Adapting the WHO BeSD Tools for Vaccination in Migrant and Refugee Populations in Uganda

Background

Catch-up vaccination is critical to closing immunity gaps among migrants, refugees, and internally displaced populations in low- and middle-income countries (LMICs). However, despite global life-course immunization policies, vaccination strategies for adolescent and adult migrant populations remain poorly defined, with persistent barriers including fragmented records, language challenges, and limited access. Existing approaches often overlook behavioural and social drivers of uptake. The WHO Behavioural and Social Drivers (BeSD) framework offers a structured approach but has not been adopted and validated for adult displaced populations.

Methods

We conducted a multi-phase adaptation, validation, and pilot of WHO BeSD tools for adult migrant and refugee populations in Uganda between June 2024–September 2026. Ethical approvals were obtained from City St George’s (2025.0126), UVRI REC (GC/127/1086), and UNCST (HS7289ES). Adaptation used a modified Delphi process involving WHO BeSD experts, Uganda Ministry of Health (EPI), Uganda National Institute for Public Health, Uganda Medical Association, implementers, and community mobilisers. A Refugee Community Coalition provided co-production input. Cognitive interviews assessed comprehension, followed by pilot testing. Tools were translated into Arabic, Luganda, and Swahili.

Results

The adapted package includes a 32-item survey and qualitative guides. Tools were reframed for life-course catch-up vaccination, with screening for under- and zero-dose individuals and a caregiver module. New items captured documentation gaps, mobility, access, language barriers, and trust. Cognitive testing improved clarity. Pilot testing showed good feasibility and acceptability, with strong validity.

Conclusions

This study provides one of the first validated BeSD adaptations for adult migrant and refugee populations. The tools offer a scalable, culturally responsive framework to improve vaccination uptake in LMIC settings.

Key messages

• WHO BeSD tools can be successfully adapted and validated for adult migrant and refugee populations, addressing gaps in understanding vaccination behaviours in humanitarian LMIC settings.

• The adapted tools provide a practical, scalable framework to identify barriers and inform targeted interventions to improve catch-up vaccination uptake among displaced populations.