从英国 3 个城市的麻疹疫情中我们了解到了什么？罗马尼亚和罗姆罗马尼亚社区中影响疫苗接种率的因素的定性探讨。
What have we learnt from measles outbreaks in 3 English cities? A qualitative exploration of factors influencing vaccination uptake in Romanian and Roma Romanian communities.
机构信息
Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
Department of Immunisation, Hepatitis and Blood Safety, Public Health England, London, NW9 5EQ, UK.
出版信息
BMC Public Health. 2020 Mar 23;20(1):381. doi: 10.1186/s12889-020-8454-x.
BACKGROUND
Since 2016, large scale measles outbreaks have heavily affected countries across Europe. In England, laboratory confirmed measles cases increased almost four-fold between 2017 and 2018, from 259 to 966 cases. Several of the 2017-18 measles outbreaks in England particularly affected Romanian and Roma Romanian communities, with the first outbreaks in these communities occurring in Birmingham, Leeds and Liverpool. This study explored factors influencing vaccination behaviours amongst Romanian and Roma Romanian communities in these three cities.
METHODS
Across Birmingham, Leeds and Liverpool, we conducted semi-structured interviews with 33 key providers to explore their experience in delivering vaccinations and managing the outbreak response. We also interviewed 9 Romanian women in one of the cities to explore their vaccination attitudes and behaviours. To categorise factors affecting vaccination we applied the 5As Taxonomy for Determinants of Vaccine Uptake (Access, Affordability, Awareness, Acceptance and Activation) during data analysis.
RESULTS
Factors related to access and acceptance, such as language and literacy, ease of registering with a general practice, and trust in health services, were reported as the main barriers to vaccination amongst the communities. Concerns around vaccination safety and importance were reported but these appeared to be less dominant contributing factors to vaccination uptake. The active decline of vaccinations amongst interviewed community members was linked to distrust in healthcare services, which were partly rooted in negative experiences of healthcare in Romania and the UK.
CONCLUSION
Access and acceptance, dominant barriers to vaccination, can be improved through the building of trust with communities. To establish trust providers must find ways to connect with and develop a greater understanding of the communities they serve. To achieve this, cultural and linguistic barriers need to be addressed. Better provider-service user relationships are crucial to reducing vaccination inequalities and tackling broader disparities in health service access.
背景
自 2016 年以来，大规模麻疹疫情严重影响了欧洲各国。在英国，2017 年至 2018 年实验室确诊的麻疹病例增加了近四倍，从 259 例增至 966 例。英国 2017-18 年的几起麻疹疫情尤其影响了罗马尼亚和罗姆罗马尼亚社区，这些社区中的首例疫情出现在伯明翰、利兹和利物浦。本研究探讨了影响这三个城市罗马尼亚和罗姆罗马尼亚社区疫苗接种行为的因素。
方法
在伯明翰、利兹和利物浦，我们对 33 名主要提供者进行了半结构式访谈，以探讨他们在提供疫苗接种和管理疫情应对方面的经验。我们还在其中一个城市采访了 9 名罗马尼亚妇女，以探讨她们的疫苗接种态度和行为。为了对影响疫苗接种的因素进行分类，我们在数据分析过程中应用了疫苗接种接受度的 5A 分类法（可及性、可负担性、知晓度、接受度和激活度）。
结果
报告称，语言和识字能力、与普通科医生注册的便利性以及对卫生服务的信任等与可及性和接受度相关的因素是社区疫苗接种的主要障碍。报告了对疫苗接种安全性和重要性的担忧，但这些因素似乎不是影响疫苗接种率的主要因素。接受采访的社区成员主动拒绝接种疫苗与对医疗服务的不信任有关，这种不信任部分源于在罗马尼亚和英国的医疗保健经历不佳。
结论
可及性和接受度是疫苗接种的主要障碍，可以通过与社区建立信任来改善。为了建立信任，提供者必须找到与他们所服务的社区建立联系并加深理解的方法。要做到这一点，需要解决文化和语言障碍。改善提供者与服务使用者之间的关系对于减少疫苗接种不平等和解决更广泛的卫生服务获取差距至关重要。
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