gms | German Medical Science

Background: Vaccination is a cost-effective tool of public health if it is accessible to all population groups. Migrants and ethnic minority populations face multiple health system barriers to vaccination [1], such as lack of culturally sensitive information in their native language, lack of awareness raising initiatives about vaccine preventable diseases or insufficient coordination of health services. The EU project ‘Reducing Inequalities in Vaccine uptake in the European region - Engaging Underserved communities’ (RIVER-EU) aims to improve access to childhood vaccination in the migrant community in Greece, the Turkish and Moroccan communities in the Netherlands, the Ukrainian minority in Poland, and marginalized Roma communities in Slovakia. Our aim was to identify and tailor potentially transferable evidence-based interventions for HPV and MMR vaccine uptake in partnership with underserved communities.

Methods: We used a participatory action research approach to build a bridge between research evidence on 36 vaccination interventions from a realist review [2] and contextual needs of underserved communities, while being open to and stimulating upcoming ideas. This transferability analysis of interventions by naturalistic inquiry was an emergent and collaborative longitudinal process to enable knowledge co-creation of academic, community and professional stakeholders, including 25 workshops and 39 interviews or focus groups for decision-making. First, we pre-selected interventions through a structured assessment of needs-based intervention usefulness with representative local advisory boards [3]. Second, we assessed transferability of these interventions in depth under consideration of the (P)opulation, (I)ntervention, (E)nvironment and (T)ransfer (PIET-T models) [4]. We used a framework analysis for data analysis under consideration of transferability criteria [5]. Results were validated for decision-making through follow-up focus groups with stakeholders and workshops with researchers in each country.

Results: Six interventions were pre-selected and analyzed for their transferability. Two interventions incorporating trained community members to support vaccination as trusted health promoters were discussed in all countries. A health promoter approach with elements of education, navigation and access to vaccines was deemed potentially transferable with adaptations in all countries to address identified health system barriers, while trust in the educator was a key issue. Adaptation refers to intervention tailoring to specific contextual needs. School-based vaccination was assessed in Greece and the Netherlands, but was not seen as transferable. Two approaches to health provider training in the Netherlands were investigated, only a culturally sensitive approach is deemed appropriate. A multilevel intervention with educational videos assessed in Slovakia is not fully transferable.

Discussion: For evidence-based public health it is essential to assess transferability of interventions from a community perspective under systematic consideration of contextual conditions. In addition to a consideration of the quality of research, it is important to understand how interventions work in the primary intervention context and how they might work in the target context. This leads to a reflection on what is considered as best evidence for improving a specific situation in a unique context to foster sustainable system change. Participatory approaches to analyzing transferability uncover unknown facilitators and barriers for successful innovation in systems and should be regarded as a prerequisite for decision-making on interventions.

The authors declare that they have no competing interests.

The authors declare that a positive ethics committee vote has been obtained.