Understanding the health system barriers and enablers to childhood MMR and HPV vaccination among disadvantaged, minority or underserved populations in middle- and high-income countries: a systematic review

Jumanah Essa-Hadad · Yanay Gorelik · Johanna P. M. Vervoort · Danielle E. M. C. Jansen · Michael L. Edelstein

32 citations0/0 files storedEuropean Journal of Public Health

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Vaccine Coverage and Hesitancy Child and Adolescent Health Public Health and Social Inequalities

Abstract

BACKGROUND: Child vaccinations are among the most effective public health interventions. However, wide gaps in child vaccination remain among different groups with uptake in most minorities or ethnic communities in Europe substantially lower compared to the general population. A systematic review was conducted to understand health system barriers and enablers to measles, mumps and rubella (MMR) and human papilloma virus (HPV) child vaccination among disadvantaged, minority populations in middle- and high-income countries. METHODS: We searched Medline, Cochrane, CINAHL, ProQuest and EMBASE for articles published from 2010 to 2021. Following title and abstract screening, full texts were assessed for relevance. Study quality was appraised using Critical Appraisal Skills Program checklists. Data extraction and analysis were performed. Health system barriers and enablers to vaccination were mapped to the World Health Organization health system building blocks. RESULTS: A total of 1658 search results were identified from five databases and 24 from reference lists. After removing duplicates, 1556 titles were screened and 496 were eligible. Eighty-six full texts were assessed for eligibility, 28 articles met all inclusion criteria. Factors that affected MMR and HPV vaccination among disadvantaged populations included service delivery (limited time, geographic distance, lack of culturally appropriate translated materials, difficulties navigating healthcare system), healthcare workforce (language and poor communication skills), financial costs and feelings of discrimination. CONCLUSION: Policymakers must consider health system barriers to vaccination faced by disadvantaged, minority populations while recognizing specific cultural contexts of each population. To ensure maximum policy impact, approaches to encourage vaccinations should be tailored to the unique population's needs. A one-size-fits-all approach is not effective.

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2015Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement 2016Rayyan—a web and mobile app for systematic reviews 2008Vaccination greatly reduces disease, disability, death and inequity worldwide 2018Under-vaccinated groups in Europe and their beliefs, attitudes and reasons for non-vaccination; two systematic reviews 2022Access to Vaccination among Disadvantaged, Isolated and Difficult-to-Reach Communities in the WHO European Region: A Systematic Review 2015Vaccination decision-making of immigrant parents in the Netherlands; a focus group study 2019‘I don’t think anybody explained to me how it works’: qualitative study exploring vaccination and primary health service access and uptake amongst Polish and Romanian communities in England 2013Vaccine uptake determinants in The Netherlands

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