UNderstanding uptake of Immunisations in TravellIng aNd Gypsy communities (UNITING): a qualitative interview study.
Gypsies, Travellers and Roma (referred to as Travellers) are less likely to access health services, including immunisation. To improve immunisation rates, we need to understand what helps and hinders individuals in these communities in taking up immunisations.



(1) Investigate the barriers to and facilitators of acceptability and uptake of immunisations among six Traveller communities across four UK cities; and (2) identify possible interventions to increase uptake of immunisations in these Traveller communities that could be tested in a subsequent feasibility study.



Three-phase qualitative study underpinned by the social ecological model. Phase 1: interviews with 174 Travellers from six communities: Romanian Roma (Bristol); English Gypsy/Irish Traveller (Bristol); English Gypsy (York); Romanian/Slovakian Roma (Glasgow); Scottish Showpeople (Glasgow); and Irish Traveller (London). Focus on childhood and adult vaccines. Phase 2: interviews with 39 service providers. Data were analysed using the framework approach. Interventions were identified using a modified intervention mapping approach. Phase 3: 51 Travellers and 25 service providers attended workshops and produced a prioritised list of potentially acceptable and feasible interventions.



There were many common accounts of barriers and facilitators across communities, particularly across the English-speaking communities. Scottish Showpeople were the most similar to the general population. Roma communities experienced additional barriers of language and being in a new country. Men, women and service providers described similar barriers and facilitators. There was widespread acceptance of childhood and adult immunisation, with current parents perceived as more positive than their elders. A minority of English-speaking Travellers worried about multiple/combined childhood vaccines, adult flu and whooping cough. Cultural concerns about vaccines offered during pregnancy and about human papillomavirus were most evident in the Bristol English Gypsy/Irish Traveller community. Language, literacy, discrimination, poor school attendance, poverty and housing were identified by Travellers and service providers as barriers for some. Trustful relationships with health professionals were important and continuity of care was valued. A few English-speaking Travellers described problems of booking and attending for immunisation. Service providers tailored their approach to Travellers, particularly the Roma. Funding cuts, NHS reforms and poor monitoring challenged their work. Five 'top-priority' interventions were agreed across communities and service providers to improve the immunisation among Travellers who are housed or settled on an authorised site: (1) cultural competence training for health professionals and frontline staff; (2) identification of Travellers in health records to tailor support and monitor uptake; (3) provision of a named frontline person in general practitioner practices to provide respectful and supportive service; (4) flexible and diverse systems for booking appointments, recall and reminders; and (5) protected funding for health visitors specialising in Traveller health, including immunisation.



No Travellers living on the roadside or on unofficial encampments were interviewed. We should exert caution in generalising to these groups.



To include development, implementation and evaluation of a national policy plan (and practice guidance plan) to promote the uptake of immunisation among Traveller communities.



Current Controlled Trials ISRCTN20019630 and UK Clinical Research Network Portfolio number 15182.



This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 72. See the NIHR Journals Library website for further project information.
Visiting Senior Research Fellow, Department of Health Sciences, University of York, York, UK.
Cath
C
Jackson
Department of Health Sciences, University of York, York, UK.
Lisa
L
Dyson
Institute of Child Health, University College London, London, UK.
Helen
H
Bedford
School of Nursing Sciences, University of East Anglia, Norwich, UK.
Francine M
FM
Cheater
College of Human and Health Sciences, Swansea University, Swansea, UK.
Louise
L
Condon
Member of English Gypsy community in Bristol, UK.
Annie
A
Crocker
Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
Carol
C
Emslie
Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
Lana
L
Ireland
Institute of Child Health, University College London, London, UK.
Philippa
P
Kemsley
Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
Susan
S
Kerr
Department of Health Sciences, University of York, York, UK.
Helen J
HJ
Lewis
Centre for Child and Adolescent Health, University of the West of England, Bristol, UK.
Julie
J
Mytton
Department of Health Sciences, University of York, York, UK.
Karen
K
Overend
Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge, UK.
Sarah
S
Redsell
Department of Health Sciences, University of York, York, UK.
Zoe
Z
Richardson
York Travellers Trust, York, UK.
Christine
C
Shepherd
Member of English Roma community in York, UK.
Lesley
L
Smith
D000293:Adolescent; D000328:Adult; D000368:Aged; D054521:Cultural Competency; D003469:Culture; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000458:organization & administration*; D006798:Housing; D006801:Humans; D007407:Interviews as Topic; D007802:Language; D008297:Male; D008875:Middle Aged; D011287:Prejudice / Q000208:ethnology; D036301:Qualitative Research; D006178:Romani People / Q000523:psychology* / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013222:State Medicine / Q000458:organization & administration; D035502:Trust; D006113:United Kingdom; D014611:Vaccination / Q000523:psychology* / Q000706:statistics & numerical data*; D055815:Young Adult