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Crawshaw AF, Goldsmith LP, Deal A, Carter J, Knights F, Seedat F, Lau K, Hayward SE, Yong J, Fyle D, Aspray N, Iwami M, Ciftci Y, Wurie F, Majeed A, Forster AS, Hargreaves S. Driving delivery and uptake of catch-up vaccination among adolescent and adult migrants in UK general practice: a mixed methods pilot study. BMC Med 2024; 22:186. [PMID: 38702767 PMCID: PMC11068568 DOI: 10.1186/s12916-024-03378-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 04/02/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Migrants in the UK and Europe face vulnerability to vaccine-preventable diseases (VPDs) due to missed childhood vaccines and doses and marginalisation from health systems. Ensuring migrants receive catch-up vaccinations, including MMR, Td/IPV, MenACWY, and HPV, is essential to align them with UK and European vaccination schedules and ultimately reduce morbidity and mortality. However, recent evidence highlights poor awareness and implementation of catch-up vaccination guidelines by UK primary care staff, requiring novel approaches to strengthen the primary care pathway. METHODS The 'Vacc on Track' study (May 2021-September 2022) aimed to measure under-vaccination rates among migrants in UK primary care and establish new referral pathways for catch-up vaccination. Participants included migrants aged 16 or older, born outside of Western Europe, North America, Australia, or New Zealand, in two London boroughs. Quantitative data on vaccination history, referral, uptake, and sociodemographic factors were collected, with practice nurses prompted to deliver catch-up vaccinations following UK guidelines. Focus group discussions and in-depth interviews with staff and migrants explored views on delivering catch-up vaccination, including barriers, facilitators, and opportunities. Data were analysed using STATA12 and NVivo 12. RESULTS Results from 57 migrants presenting to study sites from 18 countries (mean age 41 [SD 7.2] years; 62% female; mean 11.3 [SD 9.1] years in UK) over a minimum of 6 months of follow-up revealed significant catch-up vaccination needs, particularly for MMR (49 [86%] required catch-up vaccination) and Td/IPV (50 [88%]). Fifty-three (93%) participants were referred for any catch-up vaccination, but completion of courses was low (6 [12%] for Td/IPV and 33 [64%] for MMR), suggesting individual and systemic barriers. Qualitative in-depth interviews (n = 39) with adult migrants highlighted the lack of systems currently in place in the UK to offer catch-up vaccination to migrants on arrival and the need for health-care provider skills and knowledge of catch-up vaccination to be improved. Focus group discussions and interviews with practice staff (n = 32) identified limited appointment/follow-up time, staff knowledge gaps, inadequate engagement routes, and low incentivisation as challenges that will need to be addressed. However, they underscored the potential of staff champions, trust-building mechanisms, and community-based approaches to strengthen catch-up vaccination uptake among migrants. CONCLUSIONS Given the significant catch-up vaccination needs of migrants in our sample, and the current barriers to driving uptake identified, our findings suggest it will be important to explore this public health issue further, potentially through a larger study or trial. Strengthening existing pathways, staff capacity and knowledge in primary care, alongside implementing new strategies centred on cultural competence and building trust with migrant communities will be important focus areas.
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Affiliation(s)
- Alison F Crawshaw
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Lucy P Goldsmith
- Population Health Research Institute, St George's, University of London, London, UK
| | - Anna Deal
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jessica Carter
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Felicity Knights
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Farah Seedat
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Karen Lau
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Sally E Hayward
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Joanna Yong
- NHS North Central London Research Network (NoCLoR) and Clinical Research Network (CRN) North Thames, London, UK
| | - Desiree Fyle
- NHS North Central London Research Network (NoCLoR) and Clinical Research Network (CRN) North Thames, London, UK
| | - Nathaniel Aspray
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Michiyo Iwami
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Yusuf Ciftci
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Fatima Wurie
- Addiction and Inclusion Directorate, Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | | | - Sally Hargreaves
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK.
