Influences on childhood immunisation decision-making in London's Gypsy and Traveller communities
Uptake of childhood immunisations is lower among Gypsy, Roma and Traveller (GRT) communities than in the general UK population. This small-scale study aimed to elicit insights from GRT mothers on their interaction with health services in London around childhood immunisations. The purpose was to inform a larger piece of work by the NHS England and Improvement (London) Public Health Commissioning Team to inform their planning to improve access to vaccination services for GRT communities in London.
An exploratory qualitative study using semi-structured interviews and a focus group.
There was purposive sampling of mothers from any GRT background from south-west London using snowballing methods. One focus group and three interviews were conducted. A thematic analysis approach was used.
A total of nine women were recruited and seven participated between March and April 2018. Five themes were identified: adherence with antenatal care, self-declared parenting expertise, family support, childhood immunisations, keep children healthy but ‘they say wait on the MMR until they are talking’.
Compliance with antenatal care, strong parenting beliefs and cohesive family support are strong influences on decision-making regarding immunisations. The women interviewed emphasised their own expertise in child rearing. This was occasionally at odds with the health advice provided by health professionals. The women widely shared their experiences of health professionals with other family and community members and this impacted on others' intention to vaccinate. These are key issues that should be considered when trying to improve uptake of immunisations in GRT families in a face-to-face manner. Equally, it warrants further exploration in a larger-scale study to see whether this reflects the wider community and in order to tailor supplementary immunisation activities to improve uptake.
Gypsy, Roma and Traveller (GRT) communities are among the most disadvantaged minority groups in Europe, experiencing poorer infant and child health outcomes (Smart et al, 2003) and greater maternal and child mortality than the general population (Aspinall, 2005; Parry et al, 2007; Aspinall, 2014). They are also less likely to access health services; facing barriers related to discrimination, culture and language, health literacy, service-user attributes, and economic barriers (Siebelt et al, 2017; McFadden et al, 2018). In the UK, GRT communities have been identified as having a lower uptake of childhood immunisations than in the general population, significantly increasing the risk of vaccine-preventable disease among children and families (Pinkney, 2012; Dar et al, 2013; Dixon et al, 2017).
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