Culturally Tailored Women's Empowerment Strategies to Improve Immunization Uptake: Formative Research Using a Human-Centered Design Approach.

Background: Human-centered design (HCD) is vital for crafting impactful and successful health interventions. This approach has been effective in enhancing the uptake of health services, especially in rural areas. The Routine Immunization Buddy System (RIBS) is an HCD-driven intervention designed to support economically disadvantaged caregivers by empowering them to take greater responsibility for their own health and the immunization of their children. Objective: Through a community-based participatory research (CBPR), this study seeks to understand the economic, social, and health lifestyles and the impact on the health-seeking attributes of the potential beneficiaries of the project. This ensures that the identified intervention and its strategy will be implemented in a way that is of utmost benefit to the users. Methods: Using a 3-step HCD process-discovery, ideation, and formulation-the study conducted focus group discussions and key informant interviews for caregivers and stakeholders capable of influencing the woman's decision within a health setting. Semistructured interviews facilitated an in-depth exploration of participants' experiences. Data collection used audio and video recordings, detailed notes, and observation sessions. Data analysis encompassed transcription, descriptive analysis, and thematic analysis to inform evidence-based interventions. Results: Four key interconnected barriers to routine immunization were identified from the formative research: (1) vaccine hesitancy, which is driven by safety concerns and inconsistency in vaccine-related messaging; (2) gender-based decision-making constraints, where male approval often influenced access to care; (3) financial limitations affecting transport and medical costs; and (4) unequal access to health care due to geographic disparities. Caregivers emphasized the need for economic empowerment and trusted community-based health education. These findings informed a critical redesign of the intervention from a 2-arm to a 3-arm model, with peer support groups and financial empowerment components added to address both economic barriers and vaccine misinformation through culturally tailored approaches. Conclusions: The use of HCD-informed formative research has helped identify tailored women's empowerment strategies, such as economic support, community-led advocacy, and peer networks, that show promise in addressing health disparities among caregivers. These approaches are hoped to enhance caregivers' ability to make informed health decisions, ultimately contributing to improved immunization uptake and broader community well-being. The insights from this research are actively informing the design of our upcoming cluster randomized controlled trial, which aims to strengthen women's decision-making power around immunization services.