Monitor and Acceptance among Couples in Romantic Relationships:Actor-Partner Interdependence Models Based on the Monitor and Acceptance Theory

Communication could be an essential part of couples in their daily life.Based on Monitor and Acceptance Theory(MAT),the present study explored the mediating role of communication in the relationship between mindfulness and relationship quality among college-student couples.The research examined the dynamic relationship of monitoring and acceptance to relationship satisfaction in the Actor-Partner Interdependence Model(APIM),and the mediating effect of positive or negative communications in these relationships.A total of 96 pairs of couples in the universities in Nanjing,China participated in the research.Momentary measurements were used to measure the momentary levels of their monitor,acceptance,positive/negative communication,and relationship satisfaction.A Hierarchical Linear Model(HLM)was used to deal with the APIM.Results showed that the women’s monitor facet of state mindfulness negatively predicted men’s relationship satisfaction through women’s negative communication,and the women’s acceptance facet of state mindfulness positively predicted women’s relationship satisfaction through women’s positive and negative communication at the within-person level.The study highlights the importance of cooperation in monitoring and acceptance for couples to own and hold high levels of relationship satisfaction.

Market Research on College Students' Acceptance of Prepared Dishes

With the accelerated pace of life and the demand for dietary diversification,more and more people begin to pay attention to the convenience and health of diet,and the prepared dishes market is getting more and more attention and favor because of its characteristics of convenient and quick.In order to understand the acceptance of college students' to the prepared dishes market,this paper aimed to collect college students' views and suggestions on the prepared dishes market by means of a questionnaire survey.By analyzing the results of the survey,we found that college students' generally have a positive attitude towards prepared dishes markets,and they believe that prepared dishes provides convenient,fast and diversified dietary choices.However,some college students' have some concerns about the quality and food safety of the prepared dishes market,such as adding too many food additives and preservatives.Through the research on college students' acceptance of the prepared dishes market,we can reveal the demand and potential problems of college students' for the prepared dishes market from the consumer s point of view,so as to provide a reference for the future development of the prepared dishes market.

Coverage and Factors Associated with Acceptance and Satisfaction of Seasonal Malaria Chemoprevention in Six Health Zones in Benin

Introduction: Seasonal malaria chemoprevention (SMC) was adopted in 2019 in two health zones in Benin where malaria transmission is very high. Positive results led to the extension of the intervention to other zones with additional financial support. Annual SMC campaigns from 2021 to 2023 were carried out in all six health zones in the Atacora and Alibori departments. In five years of implementation, various approaches have been developed on the basis of a communication plan facilitating buy-in and acceptance by all stakeholders. The aim of this study was to assess the effective coverage and acceptance of the SMC by their beneficiary populations in 2023. Methods: It was a cross-sectional study with an analytical focus. Data collection took place from November 30 to December 13, 2023. The study population consisted of children under 5 years of age residing in the departments of Atacora and Alibori in northern Benin. A total of 3573 children under 5 years of age were included in the study, and their parents or guardians were interviewed. Results: During the 2023 campaign, 87.7% of targets were reached by SMC administration and 100.00% of children had received at least one dose of SMC by the fourth visit. Effective therapeutic coverage of SMC was 70.55%, with 99.60% in BNK, 69.40% in KGS, 16.20% in MK, 56.10% in 2KP, 92.40% in NBT and 89.60% in TMC. This coverage was statistically related to child and respondent ages (p Conclusion: SMC is a strategy accepted by the population, and the main reasons for non-participation in SMC were dominated by the absence of mothers or babysitters when the agents visited.

Acceptance of COVID-19 vaccine and its related determinants in Nigeria:An online survey

