UnderstaNding uptake of Immunisations in TravellIng and Gypsy communities (UNITING)

Problem

Gypsies, Travellers and Roma (referred to here as Travellers) are less likely to access health services including immunisation. To improve immunisation rates, we need to understand what helps and hinders individuals in these communities in taking up immunisations. This study had two aims:1. Investigate the barriers and facilitators to acceptability and uptake of immunisations amongst six Traveller communities across four UK cities;2. Identify possible interventions to increase uptake of immunisations in these Traveller communities that could be tested in a subsequent feasibility study.

Approach

Three-phase qualitative study underpinned by the Social Ecological Model.Phase 1: Interviews with 174 Travellers from six communities: Romanian Roma, English Gypsy/Irish Travellers (Bristol), English Gypsy (York), Romanian/Slovakian Roma, Scottish Show people (Glasgow) and Irish Traveller (London). Focus on childhood, adult flu and whooping cough vaccines.Phase 2: Interviews with 39 Service Providers.Data were analysed using the Framework approach. Interventions were identified using a modified intervention mapping approach.Phase 3: 51 Travellers and 25 Service Providers attended workshops and produced a prioritised list of potentially acceptable and feasible interventions to increase uptake.

Findings

There were many common accounts of barriers and facilitators across communities, particularly across the four English-speaking communities. The Scottish Showpeople were most similar to the general population. Roma communities experienced additional barriers of language and being in a new country. Men and women described similar barriers and facilitators.There was widespread acceptance of childhood and adult immunisation with current parents perceived as more positive than their elders. A minority of English-speaking Travellers worried about multiple/combined childhood vaccines, adult flu and whooping cough. Cultural concerns about pregnancy vaccines and HPV were most evident in the Bristol English Gypsy/Irish Traveller community. Language, literacy, discrimination, poor attendance at school, poverty and housing were identified as barriers for some Travellers. Trustful relationships with health professionals were seen as important and continuity of care valued. A minority of English-speaking Travellers described problems of booking and attending immunisation. Service Providers tailored their approach to Travellers, particularly for Roma. Funding cuts, NHS reforms and poor monitoring challenged their work.Five “top priority” interventions were agreed across communities to improve uptake of immunisation amongst Travellers who are housed or settled on an authorised site.1. Cultural competence training for health professionals and frontline staff2. Identify Travellers in health records to tailor support and monitor uptake3. Named frontline person in GP practice to provide respectful and supportive service4. Flexible and diverse systems for booking appointments, recall and reminders5. Protected funding for Health Visitor specialising in Traveller health including immunisation

Consequences

To promote uptake of immunisation among Traveller communities these interventions could usefully be packaged within a National Policy Plan, implemented and evaluated.