Annie Crocker

UNderstanding uptake of Immunisations in TravellIng aNd Gypsy communities (UNITING): protocol for an exploratory, qualitative study

Introduction Gypsies, Travellers and Roma (referred to here as Travellers) experience significantly poorer health and have shorter life expectancy than the general population. They are also 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 has two aims: (1) Investigate the barriers and facilitators to acceptability and uptake of immunisations among six Traveller communities in the UK; (2) Identify potential interventions to increase uptake in these Traveller communities. Methods and analysis A three-phase qualitative study with six Traveller communities. PHASE 1: In each community, we will explore up to 45 Travellers’ views about the influences on their immunisation behaviours and ideas for improving uptake in their community. PHASE 2: In each community, we will investigate 6–8 service providers’ perspectives on barriers and facilitators to childhood and adult immunisations for Traveller communities with whom they work, and ideas to improve uptake. Interview data will be analysed using the Framework approach. PHASE 3: The findings will be discussed and interventions prioritised in six workshops, each with 10–12 phase 1 and 3–4 phase 2 participants. Ethics and dissemination This research received approval from NRES Committee Yorkshire and The Humber-Leeds East (Ref. 13/YH/02). It will produce (1) findings on the barriers and facilitators to uptake of immunisations in six Traveller communities; (2) a prioritised list of potentially feasible and acceptable interventions for increasing uptake in these communities; and (3) methodological development in undertaking research with diverse Traveller communities. The study has the potential to inform new ways of delivering services to ensure high immunisation uptake. Findings will be disseminated to participants, relevant UK organisations with responsibility for the implementation of immunisation policy and Traveller health/welfare; and submitted for publication in academic journals. Trial registration number ISRCTN20019630.

G325(P) Understanding uptake of immunisations in travelling and gypsy communities

Aims To investigate the barriers and facilitators to acceptability and uptake of immunisation among Gypsy/Traveller communities in the UK. Methods We interviewed 174 Gypsy/Travellers from five communities: Romanian/Slovakian Roma, English Gypsy, Irish Travellers, English Roma, Scottish Showpeople, in four UK cities: Interviews gathered views about the influences on their immunisation behaviours (childhood, adult flu and pertussis vaccines) and ideas for improving uptake in their community. Interview data were analysed using the framework approach. The Social Ecological Model provided the theoretical framework. Results General acceptance of immunisation based on social norms and trust in health professionals was expressed by approximately half of the participants from the English Roma and London Irish Traveller communities in two cities; three quarters of the English Gypsy/Irish Traveller community and Scottish Showpeople; and almost all of the Romanian/Slovakian Roma participants. Concerns about specific vaccines were evident for particular communities e.g. pertussis vaccine in pregnancy for the English/Irish Traveller community in one city, MMR for the Scottish Showpeople. A belief that having the HPV vaccination would imply that Traveller girls are promiscuous was evident for a minority of Travellers in four communities (not Scottish Showpeople). Romanian/Slovakian Roma communities identified language barriers to accessing immunisation services and low literacy across all communities resulted in people being unable to read immunisation leaflets or letters/texts about appointments and struggling to make sense of conversations with health professionals. Relationships with health professionals appeared to be very important. Recall and reminder systems (letters, texts, phone calls) were seen as effective for the majority of participants including those who regularly travel. Most did not appear to have problems with attending appointments for immunisations although some talked about the difficulty of registering with a GP practice without a fixed address and being unable to get an appointment within two weeks. Conclusion Although these Travellers’ accounts of the barriers and facilitators to immunisation have consistency with the wider population, there are some important differences between communities. Immunisation services need to be aware of Gypsy/Traveller communities in their area and tailor services accordingly.