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Urgent action\u00a0is required to\u00a0ensure catch up of missed immunisations in children, while simultaneously building trust and demand within communities to sustainably address existing immunization gaps. This paper summarizes the findings of a process evaluation of the \u2018Let\u2019s talk about vaccines\u2019 approach by VillageReach in Mozambique and Malawi. The approach used community-based participatory research to identify the barriers to childhood vaccination faced by caregivers and healthcare workers, with human-centered design to codesign potential interventions to improve under two immunization access and uptake.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>To evaluate the implementation of the \u2018Let\u2019s talk about vaccines\u2019 approach we conducted a qualitative process evaluation guided by the Reach Effectiveness Adoption Implementation Maintenance framework\u00a0and\u00a0Consolidated Framework for Implementation Research (CFIR). We completed a total of 76 qualitative interviews and 85 self-administered surveys among caregivers, healthcare workers, health officials and other stakeholders involved in the approach. We transcribed the interviews verbatim and analysed them using thematic analysis and constructs of the RE-AIM and CFIR frameworks. We analysed the survey results in Excel.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Key elements of the approach contributing to high fidelity to community-based participatory research principles in both countries, included diverse collaborative study and project teams, involvement of eight caregiver researchers, novel and traditional participatory methods, and extensive mobilization efforts. Success factors for human-centered design in the ideation and prototyping phase included fostering equal participation and empathy, value placed on each participant\u2019s input, mitigating inherent power differences, interactive feedback processes, and extensive iterative processes leading to tangible solutions. Challenges included adjusting to new methods and contextual realities. Factors influencing the potential adoption of the approach included locally developed solutions, participant involvement, collaboration, a major advantage over alternative approaches, ease of use of the co-created interventions, alignment with government objectives, and adaptability for system-wide integration into immunization programming. The potential sustainability of the approach was supported by the involvement of health ministries, health professionals, community representatives, and capacity building of local structures. However, resource and incentive constraints posed as a potential challenge to maintaining long-term motivation and action.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The evaluation findings from the \u2018Let\u2019s talk about vaccines\u2019 approach highlighted key elements for applying community-based participatory research and human-centered design to collaboratively identify immunization barriers and create tangible solutions to overcome them. By integrating these approaches into routine immunization programs, it can potentially improve vaccination efforts for children under two in low and middle-income countries, leading to lasting change. Supporting policies that prioritize community involvement in research, program design and implementation and sustainable funding enhances immunization strategies, ensuring that they are tailored to local needs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40900-025-00677-4","type":"journal-article","created":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T06:17:55Z","timestamp":1740118675000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["A qualitative process evaluation of community-based participatory research and human-centered design in the \u2018Let\u2019s talk about vaccines\u2019 approach in Mozambique and Malawi"],"prefix":"10.1186","volume":"11","author":[{"given":"Linda","family":"Shuro","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Lawrence","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeroen","family":"De Man","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Knight","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Schneider","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanani","family":"Tabana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,2,21]]},"reference":[{"key":"677_CR1","unstructured":"The Vaccine Alliance. 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The study adhered closely to the ethical guidelines and regulations of the respective ethics committees. Participants were provided with an information sheet. Informed consent was obtained from all participants, and anonymity and confidentiality were maintained throughout the study. Participation in this evaluation did not result in any negative consequences.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical 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":"11"}}