title: Needles, Jabs and Jags: a qualitative exploration of barriers and facilitators to child and adult immunisation uptake among Gypsies, Travellers and Roma.
abstract: Gypsies, Travellers and Roma (referred to as Travellers) are less likely to access health services including immunisation. To improve immunisation rates, it is necessary to understand what helps and hinders individuals in these communities in taking up immunisations. This study had two aims. 1. Investigate the views of Travellers in the UK on the barriers and facilitators to acceptability and uptake of immunisations and explore their ideas for improving immunisation uptake; 2. Examine whether and how these responses vary across and within communities, and for different vaccines (childhood and adult).
  
  
  
  This was a qualitative, cross-sectional interview study informed by the Social Ecological Model. Semi-structured interviews were conducted with 174 Travellers from six communities: Romanian Roma, English Gypsy/Irish Travellers (Bristol), English Gypsy (York), Romanian/Slovakian Roma, Scottish Show people (Glasgow) and Irish Traveller (London). The focus was childhood and selected adult vaccines. Data were analysed using the Framework approach.
  
  
  
  Common accounts of barriers and facilitators were identified across all six Traveller communities, similar to those documented for the general population. All Roma communities experienced additional barriers of language and being in a new country. Men and women described similar barriers and facilitators although women spoke more of discrimination and low literacy. There was broad acceptance of childhood and adult immunisation across and within communities, 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 and described barriers to booking and attending immunisation. Cultural concerns about antenatal vaccines and HPV vaccination were most evident in the Bristol English Gypsy/Irish Traveller community. Language, literacy, discrimination, poor school attendance, poverty and housing were identified as barriers across different communities. Trustful relationships with health professionals were important and continuity of care valued.
  
  
  
  The experience of many Travellers in this study, and the context through which they make health decisions, is changing. This large study identified key issues that should be considered when taking action to improve uptake of immunisations in Traveller families and reduce the persistent inequalities in coverage.
  
  
  
  Current Controlled Trials ISRCTN20019630 .
authors.affiliation: Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK. cath@validresearch.co.uk.
authors.forename: Cath
authors.initials: C
authors.lastname: Jackson
authors.affiliation: UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Bedford
authors.affiliation: School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
authors.forename: Francine M
authors.initials: FM
authors.lastname: Cheater
authors.affiliation: College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, Wales, SA2 8PP, UK.
authors.forename: Louise
authors.initials: L
authors.lastname: Condon
authors.affiliation: Institute for Applied Health Research, School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK.
authors.forename: Carol
authors.initials: C
authors.lastname: Emslie
authors.affiliation: Institute for Applied Health Research, School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK.
authors.forename: Lana
authors.initials: L
authors.lastname: Ireland
authors.affiliation: UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
authors.forename: Philippa
authors.initials: P
authors.lastname: Kemsley
authors.affiliation: Institute for Applied Health Research, School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Kerr
authors.affiliation: Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK.
authors.forename: Helen J
authors.initials: HJ
authors.lastname: Lewis
authors.affiliation: University of the West of England, Centre for Child and Adolescent Health, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
authors.forename: Julie
authors.initials: J
authors.lastname: Mytton
authors.affiliation: Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Overend
authors.affiliation: Faculty of Health, Social Care and Education, Anglia Ruskin University, Young Street Site, East Road Campus, Cambridge, CB1 1PT, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Redsell
authors.affiliation: Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Richardson
authors.affiliation: York Travellers Trust, 20 Falsgrave Crescent, York, YO30 7AZ, UK.
authors.forename: Christine
authors.initials: C
authors.lastname: Shepherd
authors.affiliation: York Travellers Trust, 20 Falsgrave Crescent, York, YO30 7AZ, UK.
authors.forename: Lesley
authors.initials: L
authors.lastname: Smith
authors.affiliation: Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK.
authors.forename: Lisa
authors.initials: L
authors.lastname: Dyson
mesh_terms: D000328:Adult; D002648:Child; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants; D005006:Ethnicity; D005260:Female; D006296:Health Services; D006297:Health Services Accessibility; D006801:Humans; D007114:Immunization; D008297:Male; D010342:Patient Acceptance of Health Care; D036301:Qualitative Research; D012111:Residence Characteristics; D006178:Romani People; D012383:Romania / Q000208:ethnology; D018154:Slovakia / Q000208:ethnology; D012959:Socioeconomic Factors; D014171:Transients and Migrants; D014195:Travel; D006113:United Kingdom; D014611:Vaccination; D014612:Vaccines
chemical_list: D014612:Vaccines
keywords: Barriers; Facilitators; Gypsies; Immunisation; Immunization; Lay beliefs; Roma; Showpeople; Travellers; Vaccination