BACKGROUND Vaccine hesitancy is a major challenge in the fight against the coronavirus disease 2019(COVID-19)pandemic.Identifying the sociodemographic factors associated with vaccine acceptance among Nigerians is crucial for improving vaccine uptake.AIM To assess the acceptance rate of COVID-19 vaccine and its related determinants among Nigerians.METHODS An online cross-sectional survey(observational study)was conducted between February 2021 and May 2021,using a questionnaire hosted on SurveyMonkey.The invitation to take part in the poll was sent out to participants through social networking platforms.A logistic regression was used to determine which sociodemographic factors were associated with vaccine acceptance constructs.RESULTS A total of 1800 persons responded to the survey,a larger proportion of whom were males(53.9%)and within the age group of 21-30 years(29.4%)and earned an average income of less than$500 per month(43.3%).Only 0.56%of participants had a high perceived risk of COVID-19 infection,while only 1.11%had a perceived risk of dying from COVID-19.The perception rate of the COVID-19 vaccine among participants was 51.1%,while the acceptance rate was 63.9%.There was no significant association between the COVID-19 vaccine acceptance rate and related determinants assessed,particularly age(χ²=3.049,P=0.550),sex(χ²=0.102,P=0.749),average income(χ²=3.802,P=0.875),and religion(χ²=2.819,P=0.420).Participants with chronic conditions demonstrated a higher acceptance rate compared to the general population.CONCLUSION Despite the positive perception observed and substantial vaccine acceptance rate among the study participants,more public health interventions are still needed to enhance vaccine acceptability in Nigeria.

Acceptability of Caesarean Section among Pregnant Women Seeking Antenatal Care at Women and Newborn Hospital-University Teaching Hospitals, Lusaka Zambia

Caesarean section remains one of the most common obstetric and major operations performed on women during pregnancy and has contributed to improving maternal and foetal health. Consequently, significant mortality and morbidity from pregnancy and labour-related causes can be eliminated by a timely caesarean section. The acceptance of the life-saving procedure remains unsatisfactory in most sub-Saharan nations. The study aimed to assess the acceptability of caesarean section and associated factors among pregnant women seeking antenatal care at Women and Newborn Hospital-University Teaching Hospitals in Lusaka Zambia. The study utilised a quantitative cross-sectional analytical study design involving 420 pregnant women selected using systematic random sampling at Women and Newborn Hospital-University Teaching Hospitals Lusaka Zambia. Data was obtained using an Interview schedule and analysed using R software version 4.3.2. Chi-square, Fisher’s exact test, Wilcoxon rank sum test and binary logistic regression for statistical analysis at a 5% level of significance. The study found that the acceptability of Caesarean section as a mode of delivery was low (29%) among respondents at Women and Newborn Hospital-University Teaching Hospitals. This was influenced by marital status (P = 0.002), socioeconomic status (P = 0.050), parity (P = 0.004), gestation age (P = 0.008), previous history of caesarean section (P = 0.003), knowledge (P < 0.001), attitude (P < 0.001), and sociocultural beliefs (P = 0.045). Low acceptability of Caesarean section delivery is common among women at Women and Newborn Hospital-University Teaching Hospitals, despite its potential benefits for maternal and neonatal health. Socio-demographic and maternal characteristics, knowledge, attitude, perception, and socio-cultural beliefs play a major role in determining acceptability. Therefore, efforts to enhance acceptability should focus on improving knowledge, enhancing positive perceptions and attitudes, and allaying negative socio-cultural beliefs towards caesarean section.

Acceptance and Experience of HIV-Infected Adolescents in Two Hospitals in Yaoundé

Introduction: Access to antiretroviral drugs has improved the survival of children infected with the Human Immunodeficiency Virus (HIV). As they reach adolescence, they are confronted with various constraints related to the infection and its treatment, in addition to those of the growth period they are going through. The main aim of the study was to assess the acceptance and describe the experience of HIV infection by infected adolescents but also to investigate the factors associated with good acceptance and a positive experience. Methodology: The cross-sectional analytic study concerned HIV-infected adolescents aged 15 to 19 followed up at the Chantal Biya Foundation-Mother and Child Centre (CME-FCB) and the Yaoundé University Hospital Centre (CHUY) between February 2020 and June 2020. The study saw participants complete a questionnaire containing socio-demographic data and assessing acceptance and experience with the infection. Data analysis was accomplished using Epi info software version 7.2.2.6. Results: One hundred and thirteen HIV-infected adolescents were included in the study. The sex ratio was 0.68 and the mean age was 17 years. More than half of the adolescents had a good acceptance and positive experience with the infection. Related factors were the adolescent’s perception of good health and participation in an association with other infected adolescents. Conclusion: Emphasizing the psychological and educational follow-up of infected adolescents and encouraging their participation in associations for adolescents living with HIV could reduce the consequences of poor acceptance and ensure a better transition to adulthood. .

