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Johansen I, Selim M, J Hoffman S, Dawson-Hahn E, Yu K. Pivoting From Influenza to COVID-19 Vaccinations: How a Minnesota Vaccination Program Reduced Barriers for Refugee, Immigrant, and Migrant Communities Accessing Vaccines During the COVID-19 Pandemic. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:701-709. [PMID: 39041765 DOI: 10.1097/phh.0000000000001931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
The Minnesota Immunization Networking Initiative (MINI) led by Fairview Health Services has addressed barriers to accessing immunizations through partnerships with community organizations to provide free influenza vaccinations to historically underserved communities, especially refugee, immigrant, and migrant communities. Once the COVID-19 vaccine was available, MINI quickly pivoted operations to distribute the vaccine and provide technical assistance to community partners amidst rapidly evolving guidance. With infrastructure and a vaccination team in place, MINI responded to new and emerging needs, eg, implementing a more accessible and low-tech scheduling system, increasing staffing to meet growing needs, and expanding partnerships with community organizations and leaders. From February 2021 to September 2023, MINI organized 1120 community-based vaccine clinics and administered 43,123 COVID-19 vaccinations. Of those vaccine recipients, 88% identified as Black, Indigenous, and other people of color, and for preferred language, over half stated that they preferred a language other than English. These demographics are similar to those of the earlier influenza clinics, even as average annual clinics have tripled and average total vaccinations have quadrupled since the pivot to COVID-19 vaccination clinics. Some keys to success were: (1) consistent, bidirectional communication and shared decision-making with community partners; (2) prioritizing sustainable staffing models with the support of administrative leadership and resources; and (3) having a community-informed approach supported by the practice of hiring staff from communities served. Because of the effectiveness of this model, MINI is primed to respond to planned and unplanned emergent public health crises.
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Affiliation(s)
- Ingrid Johansen
- Community Clinical Care (Ms Johansen and Mr Selim), Fairview Health Services, Minneapolis, Minnesota; Population Health and Systems,University of Minnesota School of Nursing (Dr Hoffman); Division of General Pediatrics, University of Washington (Dr Dawson-Hahn), Seattle, Washington; and Center for Global Health and Social Responsibility Project, National Resource Center for Refugee, Immigrants, and Migrants (Ms Yu), University of Minnesota, Minneapolis, Minnesota
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Roberti J, Ini N, Belizan M, Alonso JP. Barriers and facilitators to vaccination in Latin America: a thematic synthesis of qualitative studies. CAD SAUDE PUBLICA 2024; 40:e00165023. [PMID: 38922226 PMCID: PMC11192573 DOI: 10.1590/0102-311xen165023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 04/01/2024] [Accepted: 04/09/2024] [Indexed: 06/27/2024] Open
Abstract
Vaccines are often undervalued or underused for a variety of reasons, and vaccine hesitancy is a global challenge that threatens vaccine acceptance and the goals of immunization programs. This review aimed to describe the barriers and facilitators to vaccination in Latin America. The study design was a systematic review and thematic synthesis of qualitative studies reporting on the knowledge or attitudes of adults, parents of children at vaccination age, adolescents and health professionals towards vaccination in Latin America. The databases searched were PubMed, CENTRAL, Scopus, LILACS, SciELO, and CINAHL. A total of 56 studies were included. Facilitators included vaccination being recognized as an effective strategy for preventing infectious diseases and as a requirement for access to social assistance programs, schooling or employment. Recommendations from health professionals and positive experiences with health services were also identified as facilitators. The main barriers were lack of information or counseling, structural problems such as shortages of vaccines and limited hours of operation, the inability to afford over-the-counter vaccines or transportation to health facilities, certain religious beliefs, misconceptions and safety concerns. Qualitative research can contribute to understanding perceptions and decision-making about vaccination and to designing policies and interventions to increase coverage.
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Affiliation(s)
- Javier Roberti
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Natalí Ini
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Maria Belizan
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Juan Pedro Alonso
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
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McDermid P, Abdi I, Mustafa K, Blazek K, Harris-Roxas B, Jackson CJ, Seale H. Examining the influence of community leaders and other community actors on immunisation practices in Australia: A national cross-sectional study. Vaccine 2024; 42:3647-3654. [PMID: 38704260 DOI: 10.1016/j.vaccine.2024.04.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Variation in COVID-19 vaccination coverage and increasing vaccine hesitancy are well documented, especially amongst ethnic minority populations and current channels of vaccine and communication have been found to be inadequate. It has been suggested that more be done to utilise community-led pathways to improve vaccine readiness in ethnic minority communities in Australia. The study aimed to explore receptiveness towards the role of different actors and methods of communication about immunisation. METHODS A cross-sectional survey of 1,227 adults in Australia was conducted to examine the roles of various actors in promoting vaccine uptake. Chi-square analyses and independent samples t-tests were used to identify significant associations between sociodemographic characteristics, vaccine practices, and vaccine information-seeking behaviours and (1) COVID-19 vaccine uptake (at least one dose) and (2) speaking a language other than English. RESULTS At the time of the survey, 93% of respondents had received at least one dose of the COVID-19 vaccine. There were significant associations between COVID-19 vaccine uptake and: perceived capacity to locate accurate and timely vaccine information; receiving the COVID-19 vaccination information from a Nurse or Pharmacist; and receiving a vaccine recommendation by a GP. Additionally, respondents who spoke a language other than English reported were significantly more likely to have received information from family, friends, workplaces, local councils, religious centres, community leaders, and religious leaders than those who only spoke English. CONCLUSION Significant variations in vaccine practices and vaccine information-seeking behaviours were found, especially in those who speak a language other than English. To enhance vaccine uptake and to address vaccine hesitancy in Australia, vaccine promotion strategies and health communication efforts require significant consideration of information accessibility and communication source preferences.
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Affiliation(s)
- Pippa McDermid
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Ikram Abdi
- University of Sydney, School of Public Health, Faculty of Medicine and Health, Sydney, Australia
| | - Kinza Mustafa
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Katrina Blazek
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Ben Harris-Roxas
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; School of Public Health, University of Technology Sydney, Australia
| | - Chris J Jackson
- UNSW Business School, University of New South Wales, Sydney, NSW, Australia
| | - Holly Seale
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
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Dodoo CC, Hanson-Yamoah E, Adedia D, Erzuah I, Yamoah P, Brobbey F, Cobbold C, Mensah J. Using machine learning algorithms to predict COVID-19 vaccine uptake: A year after the introduction of COVID-19 vaccines in Ghana. Vaccine X 2024; 18:100466. [PMID: 38444651 PMCID: PMC10911946 DOI: 10.1016/j.jvacx.2024.100466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/07/2024] Open
Abstract
The impact of vaccine hesitancy on global health is one that carries dire consequences. This was evident during the outbreak of the COVID-19 pandemic, where numerous theories and rumours emerged. To facilitate targeted actions aimed at increasing vaccine acceptance, it is essential to identify and understand the barriers that hinder vaccine uptake, particularly regarding the COVID-19 vaccine in Ghana, one year after its introduction in the country. We conducted a cross-sectional study utilizing self-administered questionnaires to determine factors, including barriers, that predict COVID-19 vaccine uptake among clients visiting a tertiary and quaternary hospital using some machine learning algorithms. Among the findings, machine learning models were developed and compared, with the best model employed to predict and guide interventions tailored to specific populations and contexts. A random forest model was utilized for prediction, revealing that the type of facility respondents visited and the presence of underlying medical conditions were significant factors in determining an individual's likelihood of receiving the COVID-19 vaccine. The results showed that machine learning algorithms can be of great use in determining COVID-19 vaccine uptake.
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Affiliation(s)
| | - Ebo Hanson-Yamoah
- School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana
| | - David Adedia
- School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Irene Erzuah
- School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana
| | - Peter Yamoah
- School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana
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Brooks SP, Sidhu K, Cooper E, Michelle Driedger S, Gisenya L, Kaur G, Kniseley M, Jardine CG. The influence of health service interactions and local policies on vaccination decision-making in immigrant women: A multi-site Canadian qualitative study. Vaccine 2024; 42:2793-2800. [PMID: 38514354 DOI: 10.1016/j.vaccine.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 02/15/2024] [Accepted: 03/05/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES Research on immigrant and refugee vaccination uptake in Canada shows that immunization decisions vary by vaccine type, location, age and migration status. Despite their diversity, these studies often treat immigrant and refugee populations as a single group relative to other Canadians. In this comparative study, we explored how previous risk communication and immunization experiences influence immunization decisions by immigrant and refugee women from three communities across Canada. METHODS Participants included women from the Punjabi immigrant community located in Surrey and Abbotsford, British Columbia (n = 36), the Nigerian immigrant community located in Winnipeg, Manitoba (n = 43), and the Congolese refugee community in Edmonton, Alberta (n = 18). Using focus groups guided by focused ethnography methodology, we sought to understand immunization experiences in Canada and before arrival, and what information sources influenced the immunization decision-making process by the women in the three communities. RESULTS Participants had differing past experiences in Canada and before their arrival that influenced how they used information in their vaccination decisions. Clear vaccination communications and dialogue with Canadian health care providers increased trust in Canadian health care and the likelihood of vaccine uptake. By contrast, weak vaccine recommendations and antivaccination information in the community prompted participants to decline future vaccines. CONCLUSION Given our participants' different communication preferences and needs, we argue that a one-size-fits-all communication approach is inappropriate for immigrant and refugee populations. Instead, multi-pronged communication strategies are required to reach participants and respond to previous experiences and information that may lead to vaccination hesitancy.
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Affiliation(s)
- Stephanie P Brooks
- School of Public Health, University of Alberta, 3-300 Edmonton Clinical Health Academy, 11405 - 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada.
| | - Kamaljit Sidhu
- Faculty of Health Sciences, University of the Fraser Valley, 45190 Caen Ave, Chilliwack, B.C. V2R 0N3, Canada.
| | - Elizabeth Cooper
- Faculty of Kinesiology and Health Sciences, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada.
| | - S Michelle Driedger
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, MB R3E 0W3, Canada.
| | - Linda Gisenya
- School of Public Health, University of Alberta, 3-300 Edmonton Clinical Health Academy, 11405 - 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada.
| | - Gagandeep Kaur
- Faculty of Health Sciences, University of the Fraser Valley, 45190 Caen Ave, Chilliwack, B.C. V2R 0N3, Canada.
| | - Marinel Kniseley
- Faculty of Health Sciences, University of the Fraser Valley, 45190 Caen Ave, Chilliwack, B.C. V2R 0N3, Canada.
| | - Cynthia G Jardine
- Faculty of Health Sciences, University of the Fraser Valley, 45190 Caen Ave, Chilliwack, B.C. V2R 0N3, Canada.
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Malkin J, Jessiman-Perreault G, Alberga Machado A, Teare G, Snider J, Tirmizi SF, Youngson E, Wang T, Law J, Bandara T, Rathwell M, Neudorf C, Allen Scott L. Individual and Geospatial Determinants of Health Associated With School-Based Human Papillomavirus Immunization in Alberta: Population-Based Cohort Study. JMIR Public Health Surveill 2024; 10:e45508. [PMID: 38536211 PMCID: PMC11007603 DOI: 10.2196/45508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 10/06/2023] [Accepted: 01/07/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Human papillomavirus (HPV) infection causes nearly all cervical cancer cases and is a cause of anogenital and oropharyngeal cancers. The incidence of HPV-associated cancers is inequitable, with an increased burden on marginalized groups in high-income countries. Understanding how immunization status varies by material and social deprivation, health system, and geospatial factors is valuable for prioritizing and planning HPV immunization interventions. OBJECTIVE The objective of this study was to describe school-based HPV immunization rates by individual and geospatial determinants of health in Alberta, Canada. METHODS Health administrative data for male and female individuals born in 2004 in Alberta were used to determine HPV immunization status based on age and the number of doses administered in schools during the 2014/2015-2018/2019 school years. Immunization status and its relationship with material and social deprivation and health system factors were assessed by a logistic regression model. Geospatial clustering was assessed using Getis-Ord Gi* hot spot analysis. Mean scores of material and social deprivation and health system factors were compared between hot and cold spots without full HPV immunization using independent samples t tests. A multidisciplinary team comprising researchers and knowledge users formed a co-design team to design the study protocol and review the study results. RESULTS The cohort consisted of 45,207 youths. In the adjusted model, the odds of those who did not see their general practitioner (GP) within 3 years before turning 10 years old and not being fully immunized were 1.965 times higher (95% CI 1.855-2.080) than those who did see their GP. The odds of health system users with health conditions and health system nonusers not being fully immunized were 1.092 (95% CI 1.006-1.185) and 1.831 (95% CI 1.678-1.998) times higher, respectively, than health system users without health conditions. The odds of those who lived in areas with the most material and social deprivation not being fully immunized were 1.287 (95% CI 1.200-1.381) and 1.099 (95% CI 1.029-1.174) times higher, respectively, than those who lived in areas with the least deprivation. The odds of those who lived in rural areas not being fully immunized were 1.428 times higher (95% CI 1.359-1.501) than those who lived in urban areas. Significant hot spot clusters of individuals without full HPV immunization exist in rural locations on the northern and eastern regions of Alberta. Hot spots had significantly worse mean material deprivation scores (P=.008) and fewer GP visits (P=.001) than cold spots. CONCLUSIONS Findings suggest that material and social deprivation, health system access, and rural residency impact HPV immunization. Such factors should be considered by public health professionals in other jurisdictions and will be used by the Alberta co-design team when tailoring programs to increase HPV vaccine uptake in priority populations and regions.