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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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Overmars I, Kaufman J, Holland P, Danchin M, Tuckerman J. Catch-up immunisation for migrant children in Melbourne: A qualitative study with providers to determine key challenges. Vaccine 2022; 40:6776-6784. [PMID: 36243589 DOI: 10.1016/j.vaccine.2022.08.063] [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: 02/23/2022] [Revised: 08/01/2022] [Accepted: 08/26/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Current models of immunisation service delivery in Australia are not meeting the needs of migrant children, who experience a higher burden of vaccine preventable disease and lower immunisation rates compared to non-migrant children. Understanding the experiences of immunisation providers is critical for designing effective and tailored interventions to improve this service. This study aimed to identify the facilitators and barriers to providers delivering a comprehensive catch-up immunisation service to migrant children in Melbourne, Australia. METHODS Semi-structured interviews with council and general practice immunisation providers were conducted. Recorded interviews were transcribed and coded inductively using thematic analysis. Identified themes were then deductively categorised according to the Capability, Opportunity and Motivation of Behaviour (COM-B) model. RESULTS Twenty-four providers (five practice nurses, six general practitioners, six council nurses and seven council administration officers) were interviewed between March and June 2021. Fourteen themes were identified that contributed to the delivery of an effective catch-up immunisation service. Capability themes included training, experience and skills to perform the service and communicate with families. Opportunity themes incorporated time, workplace norms, traits of migrant families, costs, systems and resources. Themes related to motivation were provider responsibility, beliefs about migrant health, and immunisation prioritisation. CONCLUSIONS Key barriers for providers to deliver a comprehensive catch-up immunisation service were related to opportunity. Developing an online tool to support catch-up schedule development and reporting, and funding provider time to calculate the schedule are primary actions that could overcome opportunity barriers. Capability and motivation barriers for general practitioners included limited time, skills, and motivation compared to nurses. These barriers may be overcome with improvements to training that focus on upskilling nurses to deliver the catch-up service. Service delivery challenges are multifactorial, requiring a range of strategies to optimise this service and increase immunisation coverage in migrant children.
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Affiliation(s)
- Isabella Overmars
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia; Vaccine Uptake Group, Murdoch Children's Research Institute, Parkville, VIC, Australia.
| | - Jessica Kaufman
- Vaccine Uptake Group, Murdoch Children's Research Institute, Parkville, VIC, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
| | | | - Margie Danchin
- Vaccine Uptake Group, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia; Department of General Medicine, The Royal Children's Hospital Melbourne, VIC, Australia
| | - Jane Tuckerman
- Vaccine Uptake Group, Murdoch Children's Research Institute, Parkville, VIC, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
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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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Tuckerman J, Holland P, Overmars I, Kaufman J, Danchin M. Revision of the Australian Immunisation Register Should be Considered to Meet the Needs of Migrant Children. J Paediatr Child Health 2021; 57:1548. [PMID: 34328242 DOI: 10.1111/jpc.15670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 07/21/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Jane Tuckerman
- Vaccine Uptake Group, 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
| | - Isabella Overmars
- Vaccine Uptake Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jessica Kaufman
- Vaccine Uptake Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Margie Danchin
- Vaccine Uptake Group, 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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Migration Health: Highlights from Inaugural International Society of Travel Medicine (ISTM) Conference on Migration Health. Curr Infect Dis Rep 2019; 21:48. [PMID: 31734735 DOI: 10.1007/s11908-019-0705-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW International migration is a global phenomenon that is growing in scope, complexity and impact. The inaugural International Society of Travel Medicine (ISTM) International Conference on Migration Health provided a forum to discuss scientific evidence on the broad issues relevant to migration health. This review summarises the key health issues, with a focus on infectious diseases, current effective strategies and future considerations presented at this forum and in the recent literature. RECENT FINDINGS Migrants face health disparities for both communicable and non-communicable diseases. Their heightened infectious disease risks, compared to host populations, are related to pre-migration exposures, the circumstances of the migration journey and the receptivity and access to health services in their receiving countries. While the prevalence of infectious diseases identified through screening programmes are generally low, delays in diagnosis and treatment for a range of treatable infectious diseases result in higher morbidity and mortality among migrants. Barriers to care in host countries occur at the patient, provider and health systems levels. Coordinated and inclusive health services, healthcare systems and health policies, responsive to patient diversity reduce these barriers. Structural barriers to healthcare provision impede equitable care to migrants and refugees. Public health and medical professionals have a role in advocating for policy reforms.
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