[Factors influencing the uptake of vaccines by adolescents with migration background. A qualitative study of adolescents, mothers, and physicians]

Defining the determinants of vaccine uptake and undervaccination in migrant populations in Europe to improve routine and COVID-19 vaccine uptake: a systematic review

Understanding why some migrants in Europe are at risk of underimmunisation and show lower vaccination uptake for routine and COVID-19 vaccines is critical if we are to address vaccination inequities and meet the goals of WHO's new Immunisation Agenda 2030. We did a systematic review (PROSPERO: CRD42020219214) exploring barriers and facilitators of vaccine uptake (categorised using the 5As taxonomy: access, awareness, affordability, acceptance, activation) and sociodemographic determinants of undervaccination among migrants in the EU and European Economic Area, the UK, and Switzerland. We searched MEDLINE, CINAHL, and PsycINFO from 2000 to 2021 for primary research, with no restrictions on language. 5259 data sources were screened, with 67 studies included from 16 countries, representing 366 529 migrants. We identified multiple access barriers-including language, literacy, and communication barriers, practical and legal barriers to accessing and delivering vaccination services, and service barriers such as lack of specific guidelines and knowledge of health-care professionals-for key vaccines including measles-mumps-rubella, diphtheria-pertussis-tetanus, human papillomavirus, influenza, polio, and COVID-19 vaccines. Acceptance barriers were mostly reported in eastern European and Muslim migrants for human papillomavirus, measles, and influenza vaccines. We identified 23 significant determinants of undervaccination in migrants (p<0·05), including African origin, recent migration, and being a refugee or asylum seeker. We did not identify a strong overall association with gender or age. Tailored vaccination messaging, community outreach, and behavioural nudges facilitated uptake. Migrants' barriers to accessing health care are already well documented, and this Review confirms their role in limiting vaccine uptake. These findings hold immediate relevance to strengthening vaccination programmes in high-income countries, including for COVID-19, and suggest that tailored, culturally sensitive, and evidence-informed strategies, unambiguous public health messaging, and health system strengthening are needed to address access and acceptance barriers to vaccination in migrants and create opportunities and pathways for offering catch-up vaccinations to migrants.

A school-based educational on-site vaccination intervention for adolescents in an urban area in Germany: feasibility and psychometric properties of instruments in a pilot study

Background

Vaccination rates for measles, mumps, and rubella (MMR) and diphtheria, tetanus, pertussis, and polio (Tdap-IPV) are not optimal among German adolescents. Education in combination with easy access to vaccination may be a promising approach to improve vaccination rates. The present paper describes a pilot study of a planned cluster randomized controlled trial (cRCT) in which we aim to improve MMR and Tdap-IPV vaccination rates together with knowledge and self-efficacy in a school setting.

Methods

The study covered 863 students from 41 classes of four schools. The optimization and feasibility of access to schools, recruitment strategies, intervention, and assessment procedures were examined. The course and content of the educational unit were evaluated with a mixed-methods approach. A pre-post measurement design was tested for the vaccination rate in all schools. Additionally, at two schools, improvement in vaccination-related knowledge and perceived self-efficacy were measured by questionnaire pre-educational unit (n=287) and post-educational unit (n=293). The remaining two schools provided only postintervention data. Finally, we evaluated the psychometric properties (i.e., reliability, retest reliability, and change rates) of the questionnaire, applying Cronbach’s alpha, factor analyses, generalized estimating equations and linear mixed models.

Results

The findings of the pilot study indicated good feasibility. Of the total sample, 437 students (50.9%) brought their vaccination cards to school, 68 students received Tdap-IPV vaccinations, and 11 received MMR vaccinations. Out of six knowledge questions, on average, the students had M=2.84 (95% CI [2.69, 3.10]) correct answers before and M=4.45 (95% CI [4.26, 4.64]) after the class. Ranging from 1 to 4, the self-efficacy scale changed by 0.3 points (p <.001); Cronbach’s alpha was 0.67 and 0.76 pre- and post-educational unit, respectively, and a one-factor solution was found. Content analysis of the five semistructured group interviews (n=12, 58.3% female) showed that all students found the length of the intervention to be appropriate. The teaching methods, including interactive and social media components, were perceived as very good.

Conclusions

A school-based educational and on-site vaccination intervention appears to be feasible in terms of procedures and the adequacy of the instruments for the adolescent target group.