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Affiliation(s)
- Jennifer Malkin
- Cancer Prevention and Screening Innovation, Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada
| | - Geneviève Jessiman-Perreault
- Cancer Prevention and Screening Innovation, Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada
| | - Amanda Alberga Machado
- Cancer Prevention and Screening Innovation, Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada
| | - Gary Teare
- Cancer Prevention and Screening Innovation, Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada
| | - Joanne Snider
- Communicable Disease Control, Provincial Population and Public Health, Alberta Health Services, Edmonton, AB, Canada
| | - Syed Farhan Tirmizi
- Communicable Disease Control, Provincial Population and Public Health, Alberta Health Services, Edmonton, AB, Canada
| | - Erik Youngson
- Provincial Research Data Services, Alberta Health Services, Edmonton, AB, Canada
| | - Ting Wang
- Provincial Research Data Services, Alberta Health Services, Edmonton, AB, Canada
| | - Jessica Law
- Cancer Prevention and Screening Innovation, Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada
| | - Thilina Bandara
- School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | | | | | - Lisa Allen Scott
- Cancer Prevention and Screening Innovation, Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada
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Aghajafari F, Wall L, Weightman AM, Ness A, Lake D, Anupindi K, Moorthi G, Kuk B, Santana M, Coakley A. An exploration of COVID-19 vaccination models for newcomer refugees and immigrants in Calgary, Canada. Arch Public Health 2024; 82:33. [PMID: 38468290 DOI: 10.1186/s13690-024-01255-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/17/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND The World Health Organization stresses the need for tailored COVID-19 models of vaccination to meet the needs of diverse populations and ultimately reach high rates of vaccination. However, little evidence exists on how COVID-19 models of vaccination operated in the novel context of the pandemic, how vulnerable populations, such as refugees, experience COVID-19 vaccination systems in high-income countries, and what lessons may be learned from vaccination efforts with vulnerable populations. To address this gap, this study explored COVID-19 vaccine delivery models available to newcomer refugees and immigrants, and refugee experiences across different COVID-19 vaccine delivery models in Calgary, Canada, and surrounding area in 2021 and 2022, to understand the barriers, strengths, and strategies of models to support access to COVID-19 vaccination for newcomer refugees and immigrants. METHODS Researchers conducted structured interviews with Government Assisted Refugees (n = 39), and semi-structured interviews with Privately Sponsored Refugees (n = 6), private refugee sponsors (n = 3), and stakeholders involved in vaccination systems (n = 13) in 2022. Thematic analysis was conducted to draw out themes related to barriers, strengths, and strategies of vaccine delivery models and the intersections with patient experiences. RESULTS Newcomer refugee and immigrant focused vaccination models and strategies were explored. They demonstrated how partnerships between organizations, multi-pronged approaches, and culturally responsive services were crucial to navigate ongoing and emergent factors, such as vaccine hesitancy, mandates, and other determinants of under-vaccination. Many vaccination models presented through interviews were not specific to refugees and included immigrants, temporary residents, ethnocultural community members, and other vulnerable populations in their design. CONCLUSIONS Increasing COVID-19 vaccine uptake for newcomer refugees and immigrants, is complex and requires trust, ongoing information provision, and local partnerships to address ongoing and emerging factors. Three key policy implications were drawn. First, findings demonstrated the need for flexible funding to offer outreach, translation, cultural interpretation, and to meet the basic needs of patients prior to engaging in vaccinations. Second, the research showed that embedding culturally responsive strategies within services ensures community needs are met. Finally, collaborating with partners that reflect the diverse needs of communities is crucial for the success of any health efforts serving newcomers.
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Affiliation(s)
- Fariba Aghajafari
- Department of Family Medicine, University of Calgary, Calgary, Canada.
| | | | | | - Alyssa Ness
- Department of Family Medicine, University of Calgary, Calgary, Canada
| | - Deidre Lake
- Alberta International Medical Graduates Association, Calgary, Canada
| | - Krishna Anupindi
- Department of Family Medicine, University of Calgary, Calgary, Canada
| | | | - Bryan Kuk
- Habitus Consulting Collective, Calgary, Canada
| | - Maria Santana
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Annalee Coakley
- Department of Family Medicine, University of Calgary, Calgary, Canada
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Kuroda M, Shaw AV, Campagna CD. The experiences of community health workers when communicating with refugees about COVID-19 vaccines in Syracuse, NY: A qualitative study. Heliyon 2024; 10:e26136. [PMID: 38434037 PMCID: PMC10906162 DOI: 10.1016/j.heliyon.2024.e26136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 03/05/2024] Open
Abstract
Background Refugees are among the most health-vulnerable members of society. Despite the importance of vaccination to mitigate the risks associated with COVID-19 infection, ensuring adequate access and uptake of the COVID-19 vaccine remains a pressing concern for refugee populations. Research has suggested that community-oriented approaches and open communication with trusted individuals are essential to address this challenge. Vaccine outreach efforts were performed in Syracuse, NY, by Community Health Workers (CHWs) as trusted refugee community members. This study explored CHWs' experiences during vaccine outreach and perceptions about COVID-19 vaccine hesitancy and acceptance among refugees, including barriers and facilitators to vaccination. Methods A qualitative study was performed using thematic analysis following six semi-structured interviews with CHWs. Results Four main themes supported by 16 sub-themes were extracted. CHWs described the (1) diverse beliefs and attitudes of refugees by ethnic group, with most having low vaccine acceptance at first. (2) Barriers included contextual barriers, lack of awareness, misinformation, and withdrawal when forced from vaccine mandates. However, CHWs also identified numerous (3) facilitators to vaccination, including the internal processing and eventual vaccine acceptance, supported by external messaging by CHWs and time. Culturally sensitive intervention strategies occurred through (4) CHW team efforts and their provision of reliable information to refugee clients, with openness and over time. The team efforts of CHWs significantly contributed to refugee acceptance and uptake of the COVID-19 vaccine. Conclusions This study revealed how the refugee population changed their belief towards the COVID-19 vaccine through trust, time, and reliable information provided by CHWs and describes culturally sensitive strategies for vaccine uptake by refugees. CHWs' reflection on COVID-19 vaccine hesitancy and acceptance among refugees during outreach efforts is an essential perspective when implementing future public health interventions.
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Affiliation(s)
- Moe Kuroda
- Norton College of Medicine, MPH Program, SUNY Upstate Medical University, Syracuse, NY, USA
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of General Medicine, Toyama University Hospital, Toyama, Japan
| | - Andrea V. Shaw
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Christina D. Campagna
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Public Health & Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
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Aghajafari F, Wall L, Weightman A, Ness A, Lake D, Anupindi K, Moorthi G, Kuk B, Santana M, Coakley A. COVID-19 Vaccinations, Trust, and Vaccination Decisions within the Refugee Community of Calgary, Canada. Vaccines (Basel) 2024; 12:177. [PMID: 38400160 PMCID: PMC10891815 DOI: 10.3390/vaccines12020177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Refugee decisions to vaccinate for COVID-19 are a complex interplay of factors which include individual perceptions, access barriers, trust, and COVID-19 specific factors, which contribute to lower vaccine uptake. To address this, the WHO calls for localized solutions to increase COVID-19 vaccine uptake for refugees and evidence to inform future vaccination efforts. However, limited evidence engages directly with refugees about their experiences with COVID-19 vaccinations. To address this gap, researchers conducted qualitative interviews (N = 61) with refugees (n = 45), sponsors of refugees (n = 3), and key informants (n = 13) connected to local COVID-19 vaccination efforts for refugees in Calgary. Thematic analysis was conducted to synthesize themes related to vaccine perspectives, vaccination experiences, and patient intersections with policies and systems. Findings reveal that refugees benefit from ample services that are delivered at various stages, that are not solely related to vaccinations, and which create multiple positive touch points with health and immigration systems. This builds trust and vaccine confidence and promotes COVID-19 vaccine uptake. Despite multiple factors affecting vaccination decisions, a key reason for vaccination was timely and credible information delivered through trusted intermediaries and in an environment that addressed refugee needs and concerns. As refugees placed trust and relationships at the core of decision-making and vaccination, it is recommended that healthcare systems work through trust and relationships to reach refugees. This can be targeted through culturally responsive healthcare delivery that meets patients where they are, including barrier reduction measures such as translation and on-site vaccinations, and educational and outreach partnerships with private groups, community organizations and leaders.
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Affiliation(s)
- Fariba Aghajafari
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Laurent Wall
- Habitus Consulting Collective, Calgary, AB T2T 1P3, Canada; (L.W.); (A.W.)
| | - Amanda Weightman
- Habitus Consulting Collective, Calgary, AB T2T 1P3, Canada; (L.W.); (A.W.)
| | - Alyssa Ness
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Deidre Lake
- Alberta International Medical Graduates Association, Calgary, AB T2E 3K8, Canada
| | - Krishna Anupindi
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Gayatri Moorthi
- Habitus Consulting Collective, Calgary, AB T2T 1P3, Canada; (L.W.); (A.W.)
| | - Bryan Kuk
- Habitus Consulting Collective, Calgary, AB T2T 1P3, Canada; (L.W.); (A.W.)
| | - Maria Santana
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Annalee Coakley
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Mosaic Refugee Health Clinic, Calgary, AB T2A 5H5, Canada
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Abdulhaq B, Hammouri M, Abu Hawas D, Dardas LA. Exploring Vaccination Challenges among Syrian Refugees in Jordan: Insights from Camps and Communities, and Perceived Parental Barriers to Childhood Vaccination Uptake. Vaccines (Basel) 2024; 12:133. [PMID: 38400117 PMCID: PMC10892480 DOI: 10.3390/vaccines12020133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
PURPOSE To identify and understand the multifaceted barriers faced by Syrian refugees when seeking vaccination services for their children. METHODS A survey questionnaire was administered through structured interviews to a sample of Syrian refugees residing inside the Al-Zaatari camp and in various urban areas across Jordanian communities. This process utilized a multi-stage sampling approach, beginning with a random selection from clusters or strata, and then employing convenience sampling within each to select participants. The survey covered demographics, barriers to vaccination, and vaccine hesitancy. RESULTS A total of 332 participants completed the survey with a mean age of 32.7 ± 10 years ranging from 18 to 67. More than half of the sample (59%) had an education of 11th grade or less. Sociodemographic disparities regarding barrier perception were evident among participants. Middle-aged adults (older than 32), males, and those with a monthly income less than USD 200 had scored significantly higher on barrier perceptions across all categories (p < 0.05). In-camp residents were less likely to face vaccination barriers compared to those living outside the camps (p < 0.001). Psychological antecedents of vaccine assessments showed that younger individuals had significantly higher scores in complacency, calculation, and constraints (p < 0.05). Participants with lower income had lower constraints and calculation scores (p < 0.05). In-camp residents had significantly higher scores in complacency, constraints, and calculation constructs compared outside camps counterparts (p < 0.05). Participants with no formal education had higher scores in complacency and constraints, and those with less than a 12th-grade education and higher education degrees scored significantly higher on the collective responsibility construct (p < 0.05). CONCLUSIONS Efforts to promote vaccination among refugees should consider the specific challenges faced by this population, including financial barriers, healthcare access inequalities, and the impact of living arrangements. Public health strategies should address not only individual and psychological factors but also the physical and logistical challenges in obtaining vaccines.
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Affiliation(s)
- Bayan Abdulhaq
- School for International Training, Brattleboro, VT 05302, USA
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Khan A, Abonyi S, Neudorf C, Galea S, Ahmed S. Barriers to and facilitators of human papillomavirus vaccination in an ethnically diverse group of migrant parents: A qualitative mixed methods study. Hum Vaccin Immunother 2023; 19:2269721. [PMID: 37870066 PMCID: PMC10595389 DOI: 10.1080/21645515.2023.2269721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 09/30/2023] [Indexed: 10/24/2023] Open
Abstract
A disparity in the uptake of the Human papillomavirus vaccine (HPVV) among immigrants and refugees leads to a social gradient in health. Recognizing that immigrants and refugees may encounter unique barriers to accessing prevention and care, this study seeks to determine barriers to and facilitators of HPVV among these subgroups to uncover high-resolution quality improvement targets of investment for under-immunized pockets of the population. The study undertook a qualitative inquiry into understanding immigrant and refugee parents' perspectives on HPV infection and HPVV experience through school-based programs. We collected data first through short online surveys (N = 15) followed by one-on-one interviews (N = 15) and then through detailed online surveys (N = 16) followed by focus group discussions (N = 3) with 4-6 participants per group discussion from different groups: Black, South Asian and West Asian. Analysis of surveys and interviews identified that: information, awareness, and education about HPV infection and HPVV were among the most cited barriers that impede the uptake of HPVV. Moreover, vaccine-related logistics were equally important, including not having immunization information packages in different languages and relying solely on the child to bring home packages in paper copies from school-based vaccine programs. A multi-component intervention remains instrumental in enhancing HPV immunization rates, given the inconsistent uptake of HPVV by these subgroups who voice unique barriers and facilitators. An educational campaign that involves educating parents who consent for their child(ren) for HPVV, the children receiving the vaccination, and training staff providing HPVV through school-based immunization programs would be paramount.
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Affiliation(s)
- Amal Khan
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
| | - Sylvia Abonyi
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
| | - Cory Neudorf
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
| | - Sandro Galea
- BU School of Public Health, Boston University School of Public Health, Boston, MA, USA
| | - Shahid Ahmed
- Department of Medical Oncology, Saskatoon Cancer Center, Saskatchewan Cancer Agency, Saskatoon, Canada
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12
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Humble RM, Dubé E, Olson J, Scott SD, MacDonald SE. Routine childhood vaccination among ethnocultural groups in Canada during the COVID-19 pandemic: A national cross-sectional study. Prev Med Rep 2023; 36:102435. [PMID: 37822977 PMCID: PMC10562748 DOI: 10.1016/j.pmedr.2023.102435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/13/2023] Open
Abstract
Some ethnocultural groups in Canada experience low routine childhood vaccination, with social locations and discriminations contributing to inequities. This study aimed to characterize routine childhood vaccination in the context of the COVID-19 pandemic, including the influence of discriminatory experiences when accessing health services. We conducted a cross-sectional national survey to assess parents' acceptance of routine vaccines for their children ≤ 17 years in Oct/Nov 2021. Descriptive statistics were used to explore differences among ethnocultural groups and logistic regression to assess associations with parents' low acceptance. Of 2531 parents, 21.8 % self-identified as Racialized minorities, 7.7 % Indigenous, 23.3 % newcomers, 10.0 % spoke minority languages most often, and 69.6 % belonged to a reference group who did not report these characteristics. Statistically significant findings included 36.6 % of Indigenous parents reporting that the pandemic made them realize that routine vaccines were more important compared to 16.7 % of newcomers. Discrimination/racism when accessing health services was most often experienced by Indigenous (27.8 %) and Racialized minorities (20.2 %), compared to the reference group (4.8 %). Racialized minorities were more likely to report low acceptance of routine vaccination (aOR = 2.19, 95 % CI: 1.18-4.05), and younger parents and those with only preschool-aged children were less likely to have low acceptance (aOR = 0.59, 95 % CI: 0.37-0.94; aOR = 0.53, 95 % CI: 0.36, 0.79). Low acceptance was associated with everyday stress preventing vaccination (aOR = 2.18, 95 % CI: 1.41-3.38). Public health decision-makers should ensure equitable access to routine childhood vaccination that targets the inclusion of ethnocultural groups, who may experience disproportionate barriers and low acceptance.
