Department of Population Health, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
Department of Health Sciences-Global Health Unit, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Eur J Public Health. 2024 Apr 3;34(2):368-374. doi: 10.1093/eurpub/ckad232.
Child vaccinations are among the most effective public health interventions. However, wide gaps in child vaccination remain among different groups with uptake in most minorities or ethnic communities in Europe substantially lower compared to the general population. A systematic review was conducted to understand health system barriers and enablers to measles, mumps and rubella (MMR) and human papilloma virus (HPV) child vaccination among disadvantaged, minority populations in middle- and high-income countries.
We searched Medline, Cochrane, CINAHL, ProQuest and EMBASE for articles published from 2010 to 2021. Following title and abstract screening, full texts were assessed for relevance. Study quality was appraised using Critical Appraisal Skills Program checklists. Data extraction and analysis were performed. Health system barriers and enablers to vaccination were mapped to the World Health Organization health system building blocks.
A total of 1658 search results were identified from five databases and 24 from reference lists. After removing duplicates, 1556 titles were screened and 496 were eligible. Eighty-six full texts were assessed for eligibility, 28 articles met all inclusion criteria. Factors that affected MMR and HPV vaccination among disadvantaged populations included service delivery (limited time, geographic distance, lack of culturally appropriate translated materials, difficulties navigating healthcare system), healthcare workforce (language and poor communication skills), financial costs and feelings of discrimination.
Policymakers must consider health system barriers to vaccination faced by disadvantaged, minority populations while recognizing specific cultural contexts of each population. To ensure maximum policy impact, approaches to encourage vaccinations should be tailored to the unique population's needs. A one-size-fits-all approach is not effective.
儿童疫苗接种是最有效的公共卫生干预措施之一。然而，不同群体之间的儿童疫苗接种率仍存在很大差距，欧洲大多数少数民族或族裔社区的疫苗接种率明显低于总人口。本系统评价旨在了解中高收入国家中处境不利的少数群体儿童接种麻疹、腮腺炎和风疹（MMR）和人乳头瘤病毒（HPV）疫苗的卫生系统障碍和促进因素。
我们检索了 Medline、Cochrane、CINAHL、ProQuest 和 EMBASE 数据库，以获取 2010 年至 2021 年发表的文章。经过标题和摘要筛选后，评估全文相关性。使用批判性评估技能计划清单评估研究质量。进行数据提取和分析。将疫苗接种的卫生系统障碍和促进因素映射到世界卫生组织卫生系统构建模块。
从五个数据库中总共确定了 1658 个搜索结果，并从参考文献列表中确定了 24 个。去除重复项后，筛选了 1556 个标题，其中 496 个符合条件。评估了 86 篇全文的合格性，28 篇文章符合所有纳入标准。影响弱势人群 MMR 和 HPV 疫苗接种的因素包括服务提供（时间有限、地理距离、缺乏文化上适当的翻译材料、难以在医疗保健系统中导航）、医疗保健劳动力（语言和沟通技巧差）、财务成本和歧视感。
政策制定者在认识到每个群体特定的文化背景的同时，必须考虑弱势少数群体面临的疫苗接种卫生系统障碍。为了确保政策产生最大影响，鼓励接种疫苗的方法应针对特定人群的需求进行调整。一刀切的方法是无效的。
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