Development of a culturally and linguistically sensitive virtual reality educational platform to improve vaccine acceptance within a refugee population: the SHIFA community engagement-public health innovation programme

Streuli, Samantha; Ibrahim, Najla; Mohamed, Alia Ibrahim; Sharma, Manupriya; Esmailian, Markie; Sezan, Ibrahim; Farrell, Carrie; Sawyer, Mark H.; Meyer, Dan M.; El-Maleh, Khaled; Thamman, Ritu; Marchetti, Alex; Lincoln, Alan J.; Courchesne, Eric; Sahid, Ahmed; Bhavnani, Sanjeev P.

doi:10.1136/bmjopen-2021-051184

Cited by 14 publications

(5 citation statements)

References 21 publications

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“…Previous literature highlights gaps in understanding around how to develop tailored and targeted health interventions involving migrants, beyond engaging with community‐based organisations and using culturally appropriate messaging 49 . There are also limited examples of participatory, co‐designed vaccination interventions involving migrant populations 50–55 . Our study addresses this gap and offers a valuable example of a community‐engaged approach to co‐designing a vaccination intervention for an underserved migrant community.…”

Section: Discussionmentioning

confidence: 93%

“… 49 There are also limited examples of participatory, co‐designed vaccination interventions involving migrant populations. 50 , 51 , 52 , 53 , 54 , 55 Our study addresses this gap and offers a valuable example of a community‐engaged approach to co‐designing a vaccination intervention for an underserved migrant community. Our study builds on previous work which used WHO TIP methodology to develop a tailored intervention to increase vaccine acceptance in a Somali community, 56 by showing how behavioural theory can be employed in a participatory study design.…”

Section: Discussionmentioning

confidence: 99%

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Co‐designing a theory‐informed, multicomponent intervention to increase vaccine uptake with Congolese migrants: A qualitative, community‐based participatory research study (LISOLO MALAMU)

Crawshaw,

Kitoko,

Nkembi

et al. 2023

Health Expectations

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IntroductionDisparities in the uptake of routine and COVID‐19 vaccinations have been observed in migrant populations, and attributed to issues of mistrust, access and low vaccine confidence. Participatory research approaches and behaviour change theory hold the potential for developing tailored vaccination interventions that address these complex barriers in partnership with communities and should be explored further.MethodsThis study used a theory‐informed, community‐based participatory research approach to co‐design a culturally tailored behaviour change intervention aimed at increasing COVID‐19 vaccine uptake among Congolese migrants in London, United Kingdom (2021–2022). It was designed and led by a community‐academic partnership in response to unmet needs in the Congolese community as the COVID‐19 pandemic started. Barriers and facilitators to COVID‐19 vaccination, information and communication preferences, and intervention suggestions were explored through qualitative in‐depth interviews with Congolese migrants, thematically analysed, and mapped to the theoretical domains framework (TDF) and the capability, opportunity, motivation, behaviour model to identify target behaviours and strategies to include in interventions. Interventions were co‐designed and tailored in workshops involving Congolese migrants.ResultsThirty‐two Congolese adult migrants (24 (75%) women, mean 14.3 (SD: 7.5) years in the United Kingdom, mean age 52.6 (SD: 11.0) years) took part in in‐depth interviews and 16 (same sample) took part in co‐design workshops. Fourteen barriers and 10 facilitators to COVID‐19 vaccination were identified; most barrier data related to four TDF domains (beliefs about consequences; emotion; social influences and environmental context and resources), and the behavioural diagnosis concluded interventions should target improving psychological capability, reflective and automatic motivations and social opportunities. Strategies included culturally tailored behaviour change techniques based on education, persuasion, modelling, enablement and environmental restructuring, which resulted in a co‐designed intervention comprising community‐led workshops, plays and posters. Findings and interventions were disseminated through a community celebration event.ConclusionsOur study demonstrates how behavioural theory can be applied to co‐designing tailored interventions with underserved migrant communities through a participatory research paradigm to address a range of health issues and inequalities. Future research should build on this empowering approach, with the goal of developing more sensitive vaccination services and interventions which respond to migrant communities' unique cultural needs and realities.Patient or Public ContributionPatient and public involvement (PPI) were embedded in the participatory study design and approach, with community members co‐producing all stages of the study and co‐authoring this paper. An independent PPI board (St George's Migrant Health Research Group Patient and Public Involvement Advisory Board) comprising five adult migrants with lived experience of accessing healthcare in the United Kingdom were also consulted at significant points over the course of the study.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Co‐designing a theory‐informed, multicomponent intervention to increase vaccine uptake with Congolese migrants: A qualitative, community‐based participatory research study (LISOLO MALAMU)

Crawshaw,

Kitoko,

Nkembi

et al. 2023

Health Expectations

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“…The project targeted Somali refugees. The community was involved through a series of discussions, interviews with Somali parents, workshops and the use of virtual reality techniques in teaching [ 64 ].…”

Section: Resultsmentioning

confidence: 99%

Challenges in the Medical and Psychosocial Care of the Paediatric Refugee—A Systematic Review