COVID-19 Vaccine Acceptance and Hesitancy among Pregnant Women: A Knowledge, Attitude, and Perceived Risks Survey in Lusaka, Zambia

Introduction: The coronavirus disease 2019 (COVID-19) is an infectious disease of the respiratory tract caused by SARS-CoV-2. Since its emergence, there have been increased rates of transmission and spread, morbidity and mortality which led to the development of COVID-19 vaccines to address the pandemic. This study assessed acceptance, knowledge, attitude, and perceived risks regarding COVID-19 vaccines among pregnant women attending antenatal care at two First-Level Hospitals in Lusaka, Zambia. Materials and Methods: This was a cross-sectional study that was conducted among 241 pregnant women using a questionnaire from August 2023 to October 2023 in two First-Level Hospitals in Lusaka district, Zambia. The collected data were analyzed using IBM Statistical Package for Social Sciences (SPSS) version 22.0. Statistical analysis was performed using a Chi-square test. The statistical significance was set at a 95% confidence level. Results: Of the 241 participants, 107 (42.7%) were aged between 24 and 34 years. Overall, 64.3% accepted the COVID-19 vaccines, of which 122 (50.6%) were already vaccinated. Further, 203 (84.6%) of the pregnant women had good knowledge, and 199 (82.6%) had positive attitudes towards COVID-19 vaccines. However, 58.5% thought COVID-19 vaccines were not safe and could cause infertility. Alongside this, 70.1% thought that COVID-19 vaccines were harmful during pregnancy. Having good knowledge of COVID-19 vaccines was associated with age (p = 0.049), education status (p = 0.001), and employment status (p = 0.001). Having a positive attitude towards COVID-19 vaccines was associated with education status (p = 0.001) and employment status (p = 0.001). Conclusion: This study found that most pregnant women had good knowledge, and positive attitudes, and the majority accepted the COVID-19 vaccine. Encouragingly, most of the pregnant women who accepted the COVID-19 vaccines were already vaccinated. Most pregnant women thought that COVID-19 vaccines had side effects, were not safe, and could be harmful during pregnancy. Consequently, this could have contributed to the hesitancy to receive a vaccine among some participants. The findings of this study demonstrate the need to provide pregnant women with continuous educational programs on the benefits of vaccinations for themselves and their children.

Status Quo of Acceptance of Illness among Reproductive Age Cervical Cancer Patients and Its Influencing Factors

Objective: To explore the status quo of acceptance of illness among reproductive-age cervical cancer patients and its influencing factors, to provide a theoretical basis for the implementation of targeted interventions. Methods: The convenience sampling method was used to investigate 256 reproductive-age cervical cancer patients using the general information questionnaire, Acceptance of Illness Scale, Reproductive Concerns After Cancer Scale, and Medical Coping Style Scale. Results: The total score of the acceptance of illness was (18.03 ± 3.24), and reproductive concerns were (57.02 ± 6.30), among reproductive-age cervical cancer patients. Multivariate analysis showed that age, number of children, income level, treatment method, level of reproductive concerns, and the yield and avoidance dimensions of medical coping style were the main influencing factors on patients’ level of illness acceptance (all P Conclusion: The acceptance of illness levels in reproductive-age cervical cancer patients was low to intermediate, and medical staff should timely identify high-risk groups and take preventive management measures based on influencing factors.

The Dissemination, Acceptance and Evolution of The Romance of the Three Kingdoms in Japan

As one of the Four Great Masterpieces of China,The Romance of the Three Kingdoms has become a landmark of ancient Chinese literature with vivid and profound character images,ups and downs of politics and war descriptions,and appealing historical plots.After being introduced to Japan in the second half of the 17th century,it was spread in Japanese society and was accepted for literary value,social needs and other reasons,then a series of evolutions were produced by combining with local culture,eventually becoming a national culture in Japan.This paper selects the most popular text of The Romance of the Three Kingdoms with 24 chapters and 120 verses in the Wanli period of the Ming Dynasty,and the Japanese translation of The Popular Romance of the Three Kingdoms published by Hunan Wenshan in 1689 as the objects,guided by Ralph Linton’s“Manifestation,Selection,Integration”cultural communication research method,to analyze the dissemination,acceptance and evolution of The Romance of the Three Kingdoms in 17-20 centuries’Japan,which started from the field of literature,then combined with various cultural forms and spread to the civic class,and finally entered politics area and produced a series of evolutions under the influence of Japanese values to become the representative culture of Japan.This paper suggests that in today’s world of frequent cultural exchanges,China should,based on strengthening cultural self-confidence,actively and appropriately select and accept foreign cultures with the attitude of prioritizing our own culture and utilizing foreign culture for our own purposes.The research outcome can provide experience for the current Chinese culture to go to the world with high quality.

