Background Inequality in immunisation uptake in Travelling communities is well documented. We need to understand barriers and facilitators to uptake for these communities. We aimed to explore these factors and identify potential interventions.
Methods A three-phase qualitative study. Phase 1: we interviewed 174 Travellers from six communities across four cities; English Roma (York), Romanian Roma and English Gypsies/Irish Travellers (Bristol), Slovakian Roma and Scottish Showpeople (Glasgow), and Irish Travellers (London). Recruited through gatekeepers and using translators where necessary, we conducted individual or family interviews, collecting views on factors influencing their uptake of vaccines and ideas for improving uptake. Phase 2: we interviewed 39 providers or commissioners of immunisation services. Phase 3: 51 Travellers and 25 service providers co-created potentially acceptable interventions. We used a framework approach to analyse transcripts, and a modified intervention mapping method to identify interventions. The Social Ecological Model provided the theoretical framework.
Results Immunisations were generally accepted by all communities; current parents mostly had greater knowledge, and were more likely to rely on health professionals and electronic media for information, than older generations. Vaccine concerns were mostly community specific, though concern that receiving HPV implied acceptance of premarital sexual relationships was reported in four communities. Low literacy, limited English and lack of interpreters were barriers to accessing information and services, including providing consent. Verbal information through trusted health professionals was highly valued. Recall and reminder systems were generally perceived as effective even for families who regularly travelled. Service providers believed that discrimination, poor school attendance, housing difficulties and poverty were wider determinants though these were infrequently reported by communities. Services tailored for Travellers were valued by users and providers where available. Five interventions to improve uptake were prioritised; cultural competence training for health professionals, identifying Travellers in health records, GP receptionist to support Travellers, flexible and diverse appointment systems, and protected funding for specialist Health Visitors.
Conclusion Factors influencing immunisation uptake are evolving with subsequent generations. It was possible to identify and agree interventions with potential to increase uptake across communities. None were so innovative they are likely to require expensive or lengthy formal testing; most could build upon existing good practice. This evidence may enable commissioners and providers to make informed and efficient investments to reduce immunisation uptake inequity.
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