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BMC Health Services Research

Open Access

What is the best way to organize vaccination services for the children of Quebec, Canada?

  • Maryse Guav1, 2,
  • Paule Clément2,
  • Carole Vanier1,
  • Sandie Briand2,
  • Cécile Michaud1, 3,
  • Chantal Boulet4,
  • Joane Désilets5,
  • Fernand Guillemette6,
  • Eve Dubé1, 7,
  • Nicole Boulianne1, 7,
  • Jacques Lemaire2,
  • Monique Landry8 and
  • Geneviève Baron1, 9
BMC Health Services Research201414(Suppl 2):P52

Published: 7 July 2014


Optimal ModelService UsageInquiry MethodologyField NoteService Organization


Recently in Quebec, Canada, several contextual elements (e.g. physician disengagement, delayed appointments and late vaccines) justified a review of how child vaccination services are offered. A 5-year study begun in 2010-2011 aims to identify the optimal organizational model(s) for vaccination services for children aged 0-5 years. The first three year process and progress are reported.

Materials and methods

This action research project adopts the Appreciative Inquiry methodology [1], using case studies [2]: 3 regions are currently studied (region 1: 16,000 births/year; region 2: 5,000 births/year; region 3:5,000 births/year). Building the model began with the development of a conceptual model drawn from a literature review. The participatory process relies on a steering committee for each case study, made up of players from local and regional levels and researchers. It meets monthly to discuss, reflect on and review vaccination service components. Various facilitation techniques foster the gradual production of an array of documents (e.g. accounts, schemas, tables) to fuel the discussion. Logbooks and field notes document the process. Qualitative analyses have been done.


To date, charts of service usage and schemas illustrating current vaccination service organization have been developed. The appointment-making processes, the functioning of vaccination clinics, the management of immunizing products and vaccination data have been described. Some courses of action have emerged and will be further explored: simplified appointment making, more systematic reminders and follow-ups, better structured vaccine transport and storage.


Thanks to the approach used, emerging solutions will be more sustainable, acceptable and adapted to needs. Identification of the optimal model(s) for the organization of child vaccination services, adjusted to the various contexts is on progress.

Authors’ Affiliations

University of Sherbrooke, Longueuil, Canada
National Institute of Public Health, Montreal, Canada
Charles LeMoyne Hospital Research Centre, Longueuil, Canada
Public Health Directorate, Agence de la sante et des services sociaux de la Montérégie, Longueuil, Canada
Public Health Directorate, Agence de la sante et des services sociaux de Lanaudière, Joliette, Canada
Public Health Directorate, Agence de la sante et des services sociaux de la Mauricie et du Centre-du-Québec, Trois-Rivières, Canada
Centre de recherche du CHU de Quebec, Canada
Quebec Ministry of Health, Montreal, Canada
Public Health Directorate, Agence de la santé et des services sociaux de I’Estrie, Sherbrooke, Canada


  1. Reed J: Appreciative Inquiry: Research for Change. 2007, Thousand Oaks: Sage PublicationsGoogle Scholar
  2. Yin R: Case study research: design and methods-Fourth Edition. 2009, Thousand Oaks: Sage PublicationsGoogle Scholar


© Guav et al; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.