The Vaccine Trust Framework: mixed-method development of a tool for understanding and quantifying trust in health systems and vaccines

This study developed and validated a contextually grounded Vaccine Trust Framework to better understand and measure trust in vaccines across low- and middle-income countries. Using an exploratory sequential mixed-methods approach, ethnographic research in Nigeria, Kenya, and Pakistan informed the creation of a framework encompassing four domains—health system promise, health system delivery, vaccine promise, and vaccine delivery—across 15 measurable dimensions. A nationally representative survey of caregivers in Kenya and Pakistan confirmed the framework’s validity, showing strong associations between trust scores and vaccination behaviors. Regional variations in trust aligned with local perceptions of health systems. The framework offers a practical tool for designing, monitoring, and evaluating trust-building interventions to strengthen vaccine demand and resilience.

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