Working together to identify what works: joint decision-making with underserved communities to select interventions for vaccine uptake

RIVER-EU research
Tamara Schloemer
Tamara Schloemer

Public Health, Task lead for Development and/or adjustment of tailored interventions (WP3), Lead Researcher, University of Maastricht

Across Europe, many ethnic, religious, and cultural minorities experience lower-than-average vaccine coverage, often due to barriers faced when accessing health services1. This inequitably increases their risk of vaccine preventable diseases.

RIVER-EU research illustrates that these health system barriers include: lack of culturally- and linguistically-appropriate information, insufficient capacities of health care professionals (e.g., patient  communication), health service delivery issues (e.g., limited hours, poor geographic coverage), and out-of-pocket or other indirect payments made by patients.

In the European Union, every child has a fundamental right to access health services2. Equitable health systems should respond to the needs of all children, no matter their living or economic conditions. RIVER-EU is implementing tailor-made interventions to reduce health system barriers for HPV and/or MMR vaccination within the following communities:

  • the recently arrived migrant community in Greece
  • the Ukrainian community in Poland
  • the Turkish and Moroccan communities in the Netherlands and
  • the marginalized Roma communities in Slovakia.

RIVER-EU’s participatory transferability analysis

As part of RIVER-EU’s research, we have developed a methodological approach to identify effective interventions and collaborate with stakeholders to assess their transferability. Inclusive approaches are essential to select and adequately adapt promising interventions to support vaccine uptake in any community, including underserved communities.

RIVER-EU’s participatory transferability analysis3 is a collaborative approach to tailoring interventions which combines the participatory action research (PAR) approach with the theory of transferability4. Participatory transferability analysis includes an in-depth analysis of the transferability of a promising intervention, i.e., whether and how that intervention might yield the desired results in the new context under consideration of community needs and contextual conditions. It is done in collaboration with members of the community, also taking into account the influence of healthcare professionals, policymakers, educators, NGOs, and other stakeholders.

Working together shaped our project

The participatory transferability analysis was based on the in-depth study of health system barriers perceived by each underserved community5, and a realist review of vaccination interventions that were effective in addressing the same health system barriers in other contexts6. Building on previous work in RIVER-EU, we established knowledge exchange partnerships between various stakeholders and consortium partners in each country (Greece, the Netherlands, Slovakia and Poland), and transferability researchers involved in RIVER-EU. These partnerships were key to understand problems and find solutions in each context, because they enabled collaborative knowledge generation.

Such a co-creation of knowledge, involving people with diverse competencies, experiences, perspectives, and ideas, required a highly adaptive and developmental research process7. This process also had to enable group decision-making using complex models to analyse transferability of interventions. This was executed through workshops and meetings with researchers in each country, as well as interviews and focus group discussions with stakeholders in each context, allowing transferability researchers to oversee and guide the participatory process.

Furthermore, transferability researchers undertook a structured data analysis to provide outcomes and specific recommendations, discussing them with the country researchers. Country researchers, acting as mediators between the underserved communities and transferability researchers were key experts in their respective contexts, ensuring that decisions on intervention selection and tailoring were made collaboratively on a scientifically sound and sustainable basis, with community needs at the centre.

Trust is key

What we have learned from the partnerships is that building trust through relationships with community members is essential for enabling the free expression of thoughts and opinions. Trust plays a crucial role in identifying and adapting suitable vaccination interventions, as illustrated by the analysis of interviews and focus groups discussions with community members. Sensitivity is paramount when addressing the health system barriers regarding vaccination. It is important to acknowledge and respect families’ experiences of inequity and their rights to healthcare access.

When it comes to vaccination, community trust must be built through targeted information, respectful and responsible (healthcare) professionals, appropriate structures and processes within the health system, and a trustworthy government. Involving relevant stakeholders in decisions about interventions and giving them a key role in shaping content from the beginning helps to identify, design, and implement interventions that best meet the needs of each underserved community. This inclusive approach ensures that the interventions are trustworthy and effectively address the specific barriers and concerns of the community.

References
  1. Siciliani L, Wild C, McKee M, Kringos D, Barry MM, Barros PP, et al. Strengthening vaccination programmes and health systems in the European Union: A framework for action. Health Policy. 2020;124(5):511-8. ↩︎
  2. Palm, W. Children’s universal right to health care in the EU: Compliance with the UNCRC. Eurohealth. 2017;23(4):3-6. ↩︎
  3. Schloemer T, Hecht H, Horstman K. Participatory transferability analysis of vaccination interventions with underserved communities, European Journal of Public Health, Volume 33, Issue Supplement_2, October 2023, ckad160.485, https://doi.org/10.1093/eurpub/ckad160.485 ↩︎
  4. Schloemer T, Schröder-Bäck P. Criteria for evaluating transferability of health interventions: a systematic review and thematic synthesis. Implement Sci. 2018 Jun 26;13(1):88. doi: 10.1186/s13012-018-0751-8. ↩︎
  5. Ganczak M. Health system barriers to vaccination in underserved communities: a tale of four countries, European Journal of Public Health, Volume 32, Issue Supplement_3, October 2022, ckac129.183, https://doi.org/10.1093/eurpub/ckac129.183 ↩︎
  6. Essa-Hadad J, Gorelik Y, Edelstein M, Improving childhood vaccination in minorities: a realist review of health system interventions, European Journal of Public Health, Volume 32, Issue Supplement_3, October 2022, ckac131.395, https://doi.org/10.1093/eurpub/ckac131.395 ↩︎
  7. Greenhalgh T, Jackson C, Shaw S, Janamian T. Achieving Research Impact Through Co-creation in Community-Based Health Services: Literature Review and Case Study. Milbank Q. 2016 Jun;94(2):392-429. doi: 10.1111/1468-0009.12197. ↩︎

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