Identifying interventions with Gypsies, Roma and Travellers to promote immunisation uptake: methodological approach and findings.
Identifying interventions with Gypsies, Roma and Travellers to promote immunisation uptake: methodological approach and findings.
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DOI：
10.1186/s12889-020-09614-4
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发表时间：
2020-10-20
影响因子：
4.5
通讯作者：
Jackson C
中科院分区：
文献类型：
--
作者：
Dyson L;Bedford H;Condon L;Emslie C;Ireland L;Mytton J;Overend K;Redsell S;Richardson Z;Jackson C
在英国，吉普赛人、罗姆人和游民（GRT）社区通常被认为处于免疫接种低或可变的风险中。许多增加一般人群吸收的战略与GRT社区相关，但可能还需要其他方法，重要的是不能假设“一刀切”。需要强有力的方法来确定可能是可接受的、可行的、有效的和具有成本效益的交付内容和方法。在本文中，我们描述了在英国四个城市的六个GRT社区确定潜在干预措施以增加免疫接种的方法；并提出出现的优先干预措施清单。这项工作分三个阶段进行：(1)改进干预绘图过程，以确定潜在干预措施的想法；(2)在51个grt和25个服务提供者的研讨会上进行两步优先排序活动，以商定每个社区潜在可行和可接受的干预措施的优先列表；(3)跨社区综合，产生最终的干预措施清单。支撑这项研究的理论框架是社会生态模型。各社区和服务提供者商定了五项重点干预措施，以改善居住或定居在授权地点的grt的免疫接种情况。这些干预措施都在社会生态模式的制度（如文化能力培训）和政策（如保护资金）层面。五种干预措施的“上游”性质加强了全科医生实践、一线工作人员和更广泛的NHS系统在提高免疫吸收方面的关键作用。所有五种干预措施都可能比grt具有更广泛的适用性。我们认为，如果将其作为一揽子措施加以实施，其影响将得到加强。上述强有力的干预措施开发和合作生产方法可以有效地应用于存在免疫接种不良问题的其他社区。当前对照试验ISRCTN20019630，注册日期：01-08-2013，前瞻性注册。
In the UK, Gypsy, Roma and Traveller (GRT) communities are generally considered to be at risk of low or variable immunisation uptake. Many strategies to increase uptake for the general population are relevant for GRT communities, however additional approaches may also be required, and importantly one cannot assume that “one size fits all”. Robust methods are needed to identify content and methods of delivery that are likely to be acceptable, feasible, effective and cost effective. In this paper, we describe the approach taken to identify potential interventions to increase uptake of immunisations in six GRT communities in four UK cities; and present the list of prioritised interventions that emerged. This work was conducted in three stages: (1) a modified intervention mapping process to identify ideas for potential interventions; (2) a two-step prioritisation activity at workshops with 51 GRTs and 25 Service Providers to agree a prioritised list of potentially feasible and acceptable interventions for each community; (3) cross-community synthesis to produce a final list of interventions. The theoretical framework underpinning the study was the Social Ecological Model. Five priority interventions were agreed across communities and Service Providers to improve the uptake of immunisation amongst GRTs who are housed or settled on an authorised site. These interventions are all at the Institutional (e.g. cultural competence training) and Policy (e.g. protected funding) levels of the Social Ecological Model. The “upstream” nature of the five interventions reinforces the key role of GP practices, frontline workers and wider NHS systems on improving immunisation uptake. All five interventions have potentially broader applicability than GRTs. We believe that their impact would be enhanced if delivered as a combined package. The robust intervention development and co-production methods described could usefully be applied to other communities where poor uptake of immunisation is a concern. Current Controlled Trials ISRCTN20019630, Date of registration 01-08-2013, Prospectively registered.
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