Klas

Grzywacz

Kulszo

et al. 2022

IJERPH

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Background: After the invasion of Ukraine, neighbouring countries were forced to find systemic solutions to provide medical care to those fleeing the war, including children, as soon as possible. In order to do this, it is necessary to know the communication problems with refugee minors and find proposals for their solutions. Methods: A systematic review of the literature from 2016 to 2022 was conducted according to PRISMA criteria. Results: Linguistic diversity and lack of professional readiness of teachers are the main constraints hindering the assistance of refugee children in schools. Problems during hospitalization include lack of continuity of medical care and lack of retained medical records. Solutions include the use of the 3C model (Communication, Continuity of care, Confidence) and the concept of a group psychological support program. Conclusions: In order to provide effective assistance to refugee minors, it is necessary to create a multidisciplinary system of care. It is hoped that the lessons learned from previous experiences will provide a resource to help refugee host countries prepare for a situation in which they are forced to provide emergency assistance to children fleeing war.

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“…London-based polio booster campaign, multiple innovations were seen in the delivery of vaccinations to marginalised groups, including offering incentives and flexible arrangements and infrastructure (e.g. out-of-hours clinics and alternative settings for vaccination (36)(37)(38)(39)(40). How these approaches could be used for delivering routine immunisations to migrants must be considered (41), ensuring the involvement and support of these communities in research and policy decisions.…”

Section: Discussionmentioning

confidence: 99%

Driving uptake of missed routine vaccines in adolescent and adult migrants: a prospective observational mixed-methods pilot study of catch-up vaccination in UK general practice

Crawshaw,

Goldsmith,

Deal

et al. 2023

Preprint

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Background Migrants in Europe may be vulnerable to vaccine preventable diseases (VPDs) because of missed routine vaccines in childhood in their country of origin and marginalisation from health and vaccine systems. To align with European schedules, migrants should be offered catch–up vaccinations, considering MMR, Td–IPV, and age–appropriate MenACWY and HPV. However, awareness and implementation of catch-up guidelines by primary care staff in the UK is considered to be poor, and there is a lack of research on effective approaches to strengthen the primary care pathway. Methods We conducted a prospective observational mixed methods pilot study ′Vacc on Track′ (May 2021-September 2022) to better understand and define new care pathways to increase catch –up vaccination for adolescent and adult migrants presenting to primary care (≥16 years, born outside Western Europe, North America, Australia, or New Zealand) in two London boroughs. We designed a standardised data collection tool to assess rates of under–vaccination in migrant populations and previous VPDs, which then prompted a referral to practice nurses to deliver catch–up vaccination for those with uncertain or incomplete immunisation status, following UK guidelines. We explored views of practice staff on delivering catch–up vaccination to migrant populations through focus group discussions and engaged migrants in in–depth interviews around approaches to catch–up vaccination. Data were analysed in STATA12 and Microsoft Excel. Results We recruited 57 migrant participants (mean age 41 [SD 7.2] years; 62% female; mean 11.3 [SD 9.1] years in UK) from 18 countries, with minimum 6 months follow–up. We did 3 focus groups with 30 practice staff and 39 qualitative in–depth interviews with migrants. Nearly all migrant participants required catch–up vaccination for MMR (86%) and Td/IPV (88%) and most reported not having been previously engaged in UK primary care around catch–up vaccination. 12 (55%) of 22 participants in Site 1 reported a past VPD, including measles and rubella. 53 (93%) of participants were referred for catch–up vaccination. However, although 43 (81%) had at least one dose (at follow–up) of a required vaccine, only 6 (12%) referred for Td–IPV and 33 (64%) of those referred for MMR had completed their required course and vaccination pathway at follow–up, suggesting there were a range of personal and environmental obstacles to migrants accessing vaccinations and all multiple doses of vaccines that need to be better considered. Staff identified seven barriers to delivering catch–up vaccines to migrants, including limited time for appointments and follow–up, language and literacy barriers when taking histories and to encourage vaccination, lack of staff knowledge of current guidelines, inadequate engagement routes, and the absence of primary care targets or incentives. Conclusions Our findings suggest adolescent and adult migrants are an under–vaccinated group and would benefit from being offered catch–up vaccination on arrival to the UK. Primary care is an important setting to deliver catch–up vaccination, but effective pathways are currently lacking, and improving vaccine coverage for key routine vaccines across a broader range of migrant groups will require designated staff champions, training, awareness–raising and financial incentives. Novel ways to deliver vaccinations in community settings should be explored, along with co–designing community-based interventions to raise awareness among these populations of the benefits of lifecourse immunisation.

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Development of a culturally and linguistically sensitive virtual reality educational platform to improve vaccine acceptance within a refugee population: the SHIFA community engagement-public health innovation programme

Cited by 14 publications

References 21 publications

Co‐designing a theory‐informed, multicomponent intervention to increase vaccine uptake with Congolese migrants: A qualitative, community‐based participatory research study (LISOLO MALAMU)

Co‐designing a theory‐informed, multicomponent intervention to increase vaccine uptake with Congolese migrants: A qualitative, community‐based participatory research study (LISOLO MALAMU)

Challenges in the Medical and Psychosocial Care of the Paediatric Refugee—A Systematic Review

Driving uptake of missed routine vaccines in adolescent and adult migrants: a prospective observational mixed-methods pilot study of catch-up vaccination in UK general practice

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