ABSTRACT
IntroductionAdult migrants are at risk of under-immunisation and are likely to need catch-up vaccination to bring them in line with the UK schedule. The COVID-19 pandemic has highlighted and exacerbated inequities in vaccine uptake, with migrants facing additional barriers to information, low vaccine confidence, and access to vaccine services. There is a need for participatory and theory-based research that meaningfully engages underserved migrant groups to make sense of their experiences and beliefs about vaccination and uses these insights to co-produce tailored interventions which can increase uptake. COVID-19 vaccination provides a unique entry-point and opportunity to explore these issues in tandem with addressing routine immunisation gaps and developing more culturally-sensitive routine vaccination services. Methods and analysisLISOLO MALAMU ( Good Talk) is a community-based participatory research study which uses co-design, design thinking and behaviour change theory to engage adult Congolese migrants in developing a tailored intervention to increase vaccine uptake. A community-academic coalition will lead and co-design the study. The study will involve i) in-depth interviews with adult Congolese migrants (foreign-born, >18 years), ii-iii) interviews and consensus workshops with clinical, public health and community stakeholders, and iv) co-design workshops with adult Congolese migrants. Qualitative data will be analysed iteratively, using Thematic Analysis, and mapped to the Theoretical Domains Framework, with participation from the coalition in discussing and interpreting findings and selecting intervention functions to guide the co-design workshops. Sociodemographic data of interview participants will be summarised using descriptive statistics. The study will run from approximately November 2021-November 2022. Ethics and disseminationEthics approval has been granted by the St Georges University Research Ethics Committee (REC reference 2021.0128). Study findings will be widely disseminated by the coalition through local community organisations in Hackney and broader academic and policy stakeholders, including a final celebration event. Recommendations for a future larger scale study and testing of prototyped interventions will be made. Strengths and limitations of this study StrengthsO_LIThis study will directly respond to ongoing calls for community-centred and participatory approaches to engaging migrants in routine and COVID-19 vaccination, by implementing a value-driven and reciprocal approach to conducting a study addressing the needs of an underserved community. C_LIO_LIThe target population was selected following a comprehensive systematic review of the evidence (1) and pre-engagement scoping work conducted with migrant community representatives in London, UK. (2, 3) C_LIO_LIIt aims to co-produce a tailored intervention to address specific barriers to, and strengthen, vaccine uptake for COVID-19 and routine vaccines in adult Congolese migrants (including MMR, Td/IPV, and HPV) as set out by UKHSA guidance (4), and has been co-designed with, and will be co-delivered by, a coalition formed of academic researchers, a council for voluntary service (a local charity which offers services and support for local voluntary and community organisations), and a Congolese community-based organisation. C_LI LimitationsO_LIAs this study is tailored to the Congolese migrant population, other migrants who also face barriers to vaccine uptake are not included. Whilst we can draw some conclusions about the experiences of other Black migrants who face similar historical and cultural barriers to uptake of routine and COVID-19 vaccines, our ability to generalise the findings to all migrant communities might be limited. C_LIO_LICo-designed intervention prototypes will not be formally implemented and evaluated in this study, however recommendations will be made so that this can be done in a future phase. C_LI
ABSTRACT
ObjectiveTo determine the extent and nature of social media use in migrant and ethnic minority communities for COVID-19 information, and implications for preventative health measures including vaccination intent and uptake. DesignA systematic review of published and grey literature following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines Eligibility Criteria for study selectionGlobal research reporting the use of social media by migrants and/or ethnic minority groups in relation to COVID-19. Data extractionWe extracted data on key outcomes, study design, country, population under study, and sample size. Results1849 unique records were screened, and 21 data sources included in our analysis involving migrant and ethnic minority populations in the UK, US, China, Jordan, Qatar, and Turkey. We found evidence of consistent use of a range of social media platforms for COVID-19 information in some migrant and ethnic minority populations (including WeChat, Facebook, WhatsApp, Instagram, Twitter, YouTube), which may stem from difficulty in accessing COVID-19 information in their native languages or from trusted sources. There were positive and negative associations with social media use reported, with some evidence suggesting circulating misinformation and social media use may be associated with lower participation in preventative health measures, including vaccine intent and uptake, findings of which are likely relevant to multiple population groups. ConclusionsSocial media platforms are an important source of information about COVID-19 for some migrant and ethnic minority populations. Urgent actions and further research are now needed to better understand the use of social media platforms for accessing health information by different population groups - particularly groups who are marginalised from health systems - effective approaches to tackling circulating misinformation, and to seize on opportunities to make better use of social media platforms to support public health communication and improve vaccine uptake. RegistrationThis study has been registered with PROSPERO (CRD42021259190).
ABSTRACT
Diverse migrant populations in Europe are at risk of under-immunisation and have recently shown lower levels of COVID-19 vaccination intent and uptake. Understanding the determinants of vaccine uptake in migrants is critical to address immediate COVID-19 vaccination inequities, and longer-term will help improve coverage for routine vaccinations, aligning with the goals of the new Immunisation Agenda 2030. We did a systematic review following PRISMA guidelines and using a PICOS framework (PROSPERO CRD42020219214; MEDLINE, CINAHL, PsycINFO databases, 1 January 2000 - 14 September 2021) exploring barriers and facilitators to vaccine uptake and determinants of under-vaccination in migrants in the EU/EEA, UK, and Switzerland. We categorised barriers/facilitators using the 5As Determinants of Vaccine Uptake Taxonomy. 5259 data sources were screened, with 67 studies included from 16 countries, representing 366,529 migrants. Access barriers were most commonly reported (language, literacy and communication barriers; practical and legal barriers to accessing/delivering vaccination services; service barriers, including lack of specific guidelines and knowledge of healthcare professionals) for key vaccines including MMR, DTP, HPV, influenza, polio, COVID-19 vaccines. Acceptance barriers were mostly reported in Eastern European and Muslim communities for HPV, measles, and influenza vaccines. We identified 23 determinants of under-vaccination in migrants, including geographical origin (where 25/26 (96%) studies showed significance) - particularly African/Eastern European origin; recent migration; being a refugee/asylum seeker; higher income; parental education level; no healthcare contact in the past year; and lower language skills. Facilitators of migrants vaccine uptake included tailored vaccination messaging, community outreach and nudging interventions. Migrants barriers to accessing healthcare are already well documented, and this review confirms their role in limiting vaccine uptake. These data hold immediate relevance to strengthening vaccination programmes in high-income countries, including for COVID-19. Our findings suggested that targeted, evidence-informed strategies are needed to address access and acceptance barriers to vaccination in migrants, including the development of migrant-sensitive and adaptable vaccination services and systems, unambiguous public health messaging, and coproduction of tailored interventions.