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Affiliation(s)
- Robin M. Humble
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Eve Dubé
- Department of Anthropology, Laval University, Quebec City, Quebec, Canada
| | - Joanne Olson
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Shannon D. Scott
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Ashfield S, Donelle L, Uppal G, Bauer MA, Kothari A. Community organization perspectives on COVID-19 vaccine hesitancy and how they increased COVID-19 vaccine confidence: a Canadian Immunization Research Network, social sciences and humanities network study. Front Public Health 2023; 11:1258742. [PMID: 37849717 PMCID: PMC10577219 DOI: 10.3389/fpubh.2023.1258742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/11/2023] [Indexed: 10/19/2023] Open
Abstract
Background COVID-19 vaccines play a critical role in reducing the morbidity and mortality associated with SARS-CoV-2 infection and despite vaccine availability, disparities in COVID-19 vaccine uptake among Canadian subgroups exist. Community organizations are uniquely situated to relay important vaccine messaging around all vaccines, understand components of vaccine hesitancy, and facilitate vaccine uptake within the communities they serve. The objective of this research was to solicit community organizations perspectives specific to COVID-19 vaccines and explore strategies of increasing vaccine uptake within their communities. Methods A qualitative focus group study was held in the spring of 2021 with 40 community organizations from across the country. Discussions focused on COVID-19 vaccine communication and awareness within their communities, vaccine misinformation, and strategies to increase vaccine acceptance and access. Data were analyzed utilizing thematic and inductive techniques. Results Vaccine hesitancy was identified among staff and clients. Vaccine confidence, complacency, convenience, and mistrust in government and authorities were identified as contributors to vaccine hesitancy. Community organizations utilized innovative and novel methods to encourage vaccine uptake and increase vaccine confidence. Leveraging established trusting relationships was key to successful messaging within communities. Conclusion Community organizations used innovative methods, built on established trust, to increase vaccine confidence within their communities and among their staff. Community agencies played an important role in COVID-19 vaccine uptake within subgroups of the Canadian population. Community organizations are key public health partners and play a critical role in increasing COVID-19 vaccine confidence.
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Affiliation(s)
- Sarah Ashfield
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
| | - Lorie Donelle
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
- Emily Myrtle Smith Endowed Professor of Nursing, Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, Columbia, SC, United States
| | - Gina Uppal
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
| | - Michael A. Bauer
- Department of Computer Science, The University of Western Ontario, London, ON, Canada
| | - Anita Kothari
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
- School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
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Fok CL, Fifita M, Tanjasiri SP. Decision-Making Regarding Elective Child and Adolescent Vaccinations Among Native Hawaiian and Pacific Islander Parents in Orange County. Health Promot Pract 2023:15248399231193707. [PMID: 37772336 DOI: 10.1177/15248399231193707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Native Hawaiians and Pacific Islanders (NHPIs) in aggregate experience greater health burdens than non-Hispanic Whites, such as a higher incidence of cervical cancer and COVID-19. Given the importance of vaccinations in preventing and reducing the severity of diseases, such as the flu, cervical cancer, and COVID-19, the receipt of vaccines during childhood and adolescence is crucial. Therefore, this qualitative study aimed to explore the factors associated with NHPI parents' decisions regarding vaccinating their children with these elective vaccinations-that is, vaccinations not required for child care, preschool, or K-12 admissions in California but highly recommended. A total of 15 NHPI parents were recruited through a community-based organization. Semi-structured interviews explored parents' reasons for accepting or denying each vaccine for their child(ren). Results demonstrated variable acceptance of each vaccine, though consistent themes included protection and concerns over side effects. This study also found two general types of parents-those who treat vaccines the same and those with varying opinions about each vaccine. Results from this study demonstrate the family- and community-oriented nature of NHPI communities, suggesting that future interventions target not only parents but also their families and communities to cultivate vaccine acceptance through social networks. Furthermore, addressing all three vaccines during well-child visits may benefit parents who view each vaccine as separate entities with individual pros and cons. Such interventions could contribute toward reducing the burdens of particularly chronic health disparities.
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Affiliation(s)
| | - Melenaite Fifita
- University of California, Irvine, CA, USA
- Pacific Islander Health Partnership, Santa Ana, CA, USA
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Colomé-Ceballos L, Clua-Espuny JL, Ceballos-García C, Clua-Queralt J, Pla-Farnós MJ, Fernández-Sáez J. Understanding Prognostic Factors for Human Papillomavirus Vaccination: A Rural Community Case-Control Study. Vaccines (Basel) 2023; 11:1536. [PMID: 37896940 PMCID: PMC10610576 DOI: 10.3390/vaccines11101536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023] Open
Abstract
HPV vaccination coverage rates can vary depending on several factors. The main objective of this study is to identify possible independent prognostic factors that have an impact on HPV vaccination in a rural community, specifically related to sexual and reproductive health. A case-control, retrospective, community-based study was carried out on women aged 15 to 40 in the primary health centers of Southern Catalonia's Terres de l'Ebre region, Spain, from 1 January 2020 to 31 December 2022. A random sample of 520 women with an average age of 29.3 (SD 7.8) years old was included in the study. Independent prognostic factors: age OR 0.680 (95% CI: 0.635-0.729, p < 0.001), immigrant origin OR 0.215 (95% CI: 0.109-0.422, p < 0.001), and HPV PCR OR 7.402 (95% CI: 2.504-21.880, p < 0.001). The variables that showed a barrier effect for HPV vaccination were age (OR 0.680, 95% CI 0.635-0.729, p < 0.001), and immigrant origin (OR 0.215, 95% CI 0.109-0.422, p < 0.001). The variable that showed a facilitating effect for HPV vaccination was HPV PCR (OR 7.402, 95% CI 2.504-21.880, p < 0.001).
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Affiliation(s)
- Lara Colomé-Ceballos
- Sexual and Reproductive Attention, SAP Terres de l'Ebre, Catalonian Health Institute, 43500 Catalonia, Spain
- Gynaecology Department, Hospital Verge de la Cinta de Tortosa, Catalonian Health Institute, 43500 Catalonia, Spain
| | - Josep Lluís Clua-Espuny
- EAP Tortosa Est. Primary Care, SAP Terres de l'Ebre, Catalonian Health Institute, 43500 Catalonia, Spain
- Unitat de Suport a la Recerca Terres de l'Ebre, Foundation University Institute for Primary Health Care Research Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Spain
| | | | - Josep Clua-Queralt
- EAP Tortosa Est. Primary Care, SAP Terres de l'Ebre, Catalonian Health Institute, 43500 Catalonia, Spain
| | - Maria Jesús Pla-Farnós
- Gynaecology Department, Hospital Universitari de Bellvitge, Carrer de la Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - José Fernández-Sáez
- Unitat de Suport a la Recerca Terres de l'Ebre, Foundation University Institute for Primary Health Care Research Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Spain
- Faculty of Nursing, Terres de l'Ebre Campus, Rovira i Virgili University, 43500 Tortosa, Spain
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Dickson K, Aboltins C, Pelly J, Jessup RL. Effective communication of COVID-19 vaccine information to recently-arrived culturally and linguistically diverse communities from the perspective of community engagement and partnership organisations: a qualitative study. BMC Health Serv Res 2023; 23:877. [PMID: 37605184 PMCID: PMC10440864 DOI: 10.1186/s12913-023-09836-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 07/20/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND In many high-income countries, COVID-19 has disproportionately impacted Culturally and Linguistically Diverse (CALD) communities. Barriers to engaging with essential health messaging has contributed to difficulties in following public health advice and exacerbated existing inequity in Australia. Research suggests that recently-arrived CALD populations are particularly vulnerable to misinformation and are more likely to experience vaccine hesitancy. The aim of this study was to explore the barriers and enablers to COVID-19 vaccination among recently-arrived CALD communities in Melbourne's outer north and identify strategies to reduce hesitancy in this population. METHODS Semi-structured interviews were conducted with representatives from community organisations working with recently-arrived CALD communities in Melbourne's north. This included a mix of peer (from the community) and health care workers. RESULTS Fifteen participants from community organisations participated in interviews. Thematic analysis identified four themes; (1) trusted sources, (2) accurate and culturally sensitive information, (3) supported pathways and (4) enablers to vaccination. CONCLUSIONS Participants reported a perceived lack of accurate, culturally sensitive health information and service provision as key barriers to vaccination in recently-arrived CALD communities. Participants identified a range of perceived enablers to increasing vaccination uptake in the communities they work with, including utilising established channels of communication and harnessing the communities' strong sense of collective responsibility. Specific strategies to reduce vaccine hesitancy included identifying and utilising trusted sources (e.g. faith leaders) to disseminate information, tailoring health messages to address cultural differences, providing opportunities to contextualise information, and modifying service delivery to enhance cultural sensitivity. There is an urgent need for increased efforts from health and government agencies to build sustainable, collaborative relationships with CALD communities.
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Affiliation(s)
- Kara Dickson
- School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Craig Aboltins
- Department of Infectious Diseases, Northern Health, Epping, VIC, 3076, Australia
- Adjunct Associate Professor, Department of Medical Education, The University of Melbourne, Melbourne, Australia
| | - Janet Pelly
- Northern Health, Epping, VIC, 3076, Australia
| | - Rebecca Leigh Jessup
- Director of Research and Evaluation, Staying Well. Northern Health, Epping, VIC, 3076, Australia.
- Adjunct Research Fellow, School of Allied Health, Human Services and Sport, La Tobe University, Bundoora, Australia.
- Adjunct Research Fellow, School of Rural Health, Monash University, Warragul, Australia.
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Scarso S, Marchetti G, Russo ML, D’Angelo F, Tosti ME, Bellini A, De Marchi C, Ferrari C, Gatta A, Caminada S, Papaevgeniou N, Dalma N, Karnaki P, Marceca M, Declich S. Access to Vaccination for Newly Arrived Migrants: Developing a General Conceptual Framework for Understanding How to Improve Vaccination Coverage in European Countries. Int J Public Health 2023; 68:1605580. [PMID: 37609078 PMCID: PMC10440383 DOI: 10.3389/ijph.2023.1605580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 07/20/2023] [Indexed: 08/24/2023] Open
Abstract
Objectives: Access to vaccination for newly arrived migrants (NAMs) is a relevant concern that requires urgent attention in EU/EEA countries. This study aimed to develop a General Conceptual Framework (GCF) for understanding how to improve vaccination coverage for NAMs, by characterizing and critically analyzing system barriers and possible strategies to increase vaccination. Methods: A theoretical conceptualization of the GCF was hypothesized based on conceptual hubs in the immunization process. Barriers and solutions were identified through a non-systematic desktop literature review and qualitative research. The GCF guided the activities and facilitated the integration of results, thereby enriching the GCF with content. Results: The study explores the vaccination of NAMs and proposes strategies to overcome barriers in their vaccination process. It introduces a framework called GCF, which consists of five interconnected steps: entitlement, reachability, adherence, achievement, and evaluation of vaccination. The study also presents barriers and solutions identified through literature review and qualitative research, along with strategies to enhance professionals' knowledge, improve reachability, promote adherence, achieve vaccination coverage, and evaluate interventions. The study concludes by recommending strategies such as proximity, provider training, a migrant-sensitive approach, and data collection to improve vaccination outcomes for NAMs. Conclusion: Ensuring equitable access to healthcare services, including vaccination, is crucial not only from a humanitarian perspective but also for the overall public health of these countries.
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Affiliation(s)
- Salvatore Scarso
- National Center for Global Health, National Institute of Health (ISS), Rome, Italy
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Roma, Italy
- Italian Society of Migration Medicine (SIMM), Rome, Italy
| | - Giulia Marchetti
- National Center for Global Health, National Institute of Health (ISS), Rome, Italy
- Italian Society of Migration Medicine (SIMM), Rome, Italy
| | - Maria Laura Russo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Roma, Italy
- Italian Society of Migration Medicine (SIMM), Rome, Italy
| | - Franca D’Angelo
- National Center for Global Health, National Institute of Health (ISS), Rome, Italy
| | - Maria Elena Tosti
- National Center for Global Health, National Institute of Health (ISS), Rome, Italy
| | - Arianna Bellini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Roma, Italy
| | - Chiara De Marchi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Roma, Italy
| | - Caterina Ferrari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Roma, Italy
| | - Angela Gatta
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Roma, Italy
| | - Susanna Caminada
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Roma, Italy
| | - Nikoletta Papaevgeniou
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, Marousi, Greece
| | - Nadia Dalma
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, Marousi, Greece
| | - Pania Karnaki
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, Marousi, Greece
| | - Maurizio Marceca
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Roma, Italy
- Italian Society of Migration Medicine (SIMM), Rome, Italy
| | - Silvia Declich
- National Center for Global Health, National Institute of Health (ISS), Rome, Italy
- Italian Society of Migration Medicine (SIMM), Rome, Italy
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Netfa F, King C, Davies C, Rashid H, Tashani M, Booy R, Rachel Skinner S. Perceived facilitators and barriers to the uptake of the human papillomavirus (HPV) vaccine among adolescents of Arabic-speaking mothers in NSW, Australia: A qualitative study. Vaccine X 2023; 14:100335. [PMID: 37409191 PMCID: PMC10318426 DOI: 10.1016/j.jvacx.2023.100335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/16/2023] [Indexed: 07/07/2023] Open
Abstract
Background Australia has a large immigrant population but there is little data regarding whether human papillomavirus (HPV) vaccination coverage in adolescents varies according to parents' cultural or ethnic background. This work aims to identify facilitators and barriers to HPV vaccination of adolescents as perceived by Arabic-speaking mothers in Western Sydney, South Western Sydney and Wollongong, NSW, Australia. Methods A purposive sampling approach was applied to recruit mothers of adolescents from Arabic speaking backgrounds who had at least one child eligible for the HPV school-based vaccination program. Face-to-face semi-structured well as online interviews were conducted in Arabic between April 2021 and July 2021. The interviews were audio-recorded, transcribed, and translated into English and examined using thematic analysis. Results Sixteen mothers of adolescents from Arabic backgrounds described facilitators and barriers to HPV vaccination. A) Facilitators of HPV vaccination included: knowledge of HPV disease, trust in the school vaccination program, opportunistic recommendations from healthcare workers, information from friends. B) Barriers to accessing HPV vaccination included communication gaps: breakdown in school-parent information flow, lack of access to the Arabic language version of the information sheet, mother - GP communication barriers, mother-child communication gap; and health system gaps: missed opportunities for vaccination. C) Mothers' suggestions to improve HPV vaccination acceptance: to involve religious and cultural leadership, encourage engagement with GPs, and provide school-based education for parents and students. Conclusion Parents could benefit from assistance with HPV vaccination decision making. Interventions via schools, health professionals and religious and cultural organisations could play important roles in HPV vaccination acceptance for Arabic speaking immigrant families and in introducing their adolescent children to this vaccine.
