Research Project

Exploring Patterns of Non-Participation Across Multiple Health Campaigns

A Qualitative Study in Ghana and Indonesia


A qualitative study on the reasons why community members in Ghana and Indonesia did not participate in public health campaigns.

Ghana and Indonesia

Neglected tropical diseases and Immunization

  • Conduct transect walks to identify non-participating households
  • Encourage community health workers to help identify missed households
  • See all promising practices

Key Messages

To better understand why some individuals in Ghana and Indonesia do not participate in public health campaigns, a research team led by the University of Ottawa and Bruyère Research Institute conducted a qualitative study in both countries.

  • Reasons for non-participation are consistent across various types of campaigns, although for each campaign, the same individuals may cite different rationales.
  • Gender roles and expectations often influence the uptake of interventions, with men deciding whether the household will participate and women coordinating the family’s participation.
  • Understanding of an intervention’s benefits is not always an indicator that a person will participate. Other factors exert greater influence on participation.
  • Rumors and subsequent misconceptions about interventions play a significant role in decisions against participating in health campaigns.
  • Distrust in health care workers is often another key factor in non-participation.



Globally, the COVID-19 pandemic disrupted public health campaigns and revealed disparities in health outcomes and access to health interventions. In response, there is an increased focus on reaching people who have not participated in these campaigns, including those never treated for neglected tropical diseases (NTDs) and children who have not been immunized.

View the slides for detail on the research methods.

Problems or Gap

Identification of non-participating individuals poses a significant challenge. However, identifying and reaching this population is critical, as high numbers of these individuals could disrupt disease control efforts and lead to increased risk of infection.

Study Objectives

The objectives of this study were to:

  • Identify patterns of acceptability, availability, and community awareness and hesitancy across multiple public health campaigns (NTDs; malaria; childhood immunizations; and COVID-19 measures, including vaccines)
  • Explore reasons for non-participation across multiple public health campaigns
  • Provide insights to ministries of health and regional health bodies to inform programmatic actions for addressing non-participation
Air Besar, Latuhalaa, Waiheru, Ambon City, Ambon Province, Indonesia
Ghana: Kpeve/Abui, Dzemeni communities/South Dayi District/Volta Region



Through transect walks, focus groups, and interviews in Ghana and Indonesia, researchers explored rationales for non-participation in health campaigns, including childhood immunizations, COVID-19 vaccination, mass drug administration, and insecticide-treated net distribution. The findings indicate that although rationales may vary by campaign at the individual level, reasons for non-participation are similar across campaigns.

  • Reasons for non-participation represented four broad categories:
    • Health system-related reasons (e.g., low vaccine availability)
    • Intervention-related reasons (e.g., fear of receiving injections)
    • Personal reasons (e.g., religious or cultural beliefs)
    • Biological reasons (e.g., pregnancy or comorbidity)

Scroll down for more key findings. 

Key Findings

  • Individuals often cited multiple rationale types when explaining why they did not participate in a campaign.
  • Non-participation occurred intentionally for a variety of reasons, such as distrust in the interventions or the health care workers. Failure to participate was sometimes unintentional; for example, the individual may have been absent during the campaign.
  • Rumors often led to misconceptions about health interventions, which dissuaded individuals from uptake of the intervention. This influence was not as prevalent with bed net campaigns.
  • Distrust in health care workers due to previous negative experiences was a commonly cited factor in non-participation.
  • Among non-participating individuals, health literacy was generally low.
  • Knowledge about an intervention’s benefits did not necessarily predict uptake of that intervention. Other factors were stronger indicators of participation.
  • Resistance to COVID-19 vaccination was common among the study participants.
  • Gender roles and expectations influenced the uptake of interventions. At the household level, men often decided whether the family would participate in a campaign. Women were responsible for coordinating the household’s receipt of the intervention.

“Mostly it is because I am not around when they come for the home visit and immunization. For example, the one at 9 months, if you miss it, the child cannot receive it again.” – Study participant

  • During campaign planning, conduct transect walks in areas with known non-participation to identify missed households and improve understanding of reasons for non-participation.
  • Train and incentivize community health workers to identify non-participating households.
  • Encourage campaign teams to verify community members’ vaccination and mass drug administration history by checking immunization cards and household registers.