Tailoring immunisation service delivery in a disadvantaged community in Australia; views of health providers and parents |
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| Institution: | 1. University of Newcastle, School of Medicine and Public Health, Newcastle, NSW, Australia;2. Hunter New England Local Health District, Population Health, Wallsend, NSW, Australia;3. Hunter New England Local Health District, East Maitland Community Health Centre, Maitland, NSW, Australia;4. University of Sydney, Faculty of Nursing and Midwifery and School of Public Health, Faculty of Medicine, Sydney, NSW, Australia;5. World Health Organization Regional Office for Europe, Division of Health Emergencies and Communicable Diseases, Amsterdam, The Netherlands;1. Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, WA, Australia;2. School of Medicine, University of Western Australia, WA, Australia;3. Department of General Medicine, The Royal Children’s Hospital, VIC, Australia;4. Department of Paediatrics, University of Melbourne, VIC, Australia;5. Vaccine and Immunisation Research Group, Murdoch Children’s Research Institute, VIC, Australia;6. Griffith University, Southport, QLD, Australia;7. Gold Coast Hospital and Health Service, Australia;8. Department of Infectious Diseases, Perth Children’s Hospital, WA, Australia;9. Department of Microbiology, PathWest Laboratory Medicine, WA, Australia;10. School of Public Health and Community Medicine, University of New South Wales, NSW, Australia;1. Department of General Practice, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, VIC 3168, Australia;2. School of Science, RMIT University, Building 223, Level 1, Bundoora Campus, Plenty Road, Bundoora, VIC 3083, Australia;3. National Ageing Research Institute, 34-54 Poplar Road, Parkville, Victoria 3052, Australia;1. Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, PO Box 855, West Perth, WA 6872, Australia;2. School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Samuels Avenue, Kensington, NSW 2033, Australia;3. National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Locked Bay 4001, Westmead, NSW 2145, Australia;4. Communicable Diseases Branch, NSW Health, Locked Mail Bay 961, North Sydney, NSW 2059, Australia;5. Communicable Diseases Control Directorate, WA Department of Health, PO Box 8172, Perth, WA 6849, Australia;6. Princess Margaret Hospital for Children, Roberts Rd, Subiaco, WA 6008, Australia;7. Curtin University, School of Public Health, GPO Box U1987, Perth 6845, Australia;8. Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, NT 0811, Australia;9. Department of Medicine, The University of Western Australia, Roberts Rd, Perth, WA 6008, Australia;10. PathWest Laboratory Medicine WA, QEII Medical Centre, Hospital Ave, Nedlands, WA 6009, Australia;1. BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Melbourne, Australia;2. Immunisation Section, Health Protection Branch, Department of Health and Human Services, Victorian State Government, Melbourne, Australia;3. Public Sector Innovation, Department of Premier and Cabinet, Victorian State Government, Melbourne, Australia;4. Behavioural Insights Unit, Department of Premier and Cabinet, Victorian State Government, Melbourne, Australia;1. Department of Neurodevelopment and Disability, The Royal Children’s Hospital, Melbourne, Australia;2. The Department of Paediatrics, The University of Melbourne, Melbourne, Australia;3. Developmental Disability and Rehabilitation Research Group, Murdoch Children’s Research Institute, Melbourne, Australia;4. Department of Haematology, The Royal Children’s Hospital, Melbourne, Australia;5. Nursing Research, The Royal Children’s Hospital, Melbourne, Australia;6. Clinical Haematology Research Group, Murdoch Children’s Research Institute, Australia;7. The Department of Nursing, The University of Melbourne, Melbourne, Australia;8. Clinical Learning and Development Unit, Bendigo Health, Victoria, Australia;9. Department of General Medicine, The Royal Children’s Hospital, Melbourne, Australia;10. Vaccine and Immunisation Research Group, Murdoch Children’s Research Institute, Melbourne, Australia;11. The School of Population Health, The University of Melbourne, Melbourne, Australia;1. Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia;2. The University of Sydney Northern Clinical School, NSW, Australia;3. National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, NSW, Australia;4. School of Public Health and Community Medicine, UNSW Medicine, University of NSW, Sydney, NSW, Australia;5. Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia;6. Communicable Diseases Branch, Health Protection NSW, Sydney, NSW, Australia;7. Perth Children''s Hospital, WA, Australia;8. School of Medicine, University of Western Australia, Perth, WA, Australia;9. Department of Microbiology, PathWest Laboratory Medicine WA, Perth Children''s Hospital, Perth, WA, Australia;10. Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia;11. National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia;12. School of Public Health, Curtin University, Perth, WA, Australia |
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| Abstract: | In 2014 the Australian immunisation target was raised from 90% to 95% of children to be fully immunised. A national priority is to identify geographic areas of low coverage and implement strategies to improve immunisation rates. Using The World Health Organization’s Tailoring Immunization Programmes (TIP) Guidelines, the aim of this study was to identify areas of low immunisation coverage for children in the Hunter New England Local Health District, New South Wales, and to gain a deeper understanding of the factors influencing immunisation in those areas in order to develop tailored strategies for increasing immunisation coverage. Data from the Australian Immunisation Register was used to identify geographic areas of low coverage. Data from interviews and focus groups with parents and service providers were used to gain a deeper understanding of the factors influencing immunisation in those areas. The regional city of Maitland in New South Wales was identified as having a persistently high number and relatively high proportion of children not fully immunised (n = 427, 15.4% in 2016). Themes from 59 stakeholder interviews and focus groups included; (i) limited engagement with health services unless the need is urgent, (ii) multi-dimensional access barriers to immunisation services in Maitland, (iii) a flexible, supportive family centred, primary health care approach, utilising strong partnerships, is most likely to be effective in increasing childhood immunisation rates in Maitland, (iv) data can be used more effectively to inform service providers about trends and individual children not fully immunised. TIP guidelines proved useful for identifying areas of low coverage and providing an understanding of determining factors and the strategies most likely to be effective. Understanding the complex problems many parents face and the access barriers that contribute to low immunisation coverage is essential in developing appropriate solutions. Finding ways to support parents and remove those barriers can contribute to higher coverage. In Maitland, targeted outreach and home visiting has been implemented in consultation with community and health service representatives to ensure that the children from socially disadvantaged populations identified do not miss out on vaccination. |
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| Keywords: | Vaccine Child health Equity Social disadvantage Health services WHO |
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