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Affiliation(s)
- Faeza Netfa
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
- Kids Research, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Catherine King
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Cristyn Davies
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
- Kids Research, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
- Sydney Institute for Infectious Diseases, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Harunor Rashid
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Mohamed Tashani
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
- Faculty of Medicine, University of Tripoli, Tripoli 13275, Libya
| | - Robert Booy
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
| | - S. Rachel Skinner
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
- Kids Research, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
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Alimoradi Z, Sallam M, Jafari E, Potenza MN, Pakpour AH. Prevalence of COVID-19 vaccine acceptance among migrant and refugee groups: A systematic review and meta-analysis. Vaccine X 2023; 14:100308. [PMID: 37223070 PMCID: PMC10163798 DOI: 10.1016/j.jvacx.2023.100308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/07/2023] [Accepted: 04/26/2023] [Indexed: 05/25/2023] Open
Abstract
Objectives Understanding COVID-19 vaccine hesitancy among migrant and refugee groups is critical for achieving vaccine equity. Therefore, we aimed to estimate the prevalence of COVID-19 vaccine acceptance among migrant and refugee populations. Methods A systematic review (PROSPERO: CRD42022333337) was conducted (December 2019-July 2022) using PubMed, Scopus, Web of Science, ProQuest and Google Scholar. Results Nineteen studies from 12 countries were included. The pooled estimated prevalence of COVID-19 vaccine willingness among migrant and refugee groups was 70% (19 studies, 95% CI: 62.3-77.4%, I2: 99.19%, τ2: 0.03). Female and male participants did not differ significantly with each other (p = 0.64). Although no individual variable contributed statistically significantly in multivariable meta-regression analysis, the multivariable model that considered methodological quality, mean age of participants, participant group and country of origin explained 67% of variance. Discussion Proportions of migrant/refugee groups receiving COVID-19 vaccinations approximated those observed among general populations. Additional studies are needed to examine factors relating to vaccine willingness to identify the most significant factors that may be targeted in interventions.
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Affiliation(s)
- Zainab Alimoradi
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman, Jordan
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman, Jordan
- Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Elahe Jafari
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Marc N. Potenza
- Departments of Psychiatry and Neuroscience and the Child Study Center and Wu Tsai Institute, Yale School of Medicine / Yale University, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
- Connecticut Council on Problem Gambling, Wethersfield, CT, USA
| | - Amir H. Pakpour
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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20
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Charania NA. "She vaccinated my baby and that's all…" Immunisation decision-making and experiences among refugee mothers resettled in Aotearoa New Zealand. BMC Public Health 2023; 23:1349. [PMID: 37442991 PMCID: PMC10347757 DOI: 10.1186/s12889-023-16266-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 07/08/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND To prevent disease outbreaks, refugee children must be age-appropriately immunised. This qualitative study gained an in-depth understanding of refugee mothers' vaccine decision-making and experiences accessing immunisation services for their children post-resettlement in Aotearoa New Zealand. METHODS An interpretive description methodology involving focus groups with refugee mothers (N = 45) was conducted in Auckland, one of the resettlement locations. Mothers were asked about their perceptions of vaccine-preventable diseases and vaccines, their experiences of attending immunisation events, and their suggestions for improvements to immunisation services. Data were analysed following the phases of reflexive thematic analysis. RESULTS Four themes were constructed. Do I have a choice? Mothers displayed pro-vaccination sentiments and parental obligation to vaccinate their children to protect their health, which underpinned their compliance with the national vaccine schedule. Transnational vaccine perceptions and behaviours It was evident that comparing their health experiences in their origin countries reinforced their positive perceptions of and trust in vaccines, health providers and their recommendations, the health system and government in New Zealand. Information sharing with their transnational networks had the potential to influence vaccine perceptions and behaviours in home and host countries. Unanswered questions and concerns Mothers discussed how many of their questions and concerns about immunisations and post-vaccine management went unanswered. Relationships and experiences matter Mothers stressed the importance of who vaccinated their child and how it was administered, highlighting that health providers' demeanour and competence influence their immunisation experiences. CONCLUSIONS Health providers are encouraged to focus on creating a positive immunisation experience for refugee background families. Qualified interpreters and provision of culturally and linguistically appropriate information are required. Transnationalism at the individual level appears to influence vaccine perceptions and behaviours among refugee-background mothers. Future research focusing on caregivers with child(ren) who are not fully vaccinated would be beneficial.
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Affiliation(s)
- Nadia A Charania
- Department of Public Health, Auckland University of Technology, Auckland, New Zealand.
- Migrant and Refugee Health Research Centre, Auckland University of Technology, Auckland, New Zealand.
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21
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Fullerton MM, Pateman M, Hasan H, Doucette EJ, Cantarutti S, Koyama A, Weightman AM, Tang T, Coakley A, Currie GR, Fabreau G, Constantinescu C, Marshall DA, Hu J. Barriers experienced by families new to Alberta, Canada when accessing routine-childhood vaccinations. BMC Public Health 2023; 23:1333. [PMID: 37438796 DOI: 10.1186/s12889-023-16258-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/06/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND As Canada and other high-income countries continue to welcome newcomers, we aimed to 1) understand newcomer parents' attitudes towards routine-childhood vaccinations (RCVs), and 2) identify barriers newcomer parents face when accessing RCVs in Alberta, Canada. METHODS Between July 6th-August 31st, 2022, we recruited participants from Alberta, Canada to participate in moderated focus group discussions. Inclusion criteria included parents who had lived in Canada for < 5 years with children < 18 years old. Focus groups were transcribed verbatim and analyzed using content and deductive thematic analysis. The capability opportunity motivation behaviour model was used as our conceptual framework. RESULTS Four virtual and three in-person focus groups were conducted with 47 participants. Overall, parents were motivated and willing to vaccinate their children but experienced several barriers related to their capability and opportunity to access RCVs. Five main themes emerged: 1) lack of reputable information about RCVs, 2) language barriers when looking for information and asking questions about RCVs, 3) lack of access to a primary care provider (PCP), 4) lack of affordable and convenient transportation options, and 5) due to the COVID-19 pandemic, lack of available vaccine appointments. Several minor themes were also identified and included barriers such as lack of 1) childcare, vaccine record sharing, PCP follow-up. CONCLUSIONS Our findings highlight that several barriers faced by newcomer families ultimately stem from issues related to accessing information about RCVs and the challenges families face once at vaccination clinics, highlighting opportunities for health systems to better support newcomers in accessing RCVs.
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Affiliation(s)
- Madison M Fullerton
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada.
- 19 to Zero Inc, Calgary, AB, Canada.
| | - Margaret Pateman
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- 19 to Zero Inc, Calgary, AB, Canada
| | | | - Emily J Doucette
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Stephen Cantarutti
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute (ACHRI), University of Calgary, Calgary, AB, Canada
| | - Amanda Koyama
- Calgary Catholic Immigration Society, Calgary, AB, Canada
| | | | - Theresa Tang
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Annalee Coakley
- Mosaic Refugee Health Clinic, Calgary, AB, Canada
- Department of Family Medicine, University of Calgary, Calgary, AB, Canada
| | - Gillian R Currie
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute (ACHRI), University of Calgary, Calgary, AB, Canada
| | - Gabriel Fabreau
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Cora Constantinescu
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Pediatric Infectious Diseases, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute (ACHRI), University of Calgary, Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jia Hu
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- 19 to Zero Inc, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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22
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Wemrell M, Vicente RP, Merlo J. Mapping sociodemographic and geographical differences in human papillomavirus non-vaccination among young girls in Sweden. Scand J Public Health 2023; 51:288-295. [PMID: 35120427 PMCID: PMC9969304 DOI: 10.1177/14034948221075410] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
AIMS Human papillomavirus (HPV) vaccination plays a key role in the prevention of cervical cancer. Yet, disparities in HPV vaccination in Sweden have persisted. Previous research on such disparities has typically focused on singular sociodemographic variables and measures of average risk. Using a multi-categorical approach and drawing on intersectionality theory, this study aimed to provide a more precise mapping of HPV non-vaccination among girls in different sociodemographic groups and geographical areas in Sweden during 2013-2020. METHODS Using nationwide register data, we conducted a multi-categorical analysis of individual heterogeneity and discriminatory accuracy complemented by a multilevel geographical analysis. We mapped HPV non-vaccination prevalence across 54 strata defined by parental income, education and country of birth, and urban versus rural place of residence. We also disentangled municipal and regional influences on HPV non-vaccination. RESULTS HPV non-vaccination was more common in groups with a low income, a low education and an immigration background, whereas among those with an immigration background, the association between income, education and HPV non-vaccination was more complex. Geographical differences were found between municipalities. However, the discriminatory accuracy of the sociodemographic and geographical groups was weak, and 50% of the non-vaccination cases were observed in eight strata, of which some are among those with low risk. CONCLUSIONS
Our findings underscore the importance of universal yet tailored approaches, including providing adequate information about HPV vaccination in Swedish and other languages, and of health-care professionals displaying sensitivity to patients' and parents' questions or needs.
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Affiliation(s)
- Maria Wemrell
- Unit for Social Epidemiology,
Department of Clinical Sciences, Lund University, Sweden,Department of Gender Studies, Lund
University, Sweden,Maria Wemrell, CRC (Social Epidemiology),
Lund University, Jan Waldenström Street 35, 20502 Malmö, Sweden. E-mail:
| | - Raquel Perez Vicente
- Unit for Social Epidemiology,
Department of Clinical Sciences, Lund University, Sweden
| | - Juan Merlo
- Unit for Social Epidemiology,
Department of Clinical Sciences, Lund University, Sweden,Centre for Primary Health Care
Research, Region Skåne, Sweden
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23
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Evola CM, Repas SJ, Dickman J, George M, Viaud-Murat E, Hershberger P, Crawford TN, Conway K. Perceptions of the SARS-CoV2 pandemic: a small comparative survey analysis between language preference populations in a United States community health center. Pathog Glob Health 2023; 117:203-211. [PMID: 35712873 PMCID: PMC9970218 DOI: 10.1080/20477724.2022.2088500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
In 2019, a new variant of coronavirus, SARS-CoV-2 (COVID-19) created a global pandemic that has highlighted and exacerbated health disparities. Educating the general public about COVID-19 is one of the primary mitigation strategies amongst health professionals. English is not the preferred language for an estimated 22% of the United States population making effective mass communication efforts difficult to achieve. This study seeks to understand and compare several topics surrounding COVID-19 health communication and healthcare disparities between individuals with English language preference (ELP) and non-English language preference (NELP) within the United States. A survey available in seven languages asking about knowledge and opinions on COVID-19, vaccines, preferred sources of health information, and other questions, was administered February-April 2021 to patients at an urban federally qualified health center that also serves global refugees and immigrants. Descriptive statistics and comparative analysis were performed to identify differences between ELP and NELP individuals. Analysis of 144 surveys, 33 of which were NELP, showed 90.97% of all patients agreed that COVID-19 was a serious disease and 66.67% would receive the COVID-19 vaccine. There were numerous differences between ELP and NELP individuals, including trust in government, symptom identification, preferred source of health information, and feelings that cultural needs had been met. This study has identified several significant differences in patient perceptions relating to the COVID-19 pandemic when comparing NELP to ELP and highlighted areas where improvement can occur. Applying this information, easily utilized targeted resources can be created to quickly intervene and address health disparities among patients seeking care at an urban community health center.
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Affiliation(s)
- Christopher M Evola
- Wright State University Boonshoft School of Medicine, United States of America
| | - Steven J Repas
- Wright State University Boonshoft School of Medicine, United States of America
| | - Jacob Dickman
- Wright State University Boonshoft School of Medicine, United States of America
| | - Monica George
- Wright State University Boonshoft School of Medicine, United States of America
| | - Estelle Viaud-Murat
- Wright State University Boonshoft School of Medicine, United States of America
| | - Paul Hershberger
- Wright State University Boonshoft School of Medicine, United States of America
| | - Timothy N Crawford
- Wright State University Boonshoft School of Medicine, United States of America
| | - Katharine Conway
- Wright State University Boonshoft School of Medicine, United States of America
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24
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Roederer T, Mollo B, Vincent C, Leduc G, Sayyad-Hilario J, Mosnier M, Vandentorren S. Estimating COVID-19 vaccine uptake and its drivers among migrants, homeless and precariously housed people in France. COMMUNICATIONS MEDICINE 2023; 3:30. [PMID: 36801917 PMCID: PMC9939372 DOI: 10.1038/s43856-023-00257-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/07/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND Migrants, people experiencing homelessness (PEH), or precariously housed (PH) are at high risk for COVID-19 infection, hospitalization, and death from COVID-19. However, while data on COVID-19 vaccine uptake in these populations are available in the USA, Canada, and Denmark, we are lacking, to the best of our knowledge, data from France. METHODS In late 2021, we carried out a cross-sectional survey to determine COVID-19 vaccine coverage in PEH/PH residing in Ile-de-France and Marseille, France, and to explore its drivers. Participants aged over 18 years were interviewed face-to-face where they slept the previous night, in their preferred language, and then stratified for analysis into three housing groups (Streets, Accommodated, and Precariously Housed). Standardized vaccination rates were computed and compared to the French population. Multilevel univariate and multivariable logistic regression models were built. RESULTS We find that 76.2% (95% confidence interval [CI] 74.3-78.1) of the 3690 participants received at least one COVID-19 vaccine dose while 91.1% of the French population did so. Vaccine uptake varies by stratum, with the highest uptake (85.6%; reference) in PH, followed by Accommodated (75.4%; adjusted odds-ratio = 0.79; 95% CI 0.51-1.09 vs. PH) and lowest in Streets (42.0%; AOR = 0.38; 95%CI 0.25-0.57 vs. PH). Use for vaccine certificate, age, socioeconomic factors, and vaccine hesitancy is associated with vaccination coverage. CONCLUSIONS In France, PEH/PH, and especially the most excluded, are less likely than the general population to receive COVID-19 vaccines. While vaccine mandate has proved an effective strategy, targeted outreach, on-site vaccinations, and sensitization activities are strategies enhancing vaccine uptake that can easily be replicated in future campaigns and other settings.
