2.1.1. Analytical Framework

The research team drew on three similar analytical frameworks to inform research questions and data collection tools: the UNICEF Journey to Health and Immunization framework [22]; the WHO Behavioural and Social Drivers framework [23]; and the Determinants of childhood vaccine coverage model [5,24]. These frameworks all explain vaccine uptake as a function of three main factors: behavioral drivers such as knowledge, awareness and beliefs, attitudes, and social norms; the practical and access issues caregivers face, including geographic and financial access; and characteristics of the health system, such as service convenience, quality, and experience of care. We used the UNICEF framework to guide analysis as it most closely represents empathy for a caregiver and concepts of HCD and intersectionality, by situating them in the center of an ecosystem [25] and explicitly recognizing the influence of multiple levels (Figure 1). This framework also captures issues faced by health personnel.

**Figure 1.** The UNICEF Journey to Health and Immunization framework. UNICEF, Demand for health services field guide: a human-centered approach. New York: UNICEF, 2018.

These models and our pilot phase forced us to clarify the meaning of 'caregiver' in our study countries. In the DRC, Mozambique, and Nigeria, we observed that mothers, or occasionally other adult female family members, had the socially prescribed role to get a child vaccinated, and so we use the term 'caregiver' in this paper with an understanding that the data primarily reflects the experiences of mothers. We acknowledge that caregivers could be men, including fathers, but these findings specifically reflect the gendered realities of the female caregivers we interacted with.
