A Co-Designed Post-ICU Follow-Up Pathway Is Feasible and May Be Associated With Improved Psychosocial Recovery for Patients and Their Caregivers: Outcomes From the IMPACT-ICU Single-Center Randomized

Immunisations represent one of the most cost-effective public health interventions, preventing millions of deaths annually and contributing significantly to child survival and development (United Nations Children’s Fund [UNICEF] ; World Health Organisation [WHO] ). However, despite global progress in immunisation coverage, substantial disparities persist, particularly in low- and middle-income countries (LMICs), where access barriers, health system constraints and inequities continue to impede optimal immunisation outcomes (Gavi ; WHO ). South Africa, despite substantial investments to ensure universal access to immunisation services through the Expanded Programme on Immunisation (EPI), continues to face challenges in achieving and sustaining optimal coverage across provinces and districts, particularly in underserved communities (National Department of Health [NDoH] ; UNICEF South Africa ). Recent evidence from African contexts further demonstrates that immunisation adherence is influenced by complex and interrelated caregiver, socio-cultural and health system factors, including vaccine confidence, service accessibility and provider communication (Wiysonge et al. ; WHO ). Research conducted LMICs and within the African contexts has identified multiple barriers to immunisation adherence, including limited vaccine knowledge, concerns about vaccine safety, logistical challenges such as transport and clinic waiting times and gendered decision-making dynamics that constrain caregivers’ autonomy in completing immunisation schedules (Wiysonge et al. ; WHO ). Understanding these multilevel determinants is essential for designing responsive, context-specific interventions that strengthen vaccine uptake and completion rates (Gavi ; UNICEF ). The Western Cape province of South Africa presents a distinctive context for examining immunisation adherence. While characterised by relatively well-developed urban healthcare infrastructure and established primary healthcare services, significant socioeconomic disparities persist, which continue to influence healthcare access, continuity of care and service utilisation patterns (NDoH ; Western Cape Department of Health and Wellness ). Although existing literature underscores the importance of caregiver perceptions, trust in health services and lived experiences in shaping immunisation decisions, there remains limited qualitative research that deeply explores these contextualised perceptions within the contemporary South African setting (UNICEF South Africa ; Wiysonge et al. ).