ABSTRACT
Background The COVID-19 pandemic has highlighted shortfalls in the delivery of vaccine programmes to older migrant groups. Guidelines exist, however, little is known around care pathways and engagement of these older cohorts in routine vaccinations in primary care, including catch-up programmes. We explored the views of primary care professionals around barriers and facilitators to catch-up vaccination in adult migrants (defined as foreign born;18+ years) with incomplete or uncertain vaccination status. Methods We did a qualitative interview study with purposive sampling and thematic analysis in UK primary care (50 practices included nationally;1 hour qualitative interviews) with 64 primary care professionals (PCPs): 48 clinical staff including GPs, Practice Nurses and healthcare assistants (HCAs);16 administrative staff including practice managers and receptionists (mean age 45 years;84.4% female;a range of ethnicities). Results Participants highlighted direct and indirect barriers to catch-up vaccines in adult migrants who may have missed vaccines as children, missed boosters, and not be aligned with the UK's vaccine schedule, from both a personal and service-delivery level, with themes including: lack of training and knowledge of guidance around catch-up vaccination among staff;unclear or incomplete vaccine records;and lack of incentivization (including financial reimbursement) and dedicated time and care pathways. Adult migrants were reported as being excluded from many vaccination initiatives, most of which focus exclusively on children. PCPs noted that migrants expressed to them a range of views around vaccines, from positivity to uncertainty, to refusal. Conclusions Vaccine uptake in adult migrants could be improved through implementing new financial incentives, strengthening care pathways and training, and working directly with local community groups to improve understanding around the benefits of vaccination at all ages. Key messages There are direct and indirect barriers to catch-up vaccines in adult migrants who may have missed vaccines as children, missed boosters, and not be aligned with the UK’s vaccine schedule. Primary care teams have a key role to play in implementing WHO’s new Immunization Agenda and to better consider catch-up vaccination to under-immunised groups across the life-course.
ABSTRACT
Background Disparities in vaccination uptake among migrant populations are well documented. WHO and ECDC have sought renewed focus on participatory research that engages migrants in co-producing tailored initiatives to address vaccination inequities and increase coverage. Methods This community-based participatory research study aims to engage Congolese migrants in co-developing a tailored approach to increase vaccine uptake. Phase 1 used poster walls and in-depth interviews with Congolese migrants (n = 32) to explore COVID-19 vaccination beliefs, experiences, and preferred information sources and communication methods, analysed iteratively and thematically in NVivo. Preliminary results Institutional distrust has shaped this population’s interpretation of the pandemic response and enabled vaccine misinformation and conspiracy theories to take hold. We found complex information networks and preference for Francophone, African and social media. Limited English proficiency and preference for the oral tradition restricted engagement with official public health messaging. Suspicion of government motives, low knowledge, and culturally specific perceptions about vaccination contributed to belief that breakthrough infections and need for COVID-19 boosters imply the vaccine is not effective. The population felt coerced by vaccination reminders and mandates, and were resultantly more hesitant to accept COVID-19 vaccination. Conclusions The population’s specific characteristics suggest that existing and trusted interpersonal networks and oral communication in first languages should be harnessed to spread credible information and encourage vaccine uptake, and mandate policies are unlikely to be effective. Training local role models to facilitate vaccination dialogues and myth-bust may be effective at changing behaviour. The next phases will gather more information from key stakeholders and engage migrants in workshops to co-design insight-driven, tailored interventions. Key messages • Global policy-setting organisations have called urgently for participatory research that engages migrants in the co-production of tailored initiatives to address vaccination inequalities. • Populations with strong interpersonal networks and low trust in public institutions may be receptive to tailored, community-centred dialogue approaches using local messengers and role models.
ABSTRACT
Issue The World Health Organization has called for tailored, community-based interventions to address disparities in vaccination uptake affecting migrant and minoritised populations, however few exist. This study directly responds to global calls for community-centred and participatory approaches to engaging migrants in routine and COVID-19 vaccination. Problem description Black and African migrants are known to be at risk of under-immunisation and have lower COVID-19 vaccine uptake rates in high-income countries. This UK study will use community-based participatory approaches to engage Congolese migrants in co-developing a tailored intervention to increase vaccine uptake. A community-academic coalition will lead the study. Community members will be trained as peer researchers and financially compensated. The final output will be an intervention strategy tailored to and embedded within the Congolese migrant community. Preliminary results The coalition held 20 hours of planning meetings and peer researcher training in 2021 and co-developed a phased study involving 1) community days with poster walls and qualitative in-depth interviews with Congolese migrants, 2) interviews and workshops with local stakeholders, and 3) co-design workshops with Congolese migrants. Following outreach and pre-engagement, approximately 80 migrants attended the community days, with more than 50 interviews and 100% left positive feedback (including: felt valued, welcomed, Congolese language recognised). Lessons Community-academic partnerships are resource-intensive but can be an effective means to build and maintain trust required to deliver a community-based research study. Academic partners should support community partners in understanding the research process to help manage expectations and provide financial compensation for their time and effort. This study offers an innovative engagement model and study design that can be adapted to other underserved populations. Key messages • Global policy-setting organisations have called urgently for participatory research that engages migrants in the co-production of tailored initiatives to address vaccination inequalities. • This study uses a novel, theory-driven, participatory approach to engage with and identify barriers to vaccination in Congolese migrants and co-design a tailored strategy to increase uptake.