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Affiliation(s)
| | - Bastien Mollo
- grid.452373.40000 0004 0643 8660Epicentre, Paris, France ,grid.452373.40000 0004 0643 8660Médecins Sans Frontières, Paris, France ,grid.411119.d0000 0000 8588 831XInfectious and Tropical Diseases Department, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | | | - Ghislain Leduc
- grid.452373.40000 0004 0643 8660Epicentre, Paris, France
| | | | | | - Stéphanie Vandentorren
- grid.493975.50000 0004 5948 8741Santé Publique France, Saint Maurice, France ,grid.508062.90000 0004 8511 8605University of Bordeaux, INSERM UMR 1219-Bordeaux Population Health, Bordeaux, France
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25
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Tuckerman J, Holland P, Kaufman J, Overmars I, Danchin M. Examining catch-up immunisation service use for migrant children in the City of Melbourne, Victoria: A quantitative study. J Paediatr Child Health 2023; 59:197-198. [PMID: 36630280 PMCID: PMC10108212 DOI: 10.1111/jpc.16284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 01/12/2023]
Affiliation(s)
- Jane Tuckerman
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Philippa Holland
- City of Melbourne Immunisation Team, Melbourne, Victoria, Australia
| | - Jessica Kaufman
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Isabella Overmars
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Margie Danchin
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
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26
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Atrooz F, Majd Z, Alrousan G, Zeidat S, Abuelezam NN, Abughosh S, Salim S. Acceptance of COVID-19 vaccination in a sample of Middle Eastern and North African (MENA) Houston residents. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001441. [PMID: 36962927 PMCID: PMC10021233 DOI: 10.1371/journal.pgph.0001441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/05/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND COVID-19 vaccination has averted a significant number of deaths in the United States, but vaccination hesitancy continues to be a problem. Therefore, examining vaccination acceptance and/or hesitancy in local communities is critical. METHODS A quantitative survey and a multivariable logistic regression model was utilized to determine predictors of COVID-19 vaccination in Middle Eastern and North African (MENA) origin Houston residents. The outcome of interest was COVID-19 vaccination status (vaccinated versus not vaccinated). Covariates included: demographics, health, and COVID-19 factors. Statistical analyses included SAS version 9.4 at a priori significance level of 0.05. RESULTS The overall vaccine acceptance rate was significantly high in this population subset (N = 366), with 77.60% vaccinated, and 22.40% not vaccinated. MENA individuals with some college degrees were less likely to report vaccination than those with a graduate degree [Odds Ratio (OR): 0.18; 95% Confidence Interval (CI): 0.04, 0.77]. Homeowners were more likely to get vaccinated than renters (OR: 2.58; 95%CI: 1.17, 5.68). Individuals practicing Islamic faith were more likely to get vaccinated than other religious affiliations (OR: 3.26; 95%CI: 1.15, 9.19). Individuals with hypertension were less likely to get vaccinated than those without it (OR: 0.34; 95%CI: 0.13, 0.92), and those with anxiety were more likely to get vaccinated than those without anxiety (OR: 4.23; 95%CI: 1.68, 10.64). CONCLUSIONS Health status, education level, financial stability, and religious affiliation are some of the determining factors that potentially influence vaccination acceptance/hesitancy among the MENA community.
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Affiliation(s)
- Fatin Atrooz
- Department of Pharmacological and Pharmaceutical Sciences, College of Pharmacy, University of Houston, Houston, Texas, United States of America
| | - Zahra Majd
- Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, Texas, United States of America
| | - Ghalya Alrousan
- Department of Pharmacological and Pharmaceutical Sciences, College of Pharmacy, University of Houston, Houston, Texas, United States of America
| | - Sarah Zeidat
- Department of Pharmacological and Pharmaceutical Sciences, College of Pharmacy, University of Houston, Houston, Texas, United States of America
| | - Nadia N Abuelezam
- William F. Connell School of Nursing, Boston College, Boston, Massachusetts, United States of America
| | - Susan Abughosh
- Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, Texas, United States of America
| | - Samina Salim
- Department of Pharmacological and Pharmaceutical Sciences, College of Pharmacy, University of Houston, Houston, Texas, United States of America
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27
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Malkin J, Allen Scott L, Alberga Machado A, Teare G, Snider J, Ali Tirmizi SF, Bandara T, Rathwell M, Neudorf C. Factors influencing human papillomavirus school-based immunization in Alberta: A mixed-methods study protocol. PLoS One 2022; 17:e0278472. [PMID: 36454791 PMCID: PMC9714709 DOI: 10.1371/journal.pone.0278472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/24/2022] [Indexed: 12/03/2022] Open
Abstract
More than 1,300 Canadians are diagnosed with cervical cancer annually, which is nearly preventable through human papillomavirus (HPV) immunization. Across Canada, coverage rates remain below the 90% target set out by the Action Plan for the Elimination of Cervical Cancer in Canada (2020-2030). To support this Plan, the Canadian Partnership Against Cancer has commissioned the Urban Public Health Network (UPHN) to coordinate a quality improvement project with Canada's school-based HPV immunization programs. In Alberta, the UPHN partnered with Alberta Health Services (AHS) for this work. This study has one overarching research question: what are parent/guardian and program stakeholder perceived barriers, enablers and opportunities to immunization for youth as part of the school-based HPV immunization program in Alberta? This study uses a mixed-methods sequential explanatory design. A survey will be emailed to a sample of Albertans with children aged 11-17 years. Questions will be based on a Conceptual Framework of Access to Health Care. Subsequent qualitative work will explore the survey's findings. Parents/guardians identifying as vaccine hesitant in the survey will be invited to participate in virtual, semi-structured, in-depth interviews. Stakeholders of the school-based immunization program will be purposively sampled from AHS' five health zones for virtual focus groups. Quantitative data will be analyzed using SAS Studio 3.6 to carry out descriptive statistics and, using logistic regression, investigate if Framework constructs are associated with parents'/guardians' decision to immunize their children. Qualitative data will be analyzed using NVivo 12 to conduct template thematic analysis guided by the Framework. Study results will provide insights for Alberta's public health practitioners to make evidence-informed decisions when tailoring the school-based HPV immunization program to increase uptake in vaccine hesitant populations. Findings will contribute to the national study, which will culminate in recommendations to increase HPV immunization uptake nationally and progress towards the 90% coverage target.
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Affiliation(s)
- Jennifer Malkin
- Public Health Evidence and Innovation Division, Provincial Population and Public Health, Alberta Health Services, Calgary, Alberta, Canada
- * E-mail:
| | - Lisa Allen Scott
- Public Health Evidence and Innovation Division, Provincial Population and Public Health, Alberta Health Services, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Amanda Alberga Machado
- Public Health Evidence and Innovation Division, Provincial Population and Public Health, Alberta Health Services, Calgary, Alberta, Canada
| | - Gary Teare
- Public Health Evidence and Innovation Division, Provincial Population and Public Health, Alberta Health Services, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joanne Snider
- Communicable Disease Control Division, Provincial Population and Public Health, Alberta Health Services, Edmonton, Alberta, Canada
| | - Syed Farhan Ali Tirmizi
- Communicable Disease Control Division, Provincial Population and Public Health, Alberta Health Services, Edmonton, Alberta, Canada
| | - Thilina Bandara
- Urban Public Health Network, Saskatoon, Saskatchewan, Canada
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Mika Rathwell
- Urban Public Health Network, Saskatoon, Saskatchewan, Canada
| | - Cordell Neudorf
- Urban Public Health Network, Saskatoon, Saskatchewan, Canada
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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28
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Daniels D, Imdad A, Buscemi-Kimmins T, Vitale D, Rani U, Darabaner E, Shaw A, Shaw J. Vaccine hesitancy in the refugee, immigrant, and migrant population in the United States: A systematic review and meta-analysis. Hum Vaccin Immunother 2022; 18:2131168. [PMID: 36332155 PMCID: PMC9746503 DOI: 10.1080/21645515.2022.2131168] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Refugees, immigrants, and migrants (RIM) in the United States (US) have been identified as an underimmunized population prior to the COVID-19 pandemic. Vaccine acceptance is critical to combat the public health threat incited by COVID-19 and other vaccine-preventable disease. To better understand escalating vaccine hesitancy among US RIM, a comprehensive evaluation of the problem and solutions is necessary. In this systematic review, we included 57 studies to describe vaccination rates, barriers, and interventions addressing vaccine hesitancy over the past decade. Meta-analysis was performed among 22 studies, concluding that RIM represent an underimmunized population compared to the general US population. Narrative synthesis and qualitative methods were used to identify critical barriers, including gaps in knowledge, poor access to medical care, and heightened distrust of the medical system. Our results demonstrate the need for effective, evidence-based interventions to increase vaccination rates among diverse RIM populations.
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Affiliation(s)
- Danielle Daniels
- Department of Pediatrics, Division of Infectious Diseases, Upstate Golisano Children’s Hospital, SUNY Upstate Medical University, Syracuse, NY, USA,CONTACT Danielle Daniels 750 East Adams St. Room 5400, Syracuse, NY13210, USA
| | - Aamer Imdad
- Department of Pediatrics, Karjoo Family Center for Pediatric Gastroenterology, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Danielle Vitale
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Uzma Rani
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Ellen Darabaner
- Hunter-Rice Health Sciences Library, Samaritan Medical Center, Watertown, NY, USA
| | - Andrea Shaw
- Department of Pediatrics, Department of Internal Medicine, Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jana Shaw
- Department of Pediatrics, Division of Infectious Diseases, Upstate Golisano Children’s Hospital, SUNY Upstate Medical University, Syracuse, NY, USA
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29
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Debela MS, Garrett APN, Charania NA. Vaccine hesitancy and its determinants among refugee parents resettled in Aotearoa New Zealand. Hum Vaccin Immunother 2022; 18:2131336. [PMID: 36315907 PMCID: PMC9746517 DOI: 10.1080/21645515.2022.2131336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Vaccine hesitancy is an important factor underpinning suboptimal vaccine uptake and evidence on marginalized subgroups, such as refugees, is limited. This cross-sectional survey was conducted in 2020/21 with former refugee parents who resettled in Aotearoa New Zealand (NZ). The Parent Attitudes about Childhood Vaccines (PACV) was offered in Somali, Oromo, Arabic, and English languages, and the reliability of the four versions were evaluated. The prevalence of parental vaccine hesitancy was explored and the association between vaccine hesitancy and sociodemographic factors was examined using logistic regression. One hundred and seventy-eight responses were included in the analysis. The Cronbach's alpha scores for Somali, Oromo, Arabic, and English PACV were 0.89, 0.64, 0.53, and 0.77, respectively. The rate of parental vaccine hesitancy was 16.3%, 95% CI (10.7, 21.3). Most caregivers were concerned about vaccine side effects (47%), safety (43%), and efficacy (40%). Less than a quarter (21%) of parents had delayed their child receiving a vaccine and 12% had refused to vaccinate their child for reasons other than medical exemptions. After adjusting for covariate/s, parents' primary source of information and education status were significantly associated with vaccine hesitancy. Media as a primary source of vaccine information and low education status were associated with higher vaccine hesitancy. Vaccine hesitancy is relatively low among former refugees and is influenced by modifiable factors, including educational level and primary source of vaccine information. Vaccine information tailored to former refugee parents' concerns are required to reduce vaccine hesitancy and improve vaccine uptake.
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Affiliation(s)
- Mulisa Senbeta Debela
- Department of Public Health, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - A. P. Nick Garrett
- Department of Biostatistics and Epidemiology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Nadia A. Charania
- Department of Public Health, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand,Migrant and Refugee Health Research Centre, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand,CONTACT Nadia A. Charania Department of Public Health, Faculty of Health and Environmental Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand
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30
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Aylsworth L, Manca T, Dubé È, Labbé F, Driedger SM, Benzies K, MacDonald N, Graham J, MacDonald SE. A qualitative investigation of facilitators and barriers to accessing COVID-19 vaccines among Racialized and Indigenous Peoples in Canada. Hum Vaccin Immunother 2022; 18:2129827. [PMID: 36218335 DOI: 10.1080/21645515.2022.2129827] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Structural and systemic inequalities can contribute to susceptibility to COVID-19 disease and limited access to vaccines. Recognizing that Racialized and Indigenous Peoples may experience unique barriers to COVID-19 vaccination, this study explored early COVID-19 vaccine accessibility, including barriers and potential solutions to vaccine access, for these communities in Canada. We conducted semi-structured interviews about challenges to accessing COVID-19 vaccination with Racialized and Indigenous Peoples, including linguistic minorities and newcomers, in Spring 2021, just as COVID-19 vaccines were becoming more widely available in Canada. Participants were purposely selected from respondents to a Canadian national online survey. Three researchers analyzed the interviews for emergent themes using a descriptive content analysis approach in NVivo. At the time of the interview, interview participants (N = 27) intended to receive (n = 15) or had received (n = 11) at least one vaccine dose, or did not state their status (n = 1). Participants described multiple barriers to COVID-19 vaccination that they personally experienced and/or anticipated they or others could experience - including technology requirements, language barriers, lack of identification documentation, and travel challenges - as well as related solutions. These were organized into three broad categories: 1) COVID-19 disease and vaccination information, 2) vaccination booking procedures, and 3) vaccination sites. These structural and systemic barriers during the initial months of vaccine rollout substantially restricted participants' COVID-19 vaccination access, even when they were eager to get vaccinated, and should be addressed early in vaccine rollouts to facilitate optimal uptake for everyone everywhere.
