title: Measuring vaccination coverage in a hard to reach minority.
abstract: BACKGROUND
  Although childhood vaccination programmes have been very successful, there are some hard to reach minority groups that object to vaccination. The Netherlands has experienced several epidemics of vaccine-preventable diseases, confined to the orthodox Protestant minority. However, vaccination coverage in this minority is still unknown and this hampers prevention and control of epidemics.
  
  
  METHODS
  We estimated vaccination coverage among the orthodox Protestant minority and its various subgroups (denominations), using two sub-studies with different design and study population. For both sub-studies separately, we determined overall vaccination coverage and vaccination coverage per denomination. The results were compared and discussed.
  
  
  RESULTS
  An online survey was filled out by 1778 orthodox Protestant youngsters, invited via orthodox Protestant media using a snowball method. Next to that, results of a national sample study on vaccination were used, of which only orthodox Protestant respondents were included in our analyses (N  =  2129). Overall vaccination coverage among orthodox Protestants in The Netherlands was estimated to be at minimum 60%. Moreover, in both sub-studies three clusters of denominations could be identified, with high (>85%), intermediate (50-75%) and low (<25%) vaccination coverage.
  
  
  CONCLUSIONS
  The integration of both sub-studies, with their own specific strengths and weaknesses, added to our insight in the vaccination coverage in this minority. Based on these results, we recommend to focus prevention and control of vaccine-preventable diseases on the orthodox Protestant subgroups with intermediate and low vaccination coverage.
authors.affiliation: Radboud University Nijmegen Medical Centre, Department of Primary and Community Care, Nijmegen, The Netherlands. h.ruijs@elg.umcn.nl
authors.forename: Wilhelmina L M
authors.initials: WL
authors.lastname: Ruijs
authors.forename: Jeannine L A
authors.initials: JL
authors.lastname: Hautvast
authors.forename: Wilke J C
authors.initials: WJ
authors.lastname: van Ansem
authors.forename: Reinier P
authors.initials: RP
authors.lastname: Akkermans
authors.forename: Kees
authors.initials: K
authors.lastname: van't Spijker
authors.forename: Marlies E J L
authors.initials: ME
authors.lastname: Hulscher
authors.forename: Koos
authors.initials: K
authors.lastname: van der Velden
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data*; D009426:Netherlands; D033303:Protestantism; D012959:Socioeconomic Factors; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult