{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T11:46:45Z","timestamp":1791373605065,"version":"4.3.1"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,4,26]],"date-time":"2024-04-26T00:00:00Z","timestamp":1714089600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,4,26]],"date-time":"2024-04-26T00:00:00Z","timestamp":1714089600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"UK Health Security Agency"},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["NIHR200929"],"award-info":[{"award-number":["NIHR200929"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["NIHR200929"],"award-info":[{"award-number":["NIHR200929"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["NIHR200929"],"award-info":[{"award-number":["NIHR200929"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["NIHR200929"],"award-info":[{"award-number":["NIHR200929"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003784","name":"Great Ormond Street Hospital for Children","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003784","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000883","name":"University of Bristol","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000883","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Public Health"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction<\/jats:title>\n                <jats:p>The introduction of a national evaluation of newborn screening for Severe Combined Immunodeficiency (SCID) in England triggered a change to the selective Bacillus Calmette-Guerin (BCG) vaccination programme delivery pathway, as this live attenuated vaccine is contraindicated in infants with SCID. The neonatal BCG vaccination programme is a targeted programme for infants at increased risk of tuberculosis and used to be offered shortly after birth. Since September 2021 the BCG vaccine is given to eligible infants within 28 days of birth, when the SCID screening outcome is available. We explore the experiences of those implementing the new pathway, and how they made sense of, engaged with, and appraised the change.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A mixed-methods evaluation was conducted between October 2022 and February 2023. This involved national online surveys with BCG commissioners and providers and qualitative semi-structured interviews with commissioners, providers, and Child Health Information System stakeholders in two urban areas. Survey data was analysed using descriptive statistics and interview data was analysed thematically. The data was triangulated using Normalization Process Theory as a guiding framework.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Survey respondents (<jats:italic>n<\/jats:italic>\u2009=\u200965) and qualitative interviewees (<jats:italic>n<\/jats:italic>\u2009=\u200916) revealed that making sense of the new pathway was an iterative process. Some expressed a desire for more direction on how to implement the new pathway. The perceived value of the change varied from positive, ambivalent, to concerned. Some felt well-prepared and that improvements to data capture, eligibility screening, and accountably brought by the change were valuable. Others were concerned about the feasibility of the 28-day target, reductions in vaccination coverage, increased resource burden, and the outcome of the SCID evaluation. New collaborations and communities of practice were required to facilitate the change. Three main challenges in implementing the pathway and meeting the 28-day vaccination target were identified: appointment non-attendance; appointment and data systems; and staffing and resourcing. Feedback mechanisms were informal and took place in tandem with implementation.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The new NHS neonatal BCG service specification has created an effective structure for monitoring and managing the BCG vaccination programme, but further work is required to support delivery of the 28-day vaccination target and improve uptake rates.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12889-024-18586-8","type":"journal-article","created":{"date-parts":[[2024,4,26]],"date-time":"2024-04-26T10:02:51Z","timestamp":1714125771000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["A new neonatal BCG vaccination pathway in England: a mixed methods evaluation of its implementation"],"prefix":"10.1186","volume":"24","author":[{"given":"Koren","family":"Jones","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgia","family":"Chisnall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Crocker-Buque","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Elliman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Horwood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Mounier-Jack","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin NJ","family":"Campbell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Saliba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracey","family":"Chantler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,4,26]]},"reference":[{"key":"18586_CR1","unstructured":"UK Health Security Agency. TB incidence and epidemiology in England, 2021. 