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Affiliation(s)
- Laura Aylsworth
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Terra Manca
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Ève Dubé
- Direction des risques biologiques et de la Santé au travail, Institut National de Santé Publique du Québec, Québec, Quebec, Canada
| | - Fabienne Labbé
- Direction des risques biologiques et de la Santé au travail, Institut National de Santé Publique du Québec, Québec, Quebec, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.,Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Noni MacDonald
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Janice Graham
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Technoscience & Regulation Research Unit, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shannon E MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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31
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MacDonald SE, Paudel YR, Du C. COVID-19 vaccine coverage among immigrants and refugees in Alberta: A population-based cross-sectional study. J Glob Health 2022; 12:05053. [PMID: 36472928 PMCID: PMC9725104 DOI: 10.7189/jogh.12.05053] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Studies have shown that immigrants have lower vaccination rates than the Canadian-born population. We sought to assess COVID-19 vaccine coverage and factors associated with uptake among foreign-born immigrants relative to the non-immigrant population in Alberta, Canada. Methods In this cross-sectional study, we analysed population-based linked administrative health data from Alberta to examine vaccine coverage for 3 931 698 Albertans, of which 731 217 were immigrants. We calculated COVID-19 vaccination coverage as the proportion of eligible Albertans with a record of receiving at least one dose of a COVID-19 vaccine as of November 29, 2021. We used multivariable logistic regression to examine the association of vaccine coverage with migration status (immigrants: four categories based on time since migration and non-immigrants) adjusting for socio-demographic variables. Results Overall, COVID-19 vaccination coverage was 78.2% (95% confidence interval (CI) = 78.1%-78.3%) among immigrants and 76.0% (95% CI = 75.9%-76.0%) among non-immigrants. Coverage among immigrants differed by continent of origin, with North America, Oceania, and Europe having the lowest coverage. Although vaccine coverage was relatively uniform across neighbourhood income quintiles for immigrants, immigrants living in rural areas had lower vaccine coverage compared to non-immigrants living in rural areas. Multivariable logistic regression analysis showed a significant interaction between age category and migration status. While immigrants below 50 years of age generally had significantly higher vaccine coverage compared to non-immigrants, there was some variation based on time since migration. Immigrants above 50 years of age showed significantly lower coverage compared to non-immigrants of the same age. Conclusions Public health interventions should focus on older immigrants, immigrants living in rural areas, and immigrants from specific continental backgrounds in order to improve COVID-19 vaccination coverage.
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Affiliation(s)
- Shannon E MacDonald
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada,Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Yuba Raj Paudel
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Crystal Du
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Chambers C, Gillis J, Lindsay J, Benoit AC, Kendall CE, Kroch A, Grewal R, Loutfy M, Mah A, O'Brien K, Ogilvie G, Raboud J, Rachlis A, Rachlis B, Yeung A, Yudin MH, Burchell AN. Low human papillomavirus vaccine uptake among women engaged in HIV care in Ontario, Canada. Prev Med 2022; 164:107246. [PMID: 36075492 DOI: 10.1016/j.ypmed.2022.107246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/08/2022] [Accepted: 09/02/2022] [Indexed: 10/31/2022]
Abstract
Women living with HIV are at higher risk for human papillomavirus (HPV)-related dysplasia and cancers and thus are prioritized for HPV vaccination. We measured HPV vaccine uptake among women engaged in HIV care in Ontario, Canada, and identified socio-demographic, behavioural, and clinical characteristics associated with HPV vaccination. During annual interviews from 2017 to 2020, women participating in a multi-site, clinical HIV cohort responded to a cross-sectional survey on HPV vaccine knowledge and receipt. We used logistic regression to derive age-adjusted odds ratios and 95% confidence intervals (CI) for factors associated with self-reported vaccine initiation (≥1 dose) or series completion (3 doses). Among 591 women (median age = 48 years; interquartile range = 40-56 years), 13.2% (95%CI = 10.5-15.9%) had received ≥1 dose. Of those vaccinated, 64.6% had received 3 doses. Vaccine initiation (≥1 dose) was significantly higher among women aged 20-29 years at 31.0% but fell to 13.9% in those aged 30-49 years and < 10% in those aged ≥50 years. After age adjustment, vaccine initiation was significantly associated with being employed (vs. unemployed but seeking work), income $40,000-$59,999 (vs. <$20,000), being married/common-law (vs. single), living with children, immigrating to Canada >5 years ago (vs. immigrating ≤5 years ago), never smoking (vs. currently smoking), and being in HIV care longer (per 10 years). Similar factors were identified for series completion (3 doses). HPV vaccine uptake remains low among women living with HIV in our cohort despite regular engagement in care. Recommendations for improving uptake include education of healthcare providers, targeted community outreach, and public funding of HPV vaccination.
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Affiliation(s)
- Catharine Chambers
- University of Toronto, Toronto, Canada; St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | | | - Joanne Lindsay
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Anita C Benoit
- University of Toronto, Toronto, Canada; Women's College Research Institute, Toronto, Canada
| | - Claire E Kendall
- Bruyère Research Institute, Ottawa, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Canada; ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Canada
| | - Abigail Kroch
- University of Toronto, Toronto, Canada; Ontario HIV Treatment Network, Toronto, Canada; Public Health Ontario, Toronto, Canada
| | - Ramandip Grewal
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; Public Health Ontario, Toronto, Canada
| | - Mona Loutfy
- Women's College Research Institute, Toronto, Canada
| | - Ashley Mah
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | | | - Gina Ogilvie
- University of British Columbia, Vancouver, Canada
| | - Janet Raboud
- University of Toronto, Toronto, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | | | - Beth Rachlis
- University of Toronto, Toronto, Canada; ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Canada
| | - Anna Yeung
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Mark H Yudin
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Ann N Burchell
- University of Toronto, Toronto, Canada; St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.
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Chiem A, Olaoye F, Quinn R, Saini V. Reasons and suggestions for improving low immunization uptake among children living in low socioeconomic status communities in Northern Alberta, Canada - A qualitative study. Vaccine 2022; 40:4464-4472. [PMID: 35701329 DOI: 10.1016/j.vaccine.2022.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 05/30/2022] [Accepted: 06/02/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Under-immunization increases the risk of acquiring vaccine-preventable diseases in children and the community. The targeted coverage rate for routine childhood immunization in Alberta, especially in disadvantaged communities in rural and remote geographic areas, has not been achieved for many years. This study was conducted to identify reasons for under-immunization in children in low socioeconomic status (SES) communities and propose suggestions to address issues/concerns identified by low SES parents for improving immunization coverage in their communities. METHODS Fourteen semi-structured phone interviews of low SES parents with under-immunized children living in rural and remote geographic areas in Northern Alberta were conducted. Transcripts were analyzed to identify relevant themes. RESULTS Busy lifestyles of many parents prevented them from taking their children to clinics for immunization, which were exacerbated by long distances to clinics, transportation issues, operating hours of clinics, and lack of reminders. Many disadvantaged parents also exhibited varying levels of vaccine hesitancy due to safety concerns, especially about newer vaccines, thereby causing some parents to delay immunizing their child intentionally. CONCLUSION Implementing procedures to alleviate access issues, such as offering extended operating hours, opening drop-in clinics/satellite clinics in distant areas, nurse visits to their homes, updating contact information of parents, frequent reminder options and addressing safety and effectiveness concerns about vaccines in plain language using evidence-based communication strategies can promote timely immunization among children of low SES parents.
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Affiliation(s)
- Alexander Chiem
- School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, Saskatchewan S7N 2Z4, Canada
| | - Funmilayo Olaoye
- Research & Innovation, Provincial Population and Public Health, Alberta Health Services, 10101, Southport Road SW, Calgary, Alberta T2W 3N2, Canada
| | - Renee Quinn
- Population and Public Health, North Zone, Alberta Health Services, 4720 55 Street, Cold Lake, Alberta T9M 1V8, Canada
| | - Vineet Saini
- Research & Innovation, Provincial Population and Public Health, Alberta Health Services, 10101, Southport Road SW, Calgary, Alberta T2W 3N2, Canada; Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, Alberta T2N 4Z6, Canada.
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Tankwanchi ABS, Jaca A, Ndlambe AM, Zantsi ZP, Bowman B, Garrison MM, Larson HJ, Vermund SH, Wiysonge CS. Non-COVID-19 vaccine hesitancy among migrant populations worldwide: a scoping review of the literature, 2000-2020. Expert Rev Vaccines 2022; 21:1269-1287. [DOI: 10.1080/14760584.2022.2084075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Anelisa Jaca
- Cochrane South Africa, South African Medical Research Council, Cape Town, SA
| | - Asiphe M Ndlambe
- Cochrane South Africa, South African Medical Research Council, Cape Town, SA
| | - Zukiswa P Zantsi
- Cochrane South Africa, South African Medical Research Council, Cape Town, SA
| | - Brett Bowman
- Department of Psychology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, SA
| | - Michelle M Garrison
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Heidi J Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Sten H Vermund
- Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, SA
- Department of Global Health, Stellenbosch University, Cape Town, SA
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, SA
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Moussaoui S, Combes S, Ibanez G, Gautier A, Relyea B, Vignier N. Are immigrants living in France more reluctant to receive vaccines than native-born French citizens? findings from the national health Barometer study. Vaccine 2022; 40:3869-3883. [DOI: 10.1016/j.vaccine.2022.05.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 04/12/2022] [Accepted: 05/14/2022] [Indexed: 01/04/2023]
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Perceptions of and hesitancy toward COVID-19 vaccination in older Chinese adults in Hong Kong: a qualitative study. BMC Geriatr 2022; 22:288. [PMID: 35387602 PMCID: PMC8985396 DOI: 10.1186/s12877-022-03000-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 03/29/2022] [Indexed: 01/20/2023] Open
Abstract
Background COVID-19 vaccination is recommended for older adults by the World Health Organization. However, by July 15, 2021, only 26% of individuals over 60 years old in Hong Kong had received a first dose of the vaccine. The health belief model and the theory of planned behavior have been used to understand the determinants for COVID-19 vaccination in past literature. However, vaccination determinants can be complex and involve social and cultural factors that cannot be explained by micro-individual factors alone; hence, the health belief model and the theory of planned behavior cannot provide a complete understanding of vaccine hesitancy. Few studies on the barriers to, hesitancy toward, and motivations for COVID-19 vaccination among older Chinese adults have been performed. The aim of this study is to fill this gap by conducting a comprehensive analysis of this subject using the critical medical anthropology framework, extending the health belief model and the theory of planned behavior in understanding vaccination determinants among the older adult population. Methods Between November 2020 and February 2021, 31 adults (24 women and 7 men) over the age of 65 took part in semi-structured, one-on-one interviews. The data we gathered were then analyzed through a phenomenological approach. Results Two major themes in the data were examined: barriers to vaccination and motivations for vaccination. The participants’ perceptions of and hesitancy toward vaccination demonstrated a confluence of factors at the individual (trust, confidence, and social support networks), microsocial (stigma toward health care workers), intermediate-social (government), and macrosocial (cultural stereotypes, civic and collective responsibility, and economic considerations) levels according to the critical medical anthropology framework. Conclusions The decision to receive a COVID-19 vaccination is a complex consideration for older adults of low socioeconomic status in Hong Kong. Using the critical medical anthropology framework, the decision-making experience is a reflection of the interaction of factors at different layers of social levels. The findings of this study extend the health belief model and the theory of planned behavior regarding the understanding of vaccination perceptions and relevant behaviors in an older adult population.
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Crawshaw AF, Farah Y, Deal A, Rustage K, Hayward SE, Carter J, Knights F, Goldsmith LP, Campos-Matos I, Wurie F, Majeed A, Bedford H, Forster AS, Hargreaves S. Defining the determinants of vaccine uptake and undervaccination in migrant populations in Europe to improve routine and COVID-19 vaccine uptake: a systematic review. THE LANCET INFECTIOUS DISEASES 2022; 22:e254-e266. [PMID: 35429463 PMCID: PMC9007555 DOI: 10.1016/s1473-3099(22)00066-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 12/13/2022]
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Thomas CM, Searle K, Galván A, Liebman AK, Mann EM, Kirsch JD, Stauffer WM. Healthcare Worker Perspectives on COVID-19 Vaccines: Implications for Increasing Vaccine Acceptance among Healthcare Workers and Patients. Vaccine 2022; 40:2612-2618. [PMID: 35315322 PMCID: PMC8904141 DOI: 10.1016/j.vaccine.2022.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/23/2022] [Accepted: 03/03/2022] [Indexed: 11/30/2022]
Abstract
Objective To understand COVID-19 vaccine perspectives among healthcare workers serving diverse communities. Methods A dual English/Spanish survey was distributed to healthcare workers in the United States from 3/12/2021–4/22/2021 by the Migrant Clinicians Network, Society of Refugee Healthcare Providers, a Federally Qualified Healthcare Center, and social media advertisement to general primary care workers. Results 517 responses were at least 50% complete and included in the analysis. Among these, 88% (457/517) indicated vaccine acceptance. Factors associated with acceptance included not reporting any vaccine concerns, identifying as male, ≥65 years of age, being a physician or advanced practice provider, and interacting directly with patients from refugee, immigrant, and migrant (RIM) communities. Participants identified educational information as most helpful for themselves when making a vaccine decision, but a healthcare provider’s recommendation as most helpful for their patients. Conclusion Healthcare workers, especially those serving RIM communities, are vaccine accepting. Tailoring vaccine-related information to healthcare workers may improve vaccine confidence for both themselves and patients who rely on them for information.
