Beyond Access: A Qualitative Exploration of the Social and Behavioural Drivers of Routine Childhood Immunisation in the Solomon Islands

Background/Objectives: Gaps in routine childhood immunisation coverage persist in the Solomon Islands, with completion of the vaccination schedule varying considerably between remote and geographically isolated communities. While structural and logistical barriers to immunisation, such as vaccine supply constraints and inadequate cold chain infrastructure, are frequently documented in such settings, far less is known about the attitudes, norms, and relationships that shape caregiver and community engagement with immunisation services. This study aimed to apply the WHO Behavioural and Social Drivers of Vaccination (BeSD) framework to generate locally grounded evidence on the drivers of routine childhood immunisation in the Solomon Islands. Methods: An exploratory qualitative study was undertaken across three rural and peri-urban sites in Guadalcanal Province. Semi-structured in-depth interviews were conducted in Solomon Pijin with 16 participants, including caregivers, community influencers, healthcare workers, and immunisation program managers. Data collection was guided by the BeSD framework, with tools adapted through cognitive interviewing and pre-testing. Data were analysed using framework analysis, organised around the four BeSD domains. Results: Caregivers expressed broadly positive attitudes towards vaccination, though this coexisted alongside concerns about post-vaccination side effects and confusion about specific vaccine types. Social norms, community and religious leaders, and gendered caregiving expectations shaped engagement with immunisation services. Geographic isolation, financial cost, and facility-level constraints further impeded routine vaccination uptake. Conclusions: Addressing immunisation gaps in the Solomon Islands requires strategies that extend beyond structural and logistical improvements alone, integrating trusted caregiver communication, meaningful engagement with community and religious leaders, and sustained investment in health system capacity and outreach reliability to build lasting, community-driven improvements in routine childhood vaccination coverage.