2023 [cited 2023 07\/07\/2023]; https:\/\/www.gov.uk\/government\/publications\/tuberculosis-in-england-2022-report-data-up-to-end-of-2021\/tb-incidence-and-epidemiology-in-england-2021."},{"key":"18586_CR2","unstructured":"World Health Organisation. Tuberculosis. 2023 [cited 2023 07\/07\/2023]; https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/tuberculosis."},{"key":"18586_CR3","unstructured":"NHS England and UK Health Security Agency. Tuberculosis (TB): action plan for England, 2021 to 2026. 2023 [cited 2023 11\/07\/2023]; https:\/\/www.gov.uk\/government\/publications\/tuberculosis-tb-action-plan-for-england\/tuberculosis-tb-action-plan-for-england-2021-to-2026."},{"key":"18586_CR4","unstructured":"UK Health Security Agency. Tuberculosis: the green book, Chap. 32. 2018 [cited 2023 25\/08\/2023]; https:\/\/www.gov.uk\/government\/publications\/tuberculosis-the-green-book-chapter-32."},{"key":"18586_CR5","unstructured":"NHS. BCG vaccine for tuberculosis (TB) overview. 2019 [cited 2023 25\/08\/2023]; https:\/\/www.nhs.uk\/conditions\/vaccinations\/bcg-tuberculosis-tb-vaccine\/."},{"key":"18586_CR6","unstructured":"UK Health Security Agency. Vaccine update: issue 327, April 2022, SCID, TB and BCG special edition. 2022; https:\/\/www.gov.uk\/government\/publications\/vaccine-update-issue-327-may-2022-scid-tb-and-bcg-special-edition\/vaccine-update-issue-327-april-2022-scid-tb-and-bcg-special-edition."},{"key":"18586_CR7","doi-asserted-by":"crossref","unstructured":"Gennery AR, Worth A. Severe combined immunodeficiency: newborn screening and the BCG vaccination. Archives of Disease in Childhood; 2022.","DOI":"10.1136\/archdischild-2022-324682"},{"issue":"711","key":"18586_CR8","doi-asserted-by":"publisher","first-page":"456","DOI":"10.3399\/bjgp21X717209","volume":"71","author":"R Nightingale","year":"2021","unstructured":"Nightingale R, Cavanagh C, Gennery AR. Evaluation of newborn screening for severe combined immunodeficiency (SCID). Br J Gen Pract. 2021;71(711):456\u20137.","journal-title":"Br J Gen Pract"},{"key":"18586_CR9","unstructured":"Marshall J. UK NSC public consultation: screening for severe combined immunodeficiency (SCID). 2017 [cited 2023 10\/10\/2023]; https:\/\/phescreening.blog.gov.uk\/2017\/10\/13\/uk-nsc-public-consultation-screening-for-severe-combined-immunodeficiency-scid\/."},{"issue":"4","key":"18586_CR10","doi-asserted-by":"publisher","first-page":"1134","DOI":"10.1016\/j.jaci.2014.02.028","volume":"133","author":"BE Marciano","year":"2014","unstructured":"Marciano BE, et al. BCG vaccination in patients with severe combined immunodeficiency: complications, risks, and vaccination policies. J Allergy Clin Immunol. 2014;133(4):1134\u201341.","journal-title":"J Allergy Clin Immunol"},{"key":"18586_CR11","unstructured":"UK Health Security Agency. BCG patient flowchart (UK Health Security Agency gateway number: 2021366. 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Normalisation Process Theory On-line Users\u2019 Manual, Toolkit and NoMAD instrument 2015 [cited. 2023; http:\/\/www.normalizationprocess.org."}],"container-title":["BMC Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-024-18586-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12889-024-18586-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-024-18586-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,26]],"date-time":"2024-04-26T10:03:19Z","timestamp":1714125799000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpublichealth.biomedcentral.com\/articles\/10.1186\/s12889-024-18586-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,26]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["18586"],"URL":"https:\/\/doi.org\/10.1186\/s12889-024-18586-8","relation":{},"ISSN":["1471-2458"],"issn-type":[{"value":"1471-2458","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,26]]},"assertion":[{"value":"30 November 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 February 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 April 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethics approval was granted by the UKHSA Research Support and Governance Office (Ref: NR0328). Participants in both the interview and online survey workstream were informed of the purpose of the evaluation, their right to confidentiality, and that any data would be appropriately handled. Written consent was obtained for the interview workstream, while implied consent was deemed appropriate for the online survey vis-\u00e0-vis the completion and submission of the online form. A data protection impact assessment was completed with the support of the LSHTM data protection office and agreed by LSHTM and UKHSA researchers to ensure that this evaluation adhered to the 2018 Data Protection Act.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1175"}}