On the Dissemination and Acceptance of Dongpo Culture in the UK and the US

This study delves into the intricate dissemination and acceptance of Dongpo Culture,epitomized by Su Shi,in the UK and the US,aiming to bolster the global recognition of Chinese literary and cultural values and advance the national strategy of“Going Out”.Su Shi’s multifaceted contributions—spanning literature,philosophy,calligraphy,and art—serve as a pinnacle of Northern Song Dynasty culture.This research evaluates the varied translations,monographs,biographies,journal articles,and doctoral dissertations about Su Shi in these Western nations,using literature analysis,typical analysis,and comparative methods.The findings reveal a robust interest in Su Shi studies in the US,marked by a proliferation of scholarly works and translations across diverse disciplines,such as literature,art,and aesthetics,establishing the US as a leading center for Dongpo Culture studies.Conversely,the UK,despite its early engagement,shows limited scholarly outputs and significant research papers on the subject.By examining Dongpo Culture’s overseas communication path and influence paradigm,this paper seeks to enhance China’s cultural soft power and self-confidence.It underscores the vital role of international cultural exchange in constructing a positive image of China’s national identity,facilitating its peaceful rise,and providing strategic insights for the global promotion of Chinese culture.

Acceptability of Kangaroo Mother Care (KMC) by Mothers with Low-Birth-Weight Babies at Arthur Davison Children’s Hospital, in Ndola, Zambia

Background: Kangaroo Mother Care is a simple safe method used to care for low-birth-weight babies. Low-birth-weight is a global public health issue that pose significant challenge to perinatal care systems. Globally, complications due to low-birth-weight are the leading cause of neonatal mortality, resulting in an estimated 1 million deaths annually. Kangaroo Mother Care (KMC) is a low-cost method of care for low-birth-weight infants in areas with inadequate incubators and power outages with positive outcomes. Objectives: To assess factors influencing acceptability of Kangaroo Mother Care (KMC) in NICU at Arthur Davison Children’s Hospital in Ndola, Zambia. Methodology: A cross sectional quantitative analytical study design was used. The study was conducted at Arthur Davison Children’s Hospital (ADCH) in Ndola, Zambia. The purposive sampling method was used to select the study participants and a total of 129 mothers with Low Weight Babies A were selected to participate structured closed ended questionnaire was used to collect data from the participants using an interview. Data was analyzed using a Statistical Package for Social Scientists (SPSS) software version 26. Cross tabulations were done to determine association of variables using a Chi square (x2) test at 95% confidence interval and were assumptions where not met, fishers exact test was used. Multivariate binary logistic regression analysis was used to quantify the relationship between the dependent and independent variables. Results: Most of the respondents had male babies 77%, 69% of the babies weighed 1000 g - 1400 g, majority 79% had normal delivery, 71% of the respondents were multigravida and most of the respondents 79% were married. The study reviewed that 85% of those who attained secondary education accepted KMC, 74% of the respondents without monthly income accepted KMC, 80% of the respondents had positive attitude and accepted KMC. 82% of the respondents who had positive perception accepted KMC. Conclusion: Acceptance of Kangaroo Mother Care (KMC) among 75% of the mothers underscores its widespread favourability as a beneficial method for infant care.

A study of current status of acceptance and influencing factors of advance care planning for patients with malignant tumors

