Utilizing the COM-B model to identify childhood routine vaccination barriers and uptake among parents and caregivers living in the frontline and Zakarpattia regions of Ukraine amidst Russia’s full-scale invasion

Abstract Background In Ukraine, historical challenges of vaccination behavior and uptake, rooted in complex social and structural factors, have long hindered efforts to reach the 95% childhood vaccination coverage for herd immunity. These difficulties were further exacerbated by the Russian Federation’s full-scale invasion in February 2022. Internally displaced people (IDPs) encountered additional barriers in host regions already under considerable strain, and vulnerable regions of Ukraine continued to experience suboptimal routine vaccination coverage and growing misinformation. Empirical research exploring vaccine behavior and uptake using qualitative methods in Ukraine is limited. Methods This study employed a qualitative design comprised of 12 online focus group discussions with parents and caregivers, including IDPs, of children under 7 years old between July and August 2024. Regions selected included the Zakarpattia oblast and the frontline areas of Kharkivska, Odeska, and Dnipropetrovska. The analysis was guided by the Capability, Opportunity, and Motivation model of behavior change (COM-B) to identify vaccination behaviors at the individual and community level. Results Participants’ capability factors demonstrated moderate knowledge of vaccines, with most of this knowledge held by mothers or female caregivers. The psychological and financial impact of the war has dramatically affected their livelihoods. Strong motivating factors included the need to protect their children from disease. A small number firmly believed the vaccine caused harm and did not vaccinate their child. State-provided free vaccines with origins outside of Europe motivated some participants to pay out of pocket. Factors affecting physical opportunities to vaccination included infrastructure damage, supply issues, and a lack of access to healthcare providers (especially for IDPs), mainly due to the war. Factors influenced by social opportunities included perceived vaccine experiences within family circles and online community groups, and the spread of vaccine rumors and misinformation. Participants heavily relied on family doctors for vaccine-related information, but many reported challenges with information-seeking and access. Conclusion Ukraine faces heightened risks of vaccine-preventable disease outbreaks due to war-related disruptions, limiting vaccination opportunities despite strong parental motivation. Improving access to services, increasing vaccine availability, providing tailored public health education, and conducting further research are needed to strengthen routine immunization among children.