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Affiliation(s)
- Christine M Thomas
- Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, United States; National Resource Center for Refugees, Immigrants, and Migrants, University of Minnesota, Minneapolis, MN, United States.
| | - Kelly Searle
- School of Public Health, University of Minnesota, Minneapolis, MN, United States; National Resource Center for Refugees, Immigrants, and Migrants, University of Minnesota, Minneapolis, MN, United States
| | - Alma Galván
- Migrant Clinicians Network, Austin, TX, United States; National Resource Center for Refugees, Immigrants, and Migrants, University of Minnesota, Minneapolis, MN, United States
| | - Amy K Liebman
- Migrant Clinicians Network, Austin, TX, United States; National Resource Center for Refugees, Immigrants, and Migrants, University of Minnesota, Minneapolis, MN, United States
| | - Erin M Mann
- National Resource Center for Refugees, Immigrants, and Migrants, University of Minnesota, Minneapolis, MN, United States
| | - Jonathan D Kirsch
- National Resource Center for Refugees, Immigrants, and Migrants, University of Minnesota, Minneapolis, MN, United States; Department of Medicine, Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, United States
| | - William M Stauffer
- Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, United States; National Resource Center for Refugees, Immigrants, and Migrants, University of Minnesota, Minneapolis, MN, United States; Center for Global Health and Social Responsibility, University of Minnesota, Minneapolis, MN, United States
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COVID-19 vaccination intention and behavior in a large, diverse, U.S. refugee population. Vaccine 2022; 40:1231-1237. [PMID: 35125223 PMCID: PMC8806127 DOI: 10.1016/j.vaccine.2022.01.057] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/08/2022] [Accepted: 01/26/2022] [Indexed: 11/23/2022]
Abstract
Introduction Refugees often face increased risk of exposure to COVID-19 due to their disproportionate representation in the essential workforce and crowded household conditions. There is a paucity of data about risk factors for under-immunization for COVID-19 among refugees. Methods Refugees were surveyed in two phases that corresponded to before and after wide availability of COVID-19 vaccines. Participants were asked about their attitudes, and perceptions about COVID-19, previous acceptance of vaccines, sources utilized to obtain trusted health information, and intent to get vaccinated. The overall participant vulnerability was assessed using the social vulnerability index. In-depth semi-structured interviews were completed with key stakeholders through snowball sampling. Results Of 247 refugees, 244 agreed to participate in the initial survey. Among those, 140 (57.4%) intended to get vaccinated, 43 (17.6%) were unsure, and 61 (25%) did not intend to get vaccinated. In the follow up survey, all 215 who were reached, agreed to provide information about their vaccination status. Among those respondents, 141 (65.6%) were either vaccinated or expressed intent to do so, and 74 (34.4%) remained hesitant. We did not observe any significant correlation between socio-demographic variables, country of origin, and vaccination status/intent. Among those who initially intended to get vaccinated, nearly 1 in 5 changed their mind and decided to forego vaccination, and among those who initially did not plan getting vaccinated, 1 in 3 changed their mind and got vaccinated. Fears related to the vaccine, concerns that the vaccine is religiously prohibited, “wait and see” how others did with the vaccine, communication and transportation barriers were commonly cited as reason not to get vaccinated. Conclusions Over a third of refugees in our study were hesitant to get vaccinated. Refugees desired additional education about the benefits and safety of vaccines along with easier access to vaccination clinics in their communities.
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Honora A, Wang KY, Chih WH. How does information overload about COVID-19 vaccines influence individuals' vaccination intentions? The roles of cyberchondria, perceived risk, and vaccine skepticism. COMPUTERS IN HUMAN BEHAVIOR 2022; 130:107176. [PMID: 35013641 PMCID: PMC8730468 DOI: 10.1016/j.chb.2021.107176] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/24/2021] [Accepted: 12/29/2021] [Indexed: 01/18/2023]
Abstract
This research proposes and tests an integrated model to explain how information overload influence vaccine skepticism and vaccination intention. In addition, this research investigates the effectiveness of using a celebrity endorsement strategy in promoting vaccination and compares its effectiveness with other endorsement types. A survey study (Study 1) was conducted to examine the mechanism underlying the impact of the COVID-19 vaccine information overload on vaccine skepticism that, subsequently, affects vaccination intention. It also examined the moderating role of celebrity endorsement trustworthiness. The results indicate that information overload positively influenced vaccine skepticism through cyberchondria and perceived risk of the vaccine, which subsequently reduces vaccination intention. The negative effect of vaccine skepticism on vaccination intention was weakened by the celebrity endorsement that was considered trustworthy. A follow-up experimental study (Study 2) was performed to compare the effectiveness of celebrity endorsement with other endorsement types (i.e., government official and medical expert endorsements). The results showed that the celebrity endorsement was more effective in mitigating the negative effect of vaccine skepticism on vaccination intention compared to government official and medical expert. The findings provide practical insights into how governments can minimize people's vaccine skeptical views and increase their vaccination intentions.
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Affiliation(s)
- Andreawan Honora
- Department of Business Administration, National Dong Hwa University, No. 1, Sec. 2, Da Hsueh Rd, Shoufeng, Hualien, 97401, Taiwan, ROC
| | - Kai-Yu Wang
- Department of Marketing, International Business and Strategy, Goodman School of Business, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON L2S3A1, Canada
| | - Wen-Hai Chih
- Department of Business Administration, National Dong Hwa University, No. 1, Sec. 2, Da Hsueh Rd, Shoufeng, Hualien, 97401, Taiwan, ROC
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Access to COVID-19 Vaccination during the Pandemic in the Informal Settlements of Rome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020719. [PMID: 35055541 PMCID: PMC8776102 DOI: 10.3390/ijerph19020719] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/29/2021] [Accepted: 01/06/2022] [Indexed: 12/10/2022]
Abstract
With the advent of vaccines, the world has a chance to see a real end to the COVID-19 pandemic. To make this possible, however, it is necessary that all groups of people are considered. Contexts of informal settlements and populations such as the homeless and migrants are often forgotten by vaccination campaigns. In this study, carried out as a result of a collaboration with MEDU, a non-profit association aimed at bringing healthcare to vulnerable populations, we provide important data related to the vaccination campaign carried out in the informal settlements of Rome. The objectives of this work are to (1) evaluate vaccination coverage in these contexts, (2) assess the gap with the vaccination coverage of the Italian population and try to hypothesize the causes, and (3) provide recommendations for how humanitarian associations can respond to reduce this gap. We observed important differences in vaccination coverage depending on the type of settlement. The percentage of vaccinated people in these contexts at the beginning of October range between 14.4% and 55.5%, underlining an important gap with the vaccination rate of Italy’s population, which is close to 80%. The data also show that particular attention must be paid to the transiting and irregular people as they are more at risk for a lack of access to vaccination. With this study, in which we provide recommendations that integrate MEDU’s fieldwork experience with the advice of the Framework report, we hope we can help those who work in similar contexts, to carry out a fair and effective vaccination campaign.
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Zhang P, Fan K, Guan H, Zhang Q, Bi X, Huang Y, Liang L, Khoso AR, Jiao M, Kang Z, Hao Y, Wu Q. Who is more likely to hesitate to accept COVID-19 vaccine: a cross-sectional survey in China. Expert Rev Vaccines 2021; 21:397-406. [PMID: 34961405 DOI: 10.1080/14760584.2022.2019581] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The aim of our study was to identify factors associated with coronavirus disease 2019 (COVID-19)vaccine willingness in China to aid future public health actions to improve vaccination. RESEARCH DESIGN AND METHODS This study was conducted in August 2020 using a mixed-method approach, including a cross-sectional self-administered anonymous questionnaire survey and in-depth interviews with community residents in China. RESULTS : Of the participants, 30.9% showedCOVID-19 vaccine hesitancy. Being female(OR=1.297), having poor health(OR=1.312), having non-health or medical-related occupations (OR=1.129), no COVID-19 infection experience(OR=1.523), living with vulnerable family members(OR=1.294), less knowledge(OR=1.371), less attention to COVID-19 information(OR=1.430), less trust in official media(OR=1.336), less perceived susceptibility to COVID-19(OR=1.367), and less protective behavior(OR=1.195) were more likely to hesitate. Qualitative research has shown that they doubt the importance and necessity, as well as the effectiveness and safety of the vaccination. The economic and service accessibility of the vaccination was an impediment to their vaccine acceptance. CONCLUSION Nearly one-thirdof people showed hesitancy to accept COVID-19 vaccination in China. Our findings highlight that health communication and publicity should be performed for the targeted population, and immunization programs should be designed to remove underlying barriers to vaccine uptake.
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Affiliation(s)
- Peng Zhang
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Kaisheng Fan
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Hanwen Guan
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Qiao Zhang
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Xuejing Bi
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Yangmu Huang
- School of Public Health, Peking University, Beijing, China
| | - Libo Liang
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Abdul Rahman Khoso
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Mingli Jiao
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Zheng Kang
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Yanhua Hao
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Qunhong Wu
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
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Grewal R, Deeks SL, Hart TA, Cox J, De Pokomandy A, Grennan T, Lambert G, Moore D, Coutlée F, Gaspar M, George C, Grace D, Jollimore J, Lachowsky NJ, Nisenbaum R, Ogilvie G, Sauvageau C, Tan DHS, Yeung A, Burchell AN. Human papillomavirus (HPV) vaccination across a cascade of knowledge, willingness, and uptake among gay, bisexual, and other men who have sex with men in Canada's three largest cities. Hum Vaccin Immunother 2021; 17:5413-5425. [PMID: 34856869 DOI: 10.1080/21645515.2021.1979379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Some Canadian jurisdictions offer publicly funded HPV vaccine to gay, bisexual, and other men who have sex with men (GBM) aged ≤26 years. We characterized factors associated with being in different stages of HPV vaccination. METHODS Engage is a sexual health study of GBM in the three largest Canadian cities recruited via respondent driven sampling (RDS). We categorized participants as: (1) unaware of HPV vaccine, (2) undecided/unwilling to get vaccinated, (3) willing to get vaccinated, (4) vaccinated with one or more doses. Our RDS-II weighted analyses used multinomial logistic regression to identify factors associated with being in earlier stages of the cascade compared to Stage 4. RESULTS Across the cities, 26-40%, 7-14%, 33-39%, and 13-28% were in Stages 1 to 4, respectively. Compared to Stage 4, being in earlier stages of the cascade was associated with bisexual-identification (Stage 1: adjusted odds ratio[aOR] = 2.84, 95% confidence interval[CI] = 1.06-7.62; Stage 2: aOR = 3.09, 95%CI = 1.19-8.05), having immigrated to Canada (Stage 1: aOR = 1.79, 95%CI 1.07-2.99), preference to keep same-sex romantic relationships private (Stage 1: aOR = 1.25, 95% CI = 1.05-1.48; Stage 2: aOR = 1.24, 95%CI = 1.05-1.46), not receiving sexual health information (Stage 1: aOR = 0.31, 95% CI = 0.13-0.71; Stage 2: aOR = 0.27, 95%CI = 0.12-0.64), not accessing a health-care provider (Stage 2: aOR = 0.36, 95%CI = 0.15-0.83), and no past hepatitis A/B vaccination (Stage 1: aOR = 0.16, 95% CI = 0.09-0.30; Stage 2: aOR = 0.18, 95%CI = 0.09-0.35; Stage 3: aOR = 0.38, 95%CI = 0.21-0.61). DISCUSSION Interventions are needed to reduce social and financial barriers, increase sexual health knowledge, and improve GBM-competent health-care access to increase vaccine uptake among GBM.
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Affiliation(s)
- R Grewal
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - S L Deeks
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Nova Scotia Department of Health and Wellness, Halifax, Canada
| | - T A Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Psychology, Ryerson University, Toronto, Canada
| | - J Cox
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, Montréal, McGill University.,Direction régionale de santé publique, CIUSSS-Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada
| | - A De Pokomandy
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
| | - T Grennan
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - G Lambert
- Direction régionale de santé publique, CIUSSS-Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada
| | - D Moore
- Department of Medicine, University of British Columbia, Vancouver, Canada.,BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - F Coutlée
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, Canada.,Department of Microbiology and Immunology, Université de Montréal, Montréal, Canada
| | - M Gaspar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - C George
- Department of Exercise, Health, and Sport Sciences, University of Maine, Portland, USA
| | - D Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - J Jollimore
- Community-Based Research Centre, Vancouver, Canada
| | - N J Lachowsky
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Community-Based Research Centre, Vancouver, Canada.,School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - R Nisenbaum
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Applied Health Research Centre, Unity Health Toronto, Toronto, Canada
| | - G Ogilvie
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - C Sauvageau
- Faculty of Medicine, Université Laval, Québec City, Canada.,Institut National de santé publique du Québec, Québec, Canada
| | - D H S Tan
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - A Yeung
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - A N Burchell
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Canada
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44
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Nyanchoga MM, Lee P, Barbery G. Exploring electronic health records to estimate the extent of catch-up immunisation and factors associated with under-immunisation among refugees and asylum seekers in south east Queensland. Vaccine 2021; 39:6238-6244. [PMID: 34556368 DOI: 10.1016/j.vaccine.2021.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 07/21/2021] [Accepted: 09/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Australia is one of the leading countries resettling people from refugee-like backgrounds. Catch-up immunisation is a key priority in this cohort. However, few studies have included asylum seekers and the adult age group in their study sample. In addition, Electronic Health Records (EHR) has recently been recognised as a vital tool in big data analysis with the capacity to contribute to informed strategic decision making. As such, the main aim of this study is to explore EHR routinely used in a specialised refugee clinic in South East Queensland to estimate the extent of catch-up immunisation and assess the factors associated with under-immunisation among refugees and asylum seekers. METHODS A quantitative study involving a secondary data analysis on a pre-existing dataset was undertaken. Relevant data was extracted from the EHR in the clinic. SPSS was used to perform Statistical data analysis. RESULTS The majority of clients originated from Papua New Guinea, followed by Iran and Afghanistan. When assessing the uptake of catch-up immunisations among refugees and asylum seekers, MMR (Measles-Mumps-Rubella), Polio and DTP (Diphtheria-Tetanus-Pertussis) had the highest uptake, while HPV (Human Papilloma Virus), Pneumococcal and Hib (Haemophilus influenza type b) immunisations had the lowest uptake. Binary logistic regression revealed that the younger patients, the refugees (compared to asylum seekers) and those with a longer residential duration in Australia are at a higher risk of being under-immunised. CONCLUSION This study indicates that the broader group of immigrants, and in particular refugees and asylum seekers, do not represent a homogenous group in terms of immunisation coverage, and that each cohort should be carefully considered during immunisation interventions and strategies. This will be particularly important during targeted health promotions and future immunisation programs in this cohort.
