Parental Beliefs, Logistical Challenges, and Improvement Opportunities for Vaccination Among Children Ages 19 to 35 Months Experiencing Homelessness.

Abstract

OBJECTIVES\nTo examine parental beliefs and logistical challenges to early childhood vaccination completion as well as opportunities to support improved vaccine uptake among families experiencing homelessness.\n\n\nSTUDY DESIGN\nA cross-sectional survey was conducted between February 2018 and October 2019 with parents of children ages 19-35 months old experiencing homelessness. Participants were recruited from 10 locations that serve families experiencing homelessness in Washington, DC, and by referral from other participants. Vaccination records were obtained from healthcare providers to determine the child s up-to-date (UTD) status with a combined 7-vaccine series.\n\n\nRESULTS\nOf 135 children of participants, only 69 (51.1%) were UTD. Most participants had at least one concern about childhood vaccines and at least one logistical barrier to completing vaccination (57% and 85.9% respectively). The most frequent barriers were getting a convenient appointment time (46.3%), remembering appointments (44.8%), and commuting to appointments (44.4%). Although only 53.3% of the participants children attended a licensed daycare center and only 43.7% received benefits from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), use of either of these programs that routinely assess vaccination status was associated with over 3 times higher adjusted odds of being UTD (aOR=3.4, 95% CI=1.6 to 7.3, and aOR=3.1, 95% CI=1.4 to 6.5, respectively).\n\n\nCONCLUSIONS\nLogistical barriers to accessing primary care services are common among children experiencing homelessness, underscoring the importance of healthcare providers offering vaccines at every opportunity. Government-regulated programs are useful for promoting vaccination, and enrollment should be encouraged because many children experiencing homelessness may not access them.