Objective:To assess the ACP acceptance among patients with malignant tumor in China and factors affecting adoption and timing.Methods:Quantitative study:The convenience sampling method was adopted from October 2020 to October 2021 to investigate 200 oncology patients by a general information questionnaire,patient's advance care planning acceptance questionnaire(ACPQ).Multiple linear stepwise regression was used to analyze the influencing factors of ACP acceptance.Qualitative study:A purposive sampling method was used to select 31 oncology patients and 13 clinical nurses for semi-structured interviews.The data were analyzed using Colaizzi's seven steps.Results:The quantitative study revealed that patients with malignancy had an upper-middle acceptance score of(66.15±7.684)for ACP,with attitude(11.26±2.064),feelings(36.64±4.208),and intention(18.25±3.275)scores.Multiple linear regression analysis showed that religious beliefs,education,monthly income,bereavement experience and notification of condition were independent risk factors for acceptance of ACP(P<0.05).The qualitative study showed that(1)oncology patients have low awareness,high demand,and low acceptability of ACP intervention;(2)they preferred to discuss ACP when medical condition or treatment plan changes;(3)family members were usually involved in ACP discussions,followed by medical personnel;(4)economy,environment,companion,and doctor-patient relationship will all influence ACP implementation.As for nurses,they(1)were unsure about the dynamic changes of ACP content and its optimal timing;(2)had limited ACP knowledge;(3)were affected by environmental factors and nurse-patient relationships;(4)were prone to have disagreements due to inadequate organization department assistance.Conclusions:clinical practitioners should discuss ACP with patients in specific conditions to increase patient acceptance.ACP development requires updated legislation,professional training,and a standardized ACP system.

Exploration of University English Teachers’Acceptance and Willingness to Use Learning Management System Data Analysis Tools

This study investigates university English teachers’acceptance and willingness to use learning management system(LMS)data analysis tools in their teaching practices.The research employs a mixed-method approach,combining quantitative surveys and qualitative interviews to understand teachers’perceptions and attitudes,and the factors influencing their adoption of LMS data analysis tools.The findings reveal that perceived usefulness,perceived ease of use,technical literacy,organizational support,and data privacy concerns significantly impact teachers’willingness to use these tools.Based on these insights,the study offers practical recommendations for educational institutions to enhance the effective adoption of LMS data analysis tools in English language teaching.

Applying the Technology Acceptance Model (TAM) in Information Technology System to Evaluate the Adoption of Decision Support System

With the beginning of the information systems’ spreading, people started thinking about using them for making business decisions. Computer technology solutions, such as the Decision Support System, make the decision-making process less complex and simpler for problem-solving. In order to make a high-quality business decision, managers need to have a great deal of appropriate information. Nonetheless, this complicates the process of making appropriate decisions. In a situation like that, the possibility of using DSS is quite logical. The aim of this paper is to find out the intended use of DSS for medium and large business organizations in USA by applying the Technology Acceptance Model (TAM). Different models were developed in order to understand and predict the use of information systems, but the information systems community mostly used TAM to ensure this issue. The purpose of the research model is to determine the elements of analysis that contribute to these results. The sample for the research consisted of the target group that was supposed to have completed an online questionnaire about the manager’s use of DSS in medium and large American companies. The information obtained from the questionnaires was analyzed through the SPSS statistical software. The research has indicated that, this is primarily used due to a significant level of Perceived usefulness and For the Perceived ease of use.

基于ACCEPT方案的EICU危重患者院内转运路径的应用

目的 :探讨基于ACCEPT方案的危重患者院内转运路径在急诊重症监护室(emergency intensive care unit,EICU)的应用效果。方法 :将2013年3—12月从EICU转运的65例危重患者设为对照组;2014年1—10月的70例危重患者设为观察组。对照组采用常规方法转运;观察组在建立基于ACCEPT方案的转运路径后,按转运路径实施院内转运。结果:两组不良事件发生率、接收科室满意度比较差异有统计学意义(P<0.01)。结论:应用基于ACCEPT方案的EICU危重患者院内转运路径,可以提高危重患者的转运安全,提升护理服务质量。

Challenges and prospects for consumer acceptance of cultured meat

Consumer acceptance of cultured meat is expected to depend on a wide diversity of determinants ranging from technologyrelated perceptions to product-specific expectations, and including wider contextual factors like media coverage, public involvement, and trust in science, policy and society. This paper discusses the case of cultured meat against this multitude of possible determinants shaping future consumer acceptance or rejection. The paper also presents insights from a primary exploratory study performed in April 2013 with consumers from Flanders（Belgium）（n=180）. The concept of cultured meat was only known（unaided） by 13% of the study participants. After receiving basic information about what cultured meat is, participants expressed favorable expectations about the concept. Only 9% rejected the idea of trying cultured meat, while two thirds hesitated and about quarter indicated to be willing to try it. The provision of additional information about the environmental benefits of cultured meat compared to traditional meat resulted in 43% of the participants indicating to be willing to try this novel food, while another 51% indicated to be ‘maybe＇ willing to do so. Price and sensory expectations emerged as major obstacles. Consumers eating mostly vegetarian meals were less convinced that cultured meat might be healthy, suggesting that vegetarians may not be the ideal primary target group for this novel meat substitute. Although exploratory rather than conclusive, the findings generally underscore doubts among consumers about trying this product when it would become available, and therefore also the challenge for cultured meat to mimic traditional meat in terms of sensory quality at an affordable price in order to become acceptable for future consumers.

