Person: Obach, Alexandra
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Obach
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Alexandra
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Alexandra Obach
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Publication Determinants of COVID-19 and non-COVID-19 vaccine confidence in low- and middle-income countries: A systematic review of qualitative evidence and thematic synthesis(2025) Blukacz, Alice; Obach, Alexandra; Vásquez, Paola; Campaña, Carla; Huerta, Catalina; Bernal, Yanara; Cabieses, BálticaBackground: The COVID-19 pandemic has shown the immediate risk for global and public health posed by vaccination inequities worldwide. The regions most affected are low- and middle-income countries (LMICs). In addition to systemic challenges, vaccine hesitancy driven by low vaccine confidence has been identified as a threat to vaccine uptake. The aim of this systematic review of qualitative literature is to explore the determinants of COVID-19 and non-COVID-19 vaccine confidence in LMICs. Methods: A systematic review was conducted following the PRISMA and ENTREQ guidelines. The electronic databases Cinahl, Embase, Pubmed, Scopus and Web of Science were searched for qualitative studies focusing on the topic of interest in LMICs published between 2013 and 2023. The quality of the studies was assessed using the Joanna Briggs Institute’s Checklist for Qualitative Research. A thematic synthesis was conducted. The study was registered on the Open Science Framework platform. Findings: 66 studies were included in the review. Three main determinants of vaccine confidence were identified: (1) General perceptions of the safety and efficacy of vaccines; (2) Information and experience; (3) Trust in healthcare providers, institutions, and systems. General perceptions of vaccine safety and efficacy were similar between COVID-19 and non-COVID-19 vaccines, and doubts regarding vaccine safety were neither new nor exclusive to the COVID-19 vaccine, indicating a persisting challenge. Furthermore, low vaccine confidence was partly determined by broader dynamics of mistrust towards Western countries and institutions, which was reflected for both vaccine groups. While conspiracy theories have been persisting determinants of low confidence, low COVID-19 vaccine confidence was partly determined by what was perceived as a lack of specific information. Conclusion: Persistent challenges to vaccine confidence were identified, rooted in colonial legacies and global health inequities, as well as limited intercultural approaches to building trust with regards to vaccines.Publication Unmet needs and new challenges in young women's sexual and reproductive health and rights: a qualitative study in Chile's Metropolitan Region(2025) Obach, Alexandra; Sadler, Michelle; Robledo, Consuelo; Wright, Ciara; Cabieses, BálticaIn Chile, despite important advances in access to contraception and a steady reduction in unplanned pregnancy, longstanding barriers for young people to access sexual and reproductive health (SRH) and rights - rooted in a conservative and religious background - have been highlighted by recent socio-political movements, including the feminist student wave of 2018 and the social uprising of 2019. The COVID-19 pandemic further strained access, leading to the suspension of many in-person services. In this context, we conducted a qualitative study between 2020 and 2023 to explore young women's perceptions of sexuality and SRH, their interactions with the formal healthcare system, and the diverse resources they engage with to access support and care. 23 in-depth interviews were carried out with heterosexual and non-heterosexual women aged 18-25 in Chile's Metropolitan Region. The findings reveal a mismatch between young women's holistic understanding of sexuality - which includes emotional, biological, and political dimensions - and the healthcare system's reductionist, heteronormative, and risk-based approach, which became more visible after these societal upheavals. As a result, young women may use biomedical SRH services strategically for prescriptions and testing, while seeking more comprehensive support outside the formal system through virtual platforms, health professionals giving online support, and civil society organisations. The study concludes that systemic changes in the health system are needed to bridge these divides and uphold the sexual and reproductive rights of young women in Chile, especially those who identify as non-heterosexual.Publication Determinants of COVID-19 and non-COVID-19 vaccine confidence in lowand middle-income countries: A systematic review of qualitative evidence and thematic synthesis(2025) Blukacz, Alice; Obach, Alexandra; Vasquez, Paola; Campaña, Carla; Huerta, Catalina; Bernal, Yanara; Cabieses, BálticaBackground: The COVID-19 pandemic has shown the immediate risk for global and public health posed by vaccination inequities worldwide. The regions most affected are low- and middle-income countries (LMICs). In addition to systemic challenges, vaccine hesitancy driven by low vaccine confidence has been identified as a threat to vaccine uptake. The aim of this systematic review of qualitative literature is to explore the determinants of COVID-19 and non-COVID-19 vaccine confidence in LMICs. Methods: A systematic review was conducted following the PRISMA and ENTREQ guidelines. The electronic databases Cinahl, Embase, Pubmed, Scopus and Web of Science were searched for qualitative studies focusing on the topic of interest in LMICs published between 2013 and 2023. The quality of the studies was assessed using the Joanna Briggs Institute's Checklist for Qualitative Research. A thematic synthesis was conducted. The study was registered on the Open Science Framework platform. Findings: 66 studies were included in the review. Three main determinants of vaccine confidence were identified: (1) General perceptions of the safety and efficacy of vaccines; (2) Information and experience; (3) Trust in healthcare providers, institutions, and systems. General perceptions of vaccine safety and efficacy were similar between COVID-19 and non-COVID-19 vaccines, and doubts regarding vaccine safety were neither new nor exclusive to the COVID-19 vaccine, indicating a persisting challenge. Furthermore, low vaccine confidence was partly determined by broader dynamics of mistrust towards Western countries and institutions, which was reflected for both vaccine groups. While conspiracy theories have been persisting determinants of low confidence, low COVID-19 vaccine confidence was partly determined by what was perceived as a lack of specific information. Conclusion: Persistent challenges to vaccine confidence were identified, rooted in colonial legacies and global health inequities, as well as limited intercultural approaches to building trust with regards to vaccines.