University of Newcastle, School of Medicine and Public Health, Newcastle, NSW, Australia.
Hunter New England Local Health District, Population Health, Wallsend, NSW, Australia.
Vaccine. 2018 May 3;36(19):2596-2603. doi: 10.1016/j.vaccine.2018.03.072. Epub 2018 Apr 6.
In 2014 the Australian immunisation target was raised from 90% to 95% of children to be fully immunised. A national priority is to identify geographic areas of low coverage and implement strategies to improve immunisation rates. Using The World Health Organization's Tailoring Immunization Programmes (TIP) Guidelines, the aim of this study was to identify areas of low immunisation coverage for children in the Hunter New England Local Health District, New South Wales, and to gain a deeper understanding of the factors influencing immunisation in those areas in order to develop tailored strategies for increasing immunisation coverage. Data from the Australian Immunisation Register was used to identify geographic areas of low coverage. Data from interviews and focus groups with parents and service providers were used to gain a deeper understanding of the factors influencing immunisation in those areas. The regional city of Maitland in New South Wales was identified as having a persistently high number and relatively high proportion of children not fully immunised (n = 427, 15.4% in 2016). Themes from 59 stakeholder interviews and focus groups included; (i) limited engagement with health services unless the need is urgent, (ii) multi-dimensional access barriers to immunisation services in Maitland, (iii) a flexible, supportive family centred, primary health care approach, utilising strong partnerships, is most likely to be effective in increasing childhood immunisation rates in Maitland, (iv) data can be used more effectively to inform service providers about trends and individual children not fully immunised. TIP guidelines proved useful for identifying areas of low coverage and providing an understanding of determining factors and the strategies most likely to be effective. Understanding the complex problems many parents face and the access barriers that contribute to low immunisation coverage is essential in developing appropriate solutions. Finding ways to support parents and remove those barriers can contribute to higher coverage. In Maitland, targeted outreach and home visiting has been implemented in consultation with community and health service representatives to ensure that the children from socially disadvantaged populations identified do not miss out on vaccination.
2014 年，澳大利亚将儿童完全免疫接种率的目标从 90%提高到 95%。一个国家的重点是确定覆盖范围低的地理区域，并实施提高免疫接种率的战略。本研究使用世界卫生组织的定制免疫规划（TIP）指南，旨在确定新南威尔士州亨特新英格兰地方卫生区儿童免疫接种率低的地区，并更深入地了解影响这些地区免疫接种的因素，以便制定有针对性的战略来提高免疫接种率。利用澳大利亚免疫登记处的数据来确定覆盖范围低的地理区域。利用与家长和服务提供者进行的访谈和焦点小组的数据，深入了解影响这些地区免疫接种的因素。新南威尔士州的梅特兰地区被确定为持续存在大量和相对较高比例的未完全免疫接种的儿童（2016 年有 427 名儿童，占 15.4%）。59 名利益相关者访谈和焦点小组的主题包括：（i）除非有紧急需要，否则与卫生服务的接触有限，（ii）梅特兰免疫服务存在多维度的获取障碍，（iii）灵活、支持性的以家庭为中心、以初级保健为基础的方法，利用强大的伙伴关系，最有可能有效地提高梅特兰儿童的免疫接种率，（iv）数据可以更有效地用于向服务提供者通报趋势和未完全免疫接种的个别儿童的情况。TIP 指南被证明对确定覆盖范围低的地区和了解确定因素以及最有可能有效的战略有用。了解许多家长面临的复杂问题以及导致免疫接种率低的获取障碍对于制定适当的解决方案至关重要。找到支持家长和消除这些障碍的方法可以有助于提高覆盖率。在梅特兰，与社区和卫生服务代表协商后，已经实施了有针对性的外展和家访，以确保确定的社会弱势群体中的儿童不会错过接种疫苗的机会。