Processing,Quality,Safety,and Acceptance of Meat Analogue Products

Rapid global population growth has caused an increasing need for products containing protein.Meat products are the most common high-protein food source,but impact the environment,cause animal welfare issues,and raise public health concerns.Consumer health and food safety are paramount to the food industry.Both the scientists and food industry are actively seeking plant proteins to substitute for animal-sourced proteins.Plant proteins have a well-balanced amino acid composition,and exhibit great potential for replacing meat via the development of healthy,high-protein,low-saturated fat,cholesterol-free,and nutritionally similar meat-like products.Generally,meat analogue formulations are specially designed and processing conditions are optimized to obtain the texture and bite of real animal meat.This article focuses on plant-based meat analogues,and covers aspects regarding processing,products,quality,and nutritional and structural modifications.Product safety consciousness and consumer acceptance are also discussed.Challenges and perspectives for future research concerning nonmeat products are presented.

STABILITY OF INNOVATION DIFFUSION MODEL WITH NONLINEAR ACCEPTANCE

In this article, an innovation diffusion model with the nonlinear acceptance is proposed to describe the dynamics of three competing products in a market. It is proved that the model admits a unique positive equilibrium, which is globally stable by excluding the existence of periodic solutions and by using the theory of three dimensional competition systems.

An Acceptance Model of Using Mobile-Government Services(AMGS)

In recent years,the telecommunications sector is no longer limited to traditional communications,but has become the backbone for the use of data,content and digital applications by individuals,governments and companies to ensure the continuation of economic and social activity in light of social distancing and total closure inmost countries in the world.Therefore,electronic government(e-Government)andmobile government(m-Government)are the results of technological evolution and innovation.Hence,it is important to investigate the factors that influence the intention to use m-Government services among Jordan’s society.This paper proposed a new m-Government acceptance model in Jordan(AMGS);this model combines the Information System(IS)Success Factor Model and Hofstede Cultural Dimensions Theory.The study was conducted by surveying different groups of the Jordanian community.Astructured questionnaire was used to collect data from203 respondents.Multiple regression analysis has been conducted to analyze the data.The results indicate that the significant predictors of citizen intention to use m-Government services in Jordan are Information Quality,Service Quality,Uncertainty Avoidance,and Indulgence vs.restraint.While,the results also suggest that Power Distance is not a significant predictor of citizen intention to use m-Government services.

Determinants of COVID-19 vaccine acceptance and encountered side-effects among the vaccinated in Bangladesh

Objective:To identify the acceptance of the vaccine based on factors influencing the vaccination program and the side effects from vaccinated people.Methods:A cross-sectional online survey of 1529 Bangladeshi adults(≥18 years)was conducted between 17 April,2021 and 26 April,2021.Statistical analysis of the data included Chi-square test and multinomial logistic regression analysis.Results:In total,67.04%of the participants were willing to accept a COVID-19 vaccine,and 45.00%of them in our study had already received.Overall Bangladeshi people were more likely to accept COVID-19 vaccine if the vaccine reduces risk of infectious disease and has no associated health risk after receiving it.Among the respondents,religions,education level,living area(urban),belif that vaccines protect against infectious diseases and vaccines do not have health-related risk and vaccination was significantly associated with the acceptance of COVID-19 vaccines.Conversely,people’s perception on development of natural immunity rather than receiving vaccines was also positively reflected.More than half(57.41%)reported minor side effects such as fever,muscle pain and headache after getting vaccine shots.Conclusions:This study revealed that the acceptance rate was influenced by socio-demographic and health-related characteristics and people are not afraid of this vaccine if they faced minor side effects after receiving it.These findings might help the government and policymakers of Bangladesh to implement necessary steps to accomplish this vaccination program effectively.