Trial registration

ISRCTN, ISRCTN18026662. Pilot study for main trial registered 8 December 2017.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12443-8.

A Multilingual Integrative Review of Health Literacy in Former Soviet Union, Russian-Speaking Immigrants

Large diasporas of former Soviet Union (FSU) immigrants are found in the USA, Germany, and Israel. To synthesize evidence, identify limitations, and propose future directions we conducted an integrative review on the health literacy of FSU immigrants, migrants, or refugees in four languages. Following integrative review and PRISMA guidelines, we searched four databases in English and performed supplementary searches in Russian, German, and Hebrew to identify qualitative and quantitative studies on FSU immigrants and health literacy. Six articles met inclusion criteria in English and one in German; the majority were published in the last five years. Only two articles measured health literacy of FSU immigrants, which was lower than the general population. Four articles were about immigrants with a mean age ≥50 years. All articles stressed the value of translated, culturally relevant health information. The health literacy of FSU immigrants is understudied, despite clear needs. Future research should include assessments of FSU immigrants’ health literacy and include diverse (e.g., age, gender) yet well-defined populations to determine both barriers and facilitators to their health literacy. This review, an example of a multilingual search, provided a comprehensive understanding of existing literature and is a useful approach for global health literacy research.

School-based educational and on-site vaccination intervention among adolescents: study protocol of a cluster randomised controlled trial

INTRODUCTION

Childhood vaccination programmes have been established in all Organisation for Economic Co-operation and Development (OECD) countries; however, measles, mumps and rubella (MMR) as well as diphtheria, tetanus, pertussis and polio (Tdap-IPV) vaccination rates are not optimal in adolescents. Education in combination with easy access vaccination may be a promising approach to improve vaccination rates. We aim at improving MMR and Tdap-IPV rates in a school setting in the context of a planned cluster randomised controlled trial (cRCT), the present paper describes the detailed protocol of this trial.

METHODS AND ANALYSIS

We will conduct a school-based cRCT, where schools will be randomised to either an educational condition addressing knowledge, risk communication and enhancing self-efficacy regarding vaccination or a low-intensity information condition. In both conditions, a bus equipped with medical staff and materials, will be delivering MMR and Tdap-IPV vaccine directly after the intervention. Schools in the city centre of Berlin, Germany, will be stratified by percentage of migration and type of school. Primary outcome is the number of students who receive vaccination in the bus. Secondary outcomes are knowledge and self-efficacy. An estimated sample size of 355 school classes with approximately 25 students per class is required. The planned analyses will take the nested structure of students, classes and schools into account.

ETHICS AND DISSEMINATION

The study will be performed according to the principles of Good Clinical Practice and the Declaration of Helsinki. Approval was obtained by the local ethics committee. Parents of all students will be informed in advance. Their written consent will be obtained, in case students are underage. For dissemination, we will engage with governmental organisations to create potential of our educational unit to be included in future public health prevention schemes.

TRIAL REGISTRATION NUMBER

ISRCTN18026662;Pre-results.

Barriers to immunization among newcomers: A systematic review

INTRODUCTION

Currently, there is a lack of comprehensive evidence exploring vaccine decision-making among newcomers. We conducted a systematic review of qualitative studies aimed at identifying factors that influence newcomers' decision-making with regards to vaccination.

METHODS

We conducted a search of MEDLINE, EMBASE, CINAHL and Cochrane Central. To be included, studies needed to employ a qualitative methodology and address newcomer attitudes, beliefs, and/or perceptions regarding vaccination. Two independent reviewers screened the articles for relevant information and applied a content analysis methodology to code the identified barriers.

RESULTS

Twenty-one studies were included in this review, and four types of barriers were identified: cultural factors, knowledge barriers, insufficient access to healthcare, and vaccine hesitancy. Insufficient knowledge about vaccination and the virus being prevented and concerns about safety were the most commonly reported barriers. A sub-analysis of barriers specific to HPV indicated that cultural beliefs about sexuality and incomplete knowledge about the role of HPV in the development of cervical cancer are major barriers to vaccine uptake.

CONCLUSION

Strategies to improve vaccination uptake in newcomers should consider focusing on the barriers identified in this review while taking into account the unique opportunities for promoting uptake within newcomer populations.