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Learn about implementation science theories, models and frameworks and their application to primary health care and immunization
Comprehensive reference guide for using implementation science theories, models and frameworks in primary health care and immunization

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BeSD: Why Caregivers Do or Do Not Vaccinate

Lesson 4 of 8 · about 10 minutes

Goal Sort the reasons caregivers give into WHO's four BeSD domains, and avoid calling an access problem "hesitancy".

WHO's Behavioural and Social Drivers of Vaccination (BeSD) framework, published in 2022, looks at vaccination from the caregiver's side. It has four domains.

Thinking andfeelingDisease risk, vaccineconfidence, safety,trustSocialprocessesFamily, leaders andhealth worker advice,gender equityMotivationIntention to vaccinatePractical issuesAvailability, cost, distance, waiting,service quality, respectVaccination
BeSD's four domains. What people think and feel, and what the people around them say, shape motivation. Practical issues decide whether a motivated caregiver gets the child vaccinated. Simplified from WHO's figure.
DomainNigerian example
Thinking and feelingAfter the HPV launch in 2023, social media posts falsely claimed the vaccine causes infertility.
Social processesTraditional leader committees in northern states pass immunization messages to district, village and ward heads.
Motivation"I plan to bring her for the next dose."
Practical issuesLong waits, a cancelled session, an informal fee, harsh treatment.

Check practical issues first. WHO places vaccine hesitancy in the motivation domain. A child who misses Penta3 because the facility cancelled the session has a motivated caregiver and a broken service.

Use It on MondayAsk five caregivers leaving your session: "What made today easy or hard?" Sort each answer into a BeSD domain.

Go deeper: BeSD profile in the inventory · BeSD to COM-B crosswalk