectives 3.1, 3.2, 3.3, 3.4 and impact evaluation indicators and methods
Objective 3 is to increase parent’s ability to make informed decision regarding vaccination for their children.15,19,22-24 Once more, there was a gap in the literature in terms of the evaluation of program conducted to increase immunisation rates for the objective and the first three sub-objectives. The methodology of data collection by Bond et al.22, the semi-structured in-depth interviews, was helpful to evaluate the impacts of the project. The sub-objective 3.3 is employing a data collection process used in a previous study on the same subject, which is a focus group.15 The sub-objectives 3.4 is supported by an article that has assessed the impact of other program that was ruined by misinformation23 and an article that is proposing a social marketing campaign based on other successful programs for other type of project.24
7.7 Objective 4 and sub-objectives 4.1, 4.2 and impact evaluation indicators and methods
A peer-reviewed article, on how to achieve higher immunisation rates amongst children in Australia, has oriented the objective and the sub-objectives 4.1.25 The same data collection method used to evaluate the impact of the program is based on the ACIR.25 The sub-objectives 4.2 has limited literature on the evaluation of programs. Therefore, the methodology is based on one of the study related to lack of transport from a systematic review, which used written questionnaire by mail to collect the data.15
Overall, there is a need to evaluate the effectiveness of programs, frameworks and taxonomy in relation to the recommendations regarding immunisation strategies made by the different authors of the studies used in this project to fill out the gap in the literature. (903 words)