Exploring caregivers’ perspectives and anticipated acceptance of hepatitis B birth-dose vaccination before the national introduction in Sierra Leone: a qualitative study

Mother-to-child transmission remains a major contributor to hepatitis B virus (HBV) infection in sub-Saharan Africa. Sierra Leone is preparing to introduce the Hepatitis B birth-dose (HepB-BD) vaccine nationally, but evidence on caregivers’ knowledge and perceptions before implementation is limited. This study explored caregivers’ knowledge, attitudes, and perceptions of the HepB-BD vaccine to inform successful national rollout. A qualitative descriptive study used 20 focus group discussions (FGDs) with 125 caregivers across six districts in Sierra Leone, exploring knowledge of hepatitis B, vaccination attitudes, perceptions of the birth-dose vaccine, and trusted health-information sources. Discussions were audio-recorded, transcribed verbatim, translated where necessary, and analysed using Braun and Clarke’s reflexive thematic analysis in NVivo 14. Sample adequacy was assessed using the concept of information power; data collection stopped after 20 FGDs, when the research team judged that the dataset held sufficient information power to address the study aim, rather than at a predefined saturation endpoint. Six themes emerged: limited health literacy regarding hepatitis B; misconceptions and uncertainty surrounding transmission; institutional trust as the foundation for vaccine acceptance; acceptance conditional upon effective communication; positive perceptions of routine childhood vaccination that facilitate birth-dose acceptance; and community information networks that shape health decisions. Despite poor knowledge of hepatitis B and its prevention, caregivers expressed anticipated willingness to accept the HepB-BD vaccine, reflecting trust in healthcare workers and confidence in routine immunisation. Participants frequently requested clear education and reassurance about vaccine safety and benefits before implementation. Caregivers described limited knowledge of hepatitis B but anticipated willingness to accept the HepB-BD vaccine, particularly when recommended and explained by trusted healthcare workers. Acceptance appeared conditional on clear information about the vaccine’s purpose and safety and was shaped by community information networks. Strengthening caregiver education, healthcare-worker communication, and community engagement before national introduction may support successful implementation. Future research should determine whether these anticipated perceptions translate into timely birth-dose vaccination uptake.