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Affiliation(s)
| | - Patricia Lee
- Senior Lecturer, School of Medicine, Gold Coast Campus, Griffith University, Southport, QLD 4222, Australia.
| | - Gaery Barbery
- Lecturer, Health Services Management, School of Medicine, Griffith University, South Bank, QLD 4101, Australia.
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45
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Kaufman J, Tuckerman J, Bonner C, Durrheim DN, Costa D, Trevena L, Thomas S, Danchin M. Parent-level barriers to uptake of childhood vaccination: a global overview of systematic reviews. BMJ Glob Health 2021; 6:bmjgh-2021-006860. [PMID: 34580071 PMCID: PMC8477248 DOI: 10.1136/bmjgh-2021-006860] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/09/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Understanding barriers to childhood vaccination is crucial to inform effective interventions for maximising uptake. Published systematic reviews include different primary studies, producing varying lists of barriers. To make sense of this diverse body of literature, a comprehensive level of summary and synthesis is necessary. This overview of systematic reviews maps all potential parent-level barriers to childhood vaccination identified in systematic reviews. It synthesises these into a conceptual framework to inform development of a vaccine barriers assessment tool. METHODS We applied Joanna Briggs methodology, searching the Epistemonikos review database and reference lists of included reviews to June 2020. Systematic reviews of qualitative or quantitative data on parent-level barriers to routine vaccination in preschool-aged children were included. Reviews addressing influenza, reporting non-modifiable determinants or reporting barriers not relevant to parents were excluded. Where possible, we extracted review details, barrier descriptions and the number, setting and design of primary studies. Two authors independently screened search results and inductively coded barrier descriptions. RESULTS We screened 464 papers, identifying 30 relevant reviews with minimal overlap. Fourteen reviews included qualitative and quantitative primary studies, seven included quantitative and seven included qualitative studies only. Two did not report included study designs. Two-thirds of reviews (n=20; 67%) only included primary studies from high-income countries. We extracted 573 barrier descriptions and inductively coded these into 64 unique barriers in six overarching categories: (1) Access, (2) Clinic or Health System Barriers, (3) Concerns and Beliefs, (4) Health Perceptions and Experiences, (5) Knowledge and Information and (6) Social or Family Influence. CONCLUSIONS A global overview of systematic reviews of parent-level barriers to childhood vaccine uptake identified 64 barriers to inform development of a new comprehensive survey instrument. This instrument will assess both access and acceptance barriers to more accurately diagnose the reasons for under-vaccination in children in different settings.
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Affiliation(s)
- Jessica Kaufman
- Vaccine Uptake Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia .,Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Tuckerman
- Vaccine Uptake Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Carissa Bonner
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - David N Durrheim
- Health Protection, Hunter New England Health, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Daniel Costa
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - Lyndal Trevena
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - Susan Thomas
- Health Protection, Hunter New England Health, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Margie Danchin
- Vaccine Uptake Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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Zhang M, Gurung A, Anglewicz P, Subedi P, Payton C, Ali A, Ibrahim A, Haider M, Hamidi N, Atem J, Thang J, Wang S, Kim C, Kimball SL, Karaki F, Nazhat N, Abouagila M, Yun K. Acceptance of COVID-19 Vaccine Among Refugees in the United States. Public Health Rep 2021; 136:774-781. [PMID: 34546812 DOI: 10.1177/00333549211045838] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Little is known about COVID-19 vaccination intentions among refugee communities in the United States. The objective of this study was to measure COVID-19 vaccination intentions among a sample of refugees in the United States and the reasons for their vaccine acceptance or hesitancy. METHODS From December 2020 through January 2021, we emailed or text messaged anonymous online surveys to 12 bilingual leaders in the Afghan, Bhutanese, Somali, South Sudanese, and Burmese refugee communities in the United States. We asked community leaders to complete the survey and share the link with community members who met the inclusion criteria (arrived in the United States as refugees, were aged ≥18, and currently lived in the United States). We compared the characteristics of respondents who intended to receive the COVID-19 vaccine with those of respondents who did not intend to receive the vaccine or were unsure. We then conducted crude and adjusted logistic regression analysis to measure the association between employment as an essential worker and COVID-19 vaccine acceptance. RESULTS Of 435 respondents, 306 (70.3%) indicated that they planned to receive a COVID-19 vaccine. Being an essential worker (adjusted odds ratio [aOR] = 2.37; 95% CI, 1.44-3.90) and male sex (aOR = 1.87; 95% CI, 1.12-3.12) were significantly associated with higher odds of intending to receive a COVID-19 vaccine. Among respondents who intended to receive a COVID-19 vaccine, wanting to protect themselves (68.6%), family members (65.0%), and other people (54.3%) were the main reasons. CONCLUSION Many refugees who responded to the survey, especially those who worked in essential industries, intended to receive a COVID-19 vaccine. Community organizations, health care providers, and public health agencies should work together to ensure that vaccine registration and vaccination sites are accessible to refugees.
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Affiliation(s)
- Mengxi Zhang
- 5666 Department of Nutrition and Health Science, Ball State University College of Health, Muncie, IN, USA
| | - Ashok Gurung
- 6567 PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Philip Anglewicz
- 25802 Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Parangkush Subedi
- 1243 Office of Refugee Resettlement, US Department of Health and Human Services, Washington, DC, USA
| | - Colleen Payton
- 1688 School of Nursing and Public Health, Moravian University, Bethlehem, PA, USA
| | - Ahmed Ali
- Somali Health Board, Seattle, WA, USA
| | - Anisa Ibrahim
- 21618 Pediatric Clinic, Harborview Medical Center, Seattle, WA, USA
| | - Mahri Haider
- Division of General Internal Medicine, University of Washington, Seattle, WA, USA.,21618 International Medicine Clinic, Harborview Medical Center, Seattle, WA, USA
| | | | - Jacob Atem
- Southern Sudan Healthcare Organization, Okemos, MI, USA
| | - Jenni Thang
- 311308 Department of Consulting Psychology, Purdue University, West Lafayette, IN, USA
| | - Siqin Wang
- 1974 School of Earth and Environmental Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Curi Kim
- 1243 Office of Refugee Resettlement, US Department of Health and Human Services, Washington, DC, USA
| | - Sarah L Kimball
- 12259 Boston University School of Medicine, Boston, MA, USA.,12259 Immigrant & Refugee Health Center, Boston Medical Center, Boston, MA, USA
| | - Fatima Karaki
- 166668 Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Najib Nazhat
- 229681 Refugee Resettlement and Placement Services, Lutheran Community Services Northwest, SeaTac, WA, USA
| | - Mouammar Abouagila
- 229681 Refugee Resettlement and Placement Services, Lutheran Community Services Northwest, Tacoma, WA, USA
| | - Katherine Yun
- 6567 Division of General Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Arat A, Moore HC, Goldfeld S, Östberg V, Sheppeard V, Gidding HF. Childhood vaccination coverage in Australia: an equity perspective. BMC Public Health 2021; 21:1337. [PMID: 34229652 PMCID: PMC8261950 DOI: 10.1186/s12889-021-11345-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study describes trends in social inequities in first dose measles-mumps-rubella (MMR1) vaccination coverage in Western Australia (WA) and New South Wales (NSW). Using probabilistically-linked administrative data for 1.2 million children born between 2002 and 2011, we compared levels and trends in MMR1 vaccination coverage measured at age 24 months by maternal country of birth, Aboriginal status, maternal age at delivery, socio-economic status, and remoteness in two states. RESULTS Vaccination coverage was 3-4% points lower among children of mothers who gave birth before the age of 20 years, mothers born overseas, mothers with an Aboriginal background, and parents with a low socio-economic status compared to children that did not belong to these social groups. In both states, between 2007 and 2011 there was a decline of 2.1% points in MMR1 vaccination coverage for children whose mothers were born overseas. In 2011, WA had lower coverage among the Aboriginal population (89.5%) and children of young mothers (89.3%) compared to NSW (92.2 and 92.1% respectively). CONCLUSION Despite overall high coverage of MMR1 vaccination, coverage inequalities increased especially for children of mothers born overseas. Strategic immunisation plans and policy interventions are important for equitable vaccination levels. Future policy should target children of mothers born overseas and Aboriginal children.
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Affiliation(s)
- Arzu Arat
- Institute of Environmental Medicine, Unit of Occupational Medicine, Karolinska Institute, Stockholm, Sweden.
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Sharon Goldfeld
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Viveca Östberg
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Vicky Sheppeard
- Communicable Diseases Branch, Health Protection NSW, North Sydney, NSW, Australia
| | - Heather F Gidding
- Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia
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48
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Human papillomavirus vaccination in immigrants and descendants of immigrants in Denmark. Eur J Cancer Prev 2021; 29:149-156. [PMID: 31425314 DOI: 10.1097/cej.0000000000000524] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
OBJECTIVE In Denmark, human papillomavirus (HPV) vaccination has been offered at age of 12 to girls born in 1996 and later. In this cohort study, we examined routine HPV vaccination uptake in immigrants and descendants from different countries and regions compared with native Danes, including the influence of socioeconomic characteristics and potential changes in uptake by birth cohort. METHODS In nationwide registers, we identified all girls born in 1996-2003 (n = 260 251) and obtained information on country of origin, HPV vaccinations and parents' income and employment. Vaccination was defined as receiving ≥1 dose within 2 years after eligibility for routine vaccination. Odds ratios (ORs) were estimated by logistic regression separately for birth cohorts 1996-2000 and 2001-2003. RESULTS Uptake in immigrants and descendants varied by country and region of origin. Overall, immigrants had lower uptake than native Danes, in birth cohorts 1996-2000 [79% vs. 93%, OR = 0.31; 95% confidence interval (CI), 0.29-0.34] and 2001-2003 (63% vs. 73%, OR = 0.60; 95% CI, 0.54-0.66). Descendants had lower uptake than native Danes in cohorts 1996-2000 (89% vs. 93%, OR = 0.65; 95% CI, 0.60-0.68), but higher uptake in cohorts 2001-2003 (76% vs. 73%, OR = 1.15; 95% CI, 1.08-1.21). Most associations were attenuated, but not entirely explained, when adjusting for socioeconomic characteristics. CONCLUSION HPV vaccination uptake varied by country and region. Most immigrants had lower uptake than native Danes, and in most groups, this was not fully explained by socioeconomic differences. Patterns in descendants were mixed. Interventions to increase uptake should be tailored to specific groups of immigrants/descendants.
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49
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Tankwanchi AS, Bowman B, Garrison M, Larson H, Wiysonge CS. Vaccine hesitancy in migrant communities: a rapid review of latest evidence. Curr Opin Immunol 2021; 71:62-68. [PMID: 34118728 DOI: 10.1016/j.coi.2021.05.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 12/30/2022]
Abstract
By refusing or delaying vaccination, vaccine hesitant individuals and communities undermine the prevention, and ultimately, elimination of communicable diseases against which safe and effective vaccines are available. We reviewed recent evidence of vaccine hesitancy within migrant communities in the context of increased human mobility and widespread anti-immigrant sentiment and manifest xenophobia. Among many immigrant parents and families, vaccine hesitancy is largely associated with fears and misinformation about vaccine harms, limited knowledge of both preventable diseases and vaccines, distrust of host countries' health systems and their attendant intentions, language barriers, and perceived incompatibility between vaccine uptake and migrants' religion. Hesitancy toward measles, influenza, and human papillomavirus vaccines are most discernible, and main migrant populations involved include Somalis and Poles.
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Affiliation(s)
| | - Brett Bowman
- Department of Psychology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Michelle Garrison
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA; Department of Psychiatry and Behavioral Sciences, Seattle Children's Hospital and University of Washington, Seattle, WA, USA
| | - Heidi Larson
- Department of Health Metrics Sciences, University of Washington School of Medicine, Seattle, WA USA; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa; Department of Global Health, Stellenbosch University, Cape Town, South Africa; School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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50
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Badre-Esfahani S, Petersen LK, Tatari CR, Blaakær J, Andersen B, Seibæk L. Perceptions of cervical cancer prevention among a group of ethnic minority women in Denmark-A qualitative study. PLoS One 2021; 16:e0250816. [PMID: 34061863 PMCID: PMC8168878 DOI: 10.1371/journal.pone.0250816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 04/14/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Cervical cancer screening (CCS) and human papillomavirus vaccination (HPVV) are effective measures against cervical cancer (CC). Attendance in HPVV and CCS provides the greatest protection, while combined non-attendance in HPVV and CCS provides little to no protection. It is hence concerning that some large ethnic minority groups show considerably lower HPVV and CCS attendance than other women-especially women from Middle-Eastern and North African (MENA) countries and Pakistan. Little is, however, known about the reasons for this low combined attendance pattern n. AIM To explore perceptions of and barriers to HPVV and CCS, among MENA and Pakistani women in Denmark. METHOD Focus group interviews were conducted. Data was transcribed verbatim, and analysed using systematic text condensation. FINDINGS Seventeen long-term resident women originating from six major MENA countries and Pakistan were included. Mean age was 36 years. We found that these women, across different age groups and descent, had sparse knowledge and understanding about CC, and their perceived relevance of disease prevention was low. Compared to HPVV, their barriers to CCS were more fixed and often linked to socio-cultural factors such as taboos related to female genitals and sexuality. Moreover, they presented unmet expectations and signs of mistrust in the healthcare system. However, at the end of the interviews, participants became more attentive toward CC prevention, particularly toward HPVV. CONCLUSION Elements of insufficient knowledge and understanding of CC and its prevention were found among a group of MENA and Pakistani women. Their socio-cultural background further represents a barrier particularly towards CCS. Additionally, negative experiences and unmet expectations lessen their trust in the healthcare system. All of which underlines the need for new tailored CC preventive strategies for this group. Based on our findings we suggest that future studies develop and evaluate interventions aiming to improve HPVV and CCS, including user-involvement.
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Affiliation(s)
- Sara Badre-Esfahani
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus N, Denmark
- Department of Public Health Programmes, Randers Regional Hospital, Randers NO, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lone Kjeld Petersen
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense C, Denmark
- Open Patient data Explorative Network, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Camilla Rahr Tatari
- Department of Public Health Programmes, Randers Regional Hospital, Randers NO, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jan Blaakær
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Berit Andersen
- Department of Public Health Programmes, Randers Regional Hospital, Randers NO, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lene Seibæk
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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