Deal Anna, Salloum Maha, Hayward Sally E, Crawshaw Alison F, Knights Felicity, Carter Jessica, Al-Sharabi Isra, Yahia Reem, Fisher Stephanie, Morais Beatriz, Bouaddi Oumnia, Jones Lucy, Miller Anna, Mounier-Jack Sandra, Hargreaves Sally
The Migrant Health Research Group, City St George's, University of London, UK.
Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
SSM Qual Res Health. 2025 Jun;7:100515. doi: 10.1016/j.ssmqr.2024.100515.
Individuals living in initial asylum accommodation are at increased risk of vaccine-preventable disease, yet confidence in vaccination may be low in these settings. Our aim was to understand the influence of experiences within the UK asylum system on vaccine confidence and decision-making from a sociological perspective.
In-depth semi-structured interviews were carried out on views and experiences around vaccination (09/2020-08/2021) with individuals seeking asylum or having recently been granted asylum (<10 years in the UK). Interviews were audio-recorded, transcribed and analysed in NVivo 12 using a reflexive thematic analysis through an inductive approach.
25 participants were interviewed (mean age: 37 years, mean time in UK: 6 years, 72% female), of whom 13 were living in asylum accommodation at the time of interview. Analysis generated three main themes: 1) the detrimental impact of trauma and fear, both within the UK asylum system and prior, on perceptions of risk and vaccination decisions, 2) the effect of marginalisation, discrimination and neglect within the asylum system on an individual's trust and 3) the structural violence and restricted agency imposed on asylum seekers and its effect on ability and motivation to vaccinate. Past trauma or negative experiences since arriving in the UK, such as feeling forced to receive 'invasive' healthcare interventions in asylum accommodation may lead to distrust, increased perception of danger and avoidance of perceived 'risks' such as vaccination. Participants described how their struggle to cover basic necessities, social isolation and precarious living conditions imposed by the asylum system left them with more pressing priorities than vaccination. Participants who perceived that they had been cared for with empathy in the healthcare system or who described feeling empowered to make their own decision about vaccination often suggested they would be likely to accept vaccination if offered.
Asylum seekers and refugees have often experienced substantial trauma and precarity and have a lack of agency directly imposed on them by the asylum system. These factors are likely to impact trust and decision-making around vaccination, with some also representing systemic or structural barriers to accessing services. Formative experiences in the UK are key to establishing trust in healthcare settings; a trauma-informed approach should be central in developing vaccination interventions for these groups, particularly in asylum accommodation.
居住在初始庇护住所的个人感染疫苗可预防疾病的风险增加，但在这些环境中对疫苗接种的信心可能较低。我们的目的是从社会学角度了解英国庇护系统内的经历对疫苗信心和决策的影响。
对寻求庇护或最近获得庇护（在英国居住<10年）的个人就疫苗接种的观点和经历进行了深入的半结构化访谈（2020年9月至2021年8月）。访谈进行了录音、转录，并在NVivo 12中使用反思性主题分析通过归纳法进行分析。
共访谈了25名参与者（平均年龄：37岁，在英国的平均时间：6年，72%为女性），其中13人在访谈时居住在庇护住所。分析产生了三个主要主题：1）英国庇护系统内外的创伤和恐惧对风险认知和疫苗接种决策的不利影响，2）庇护系统内的边缘化、歧视和忽视对个人信任的影响，3）施加于寻求庇护者的结构性暴力和受限的能动性及其对疫苗接种能力和动机的影响。抵达英国后的过往创伤或负面经历，如在庇护住所中感到被迫接受“侵入性”医疗干预，可能导致不信任、对危险的认知增加以及对疫苗接种等感知“风险”的回避。参与者描述了他们在满足基本生活需求方面的挣扎、庇护系统造成的社会隔离和不稳定的生活条件，使他们有比疫苗接种更紧迫的优先事项。那些认为在医疗系统中得到了共情关怀或描述自己有能力就疫苗接种做出决定的参与者通常表示，如果提供疫苗接种，他们很可能会接受。
寻求庇护者和难民经常经历大量创伤和不稳定状况，并且直接受到庇护系统施加的能动性缺失的影响。这些因素可能会影响围绕疫苗接种的信任和决策，其中一些因素也代表了获得服务的系统性或结构性障碍。在英国的形成性经历是在医疗环境中建立信任的关键；以创伤知情为导向的方法应成为为这些群体制定疫苗接种干预措施的核心，特别是在庇护住所。
