Needles, Jabs and Jags: a qualitative exploration of barriers and facilitators to child and adult immunisation among Gypsies, Travellers and Roma

Cath Jackson, Helen Bedford, Francine M. Cheater, Louise Condon, Carol Emslie, Lana Ireland, Philippa Kemsley, Susan Kerr, Helen J. Lewis, Julie Mytton, Karen Overend, Sarah Redsell, Zoe Richardson, Christine Shepherd, Lesley Smith, Lisa Dyson

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Abstract

Background
Gypsies, Travellers and Roma (referred to as Travellers) are less likely to access health services including immunisation. To improve immunisation rates, it is necessary to understand what helps and hinders individuals in these communities in taking up immunisations. This study had two aims.
1. Investigate the views of Travellers in the UK on the barriers and facilitators to acceptability and uptake of immunisations and explore their ideas for improving immunisation uptake;

2. Examine whether and how these responses vary across and within communities, and for different vaccines (childhood and adult).

Methods
This was a qualitative, cross-sectional interview study informed by the Social Ecological Model. Semi-structured interviews were conducted 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). The focus was childhood and selected adult vaccines. Data were analysed using the Framework approach.

Results
Common accounts of barriers and facilitators were identified across all six Traveller communities, similar to those documented for the general population. All Roma communities experienced additional barriers of language and being in a new country. Men and women described similar barriers and facilitators although women spoke more of discrimination and low literacy. There was broad acceptance of childhood and adult immunisation across and within communities, 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 and described barriers to booking and attending immunisation. Cultural concerns about antenatal vaccines and HPV vaccination were most evident in the Bristol English Gypsy/Irish Traveller community. Language, literacy, discrimination, poor school attendance, poverty and housing were identified as barriers across different communities. Trustful relationships with health professionals were important and continuity of care valued.

Conclusions
The experience of many Travellers in this study, and the context through which they make health decisions, is changing. This large study identified key issues that should be considered when taking action to improve uptake of immunisations in Traveller families and reduce the persistent inequalities in coverage.
Original languageEnglish
JournalBMC Public Health
Volume17
Issue number254
Early online date14 Mar 2017
DOIs
Publication statusPublished - 2017

Fingerprint

Roma
Needles
Immunization
Vaccines
Interviews
Communication Barriers
Combined Vaccines
Papillomavirus Vaccines
Continuity of Patient Care
Whooping Cough
Health
Poverty
Health Services
Vaccination
Language
Cross-Sectional Studies
Parents

Keywords

  • immunisation
  • vaccination
  • Travellers
  • Gypsies
  • Roma
  • showpeople
  • Lay beliefs
  • barriers
  • facilitators

Cite this

Jackson, Cath ; Bedford, Helen ; Cheater, Francine M. ; Condon, Louise ; Emslie, Carol ; Ireland, Lana ; Kemsley, Philippa ; Kerr, Susan ; Lewis, Helen J. ; Mytton, Julie ; Overend, Karen ; Redsell, Sarah ; Richardson, Zoe ; Shepherd, Christine ; Smith, Lesley ; Dyson, Lisa . / Needles, Jabs and Jags: a qualitative exploration of barriers and facilitators to child and adult immunisation among Gypsies, Travellers and Roma. In: BMC Public Health. 2017 ; Vol. 17, No. 254.
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abstract = "BackgroundGypsies, Travellers and Roma (referred to as Travellers) are less likely to access health services including immunisation. To improve immunisation rates, it is necessary to understand what helps and hinders individuals in these communities in taking up immunisations. This study had two aims.1. Investigate the views of Travellers in the UK on the barriers and facilitators to acceptability and uptake of immunisations and explore their ideas for improving immunisation uptake; 2. Examine whether and how these responses vary across and within communities, and for different vaccines (childhood and adult). MethodsThis was a qualitative, cross-sectional interview study informed by the Social Ecological Model. Semi-structured interviews were conducted 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). The focus was childhood and selected adult vaccines. Data were analysed using the Framework approach.ResultsCommon accounts of barriers and facilitators were identified across all six Traveller communities, similar to those documented for the general population. All Roma communities experienced additional barriers of language and being in a new country. Men and women described similar barriers and facilitators although women spoke more of discrimination and low literacy. There was broad acceptance of childhood and adult immunisation across and within communities, 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 and described barriers to booking and attending immunisation. Cultural concerns about antenatal vaccines and HPV vaccination were most evident in the Bristol English Gypsy/Irish Traveller community. Language, literacy, discrimination, poor school attendance, poverty and housing were identified as barriers across different communities. Trustful relationships with health professionals were important and continuity of care valued.ConclusionsThe experience of many Travellers in this study, and the context through which they make health decisions, is changing. This large study identified key issues that should be considered when taking action to improve uptake of immunisations in Traveller families and reduce the persistent inequalities in coverage.",
keywords = "immunisation, vaccination, Travellers, Gypsies, Roma, showpeople, Lay beliefs, barriers, facilitators",
author = "Cath Jackson and Helen Bedford and Cheater, {Francine M.} and Louise Condon and Carol Emslie and Lana Ireland and Philippa Kemsley and Susan Kerr and Lewis, {Helen J.} and Julie Mytton and Karen Overend and Sarah Redsell and Zoe Richardson and Christine Shepherd and Lesley Smith and Lisa Dyson",
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Jackson, C, Bedford, H, Cheater, FM, Condon, L, Emslie, C, Ireland, L, Kemsley, P, Kerr, S, Lewis, HJ, Mytton, J, Overend, K, Redsell, S, Richardson, Z, Shepherd, C, Smith, L & Dyson, L 2017, 'Needles, Jabs and Jags: a qualitative exploration of barriers and facilitators to child and adult immunisation among Gypsies, Travellers and Roma', BMC Public Health, vol. 17, no. 254. https://doi.org/10.1186/s12889-017-4178-y

Needles, Jabs and Jags: a qualitative exploration of barriers and facilitators to child and adult immunisation among Gypsies, Travellers and Roma. / Jackson, Cath; Bedford, Helen; Cheater, Francine M.; Condon, Louise; Emslie, Carol; Ireland, Lana; Kemsley, Philippa ; Kerr, Susan; Lewis, Helen J.; Mytton, Julie ; Overend, Karen; Redsell, Sarah ; Richardson, Zoe ; Shepherd, Christine ; Smith, Lesley ; Dyson, Lisa .

In: BMC Public Health, Vol. 17, No. 254, 2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Needles, Jabs and Jags: a qualitative exploration of barriers and facilitators to child and adult immunisation among Gypsies, Travellers and Roma

AU - Jackson, Cath

AU - Bedford, Helen

AU - Cheater, Francine M.

AU - Condon, Louise

AU - Emslie, Carol

AU - Ireland, Lana

AU - Kemsley, Philippa

AU - Kerr, Susan

AU - Lewis, Helen J.

AU - Mytton, Julie

AU - Overend, Karen

AU - Redsell, Sarah

AU - Richardson, Zoe

AU - Shepherd, Christine

AU - Smith, Lesley

AU - Dyson, Lisa

N1 - Created as a conference paper (24702454) changed to article template - ET

PY - 2017

Y1 - 2017

N2 - BackgroundGypsies, Travellers and Roma (referred to as Travellers) are less likely to access health services including immunisation. To improve immunisation rates, it is necessary to understand what helps and hinders individuals in these communities in taking up immunisations. This study had two aims.1. Investigate the views of Travellers in the UK on the barriers and facilitators to acceptability and uptake of immunisations and explore their ideas for improving immunisation uptake; 2. Examine whether and how these responses vary across and within communities, and for different vaccines (childhood and adult). MethodsThis was a qualitative, cross-sectional interview study informed by the Social Ecological Model. Semi-structured interviews were conducted 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). The focus was childhood and selected adult vaccines. Data were analysed using the Framework approach.ResultsCommon accounts of barriers and facilitators were identified across all six Traveller communities, similar to those documented for the general population. All Roma communities experienced additional barriers of language and being in a new country. Men and women described similar barriers and facilitators although women spoke more of discrimination and low literacy. There was broad acceptance of childhood and adult immunisation across and within communities, 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 and described barriers to booking and attending immunisation. Cultural concerns about antenatal vaccines and HPV vaccination were most evident in the Bristol English Gypsy/Irish Traveller community. Language, literacy, discrimination, poor school attendance, poverty and housing were identified as barriers across different communities. Trustful relationships with health professionals were important and continuity of care valued.ConclusionsThe experience of many Travellers in this study, and the context through which they make health decisions, is changing. This large study identified key issues that should be considered when taking action to improve uptake of immunisations in Traveller families and reduce the persistent inequalities in coverage.

AB - BackgroundGypsies, Travellers and Roma (referred to as Travellers) are less likely to access health services including immunisation. To improve immunisation rates, it is necessary to understand what helps and hinders individuals in these communities in taking up immunisations. This study had two aims.1. Investigate the views of Travellers in the UK on the barriers and facilitators to acceptability and uptake of immunisations and explore their ideas for improving immunisation uptake; 2. Examine whether and how these responses vary across and within communities, and for different vaccines (childhood and adult). MethodsThis was a qualitative, cross-sectional interview study informed by the Social Ecological Model. Semi-structured interviews were conducted 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). The focus was childhood and selected adult vaccines. Data were analysed using the Framework approach.ResultsCommon accounts of barriers and facilitators were identified across all six Traveller communities, similar to those documented for the general population. All Roma communities experienced additional barriers of language and being in a new country. Men and women described similar barriers and facilitators although women spoke more of discrimination and low literacy. There was broad acceptance of childhood and adult immunisation across and within communities, 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 and described barriers to booking and attending immunisation. Cultural concerns about antenatal vaccines and HPV vaccination were most evident in the Bristol English Gypsy/Irish Traveller community. Language, literacy, discrimination, poor school attendance, poverty and housing were identified as barriers across different communities. Trustful relationships with health professionals were important and continuity of care valued.ConclusionsThe experience of many Travellers in this study, and the context through which they make health decisions, is changing. This large study identified key issues that should be considered when taking action to improve uptake of immunisations in Traveller families and reduce the persistent inequalities in coverage.

KW - immunisation

KW - vaccination

KW - Travellers

KW - Gypsies

KW - Roma

KW - showpeople

KW - Lay beliefs

KW - barriers

KW - facilitators

U2 - 10.1186/s12889-017-4178-y

DO - 10.1186/s12889-017-4178-y

M3 - Article

VL - 17

JO - BMC Public Health

JF - BMC Public Health

SN - 1471-2458

IS - 254

ER -