The report presents results from a pilot test of Tailoring Immunization Programmes (TIP), a method developed by WHO/Europe to identify barriers and motivating factors to MMR vaccination in communities with low coverage in Sweden.
The study is the basis for suggested tailored communication and educational interventions with the goal of increasing vaccination coverage in the studied populations.
This report describes experiences and lessons learned during the implementation of the TIP and is mainly intended for health care professionals, other national authorities, and non-governmental organisations.
The WHO Regional Office for Europe (WHO/Europe) has developed a method called Tailoring Immunizations Programmes (TIP) to identify which factors are important for parental decisionmaking about vaccination in groups with low vaccination coverage. The method is also designed to identify potential targeted interventions to improve vaccination coverage.
This report presents the results of studies performed using the TIP method focusing on three identified populations with low or suspected low vaccination coverage:
- the anthroposophic community in Järna, southern Stockholm
- the Somali community in Rinkeby and Tensta, northern Stockholm
- the undocumented migrant communities in Stockholm and Gothenburg
The aim was to better understand the populations, identify barriers and motivating factors for receiving the MMR (measles, mumps and rubella) vaccination, and to identify targeted interventions in order to limit the spread of measles and rubella in Sweden.
Parents who postpone MMR vaccinations in Järna do so either because they believe children are too young to be vaccinated at the recommended 18 months or because they believe in prioritizing natural immunity. Somali parents who decline MMR vaccination generally have a notion that the MMR vaccine can cause side effects such as autism. The undocumented migrant parents consistently expressed that they want to vaccinate their children to keep them healthy, but that lack of access to health care is a key barrier.
The study showed that there are different needs for targeted communication efforts and interventions in these three hard-to-reach populations. The importance of health care professionals' attitudes towards vaccinations was highlighted in all populations. Parents from the anthroposophic and Somali communities requested balanced information about vaccines and an objective dialogue with health care professionals using evidencebased information. The Somali parents do not use the traditional channels offered through the Child Welfare Centre (CWC) and School Healthcare, so innovative methods are needed for dissemination of knowledge, preferably through existing local networks and in the Somali language. Health professionals also need assistance with targeted information, methods, and support to reach out to this population with information about immunizations. Newly arrived migrants need to be better informed about their legal entitlements to health care and health screening services. The health professionals at the CWC and primary health care services need to receive additional information about the new law on health care for undocumented persons as well as education, training, and support on how to approach the undocumented migrants in a health care context.
As a result of this study, the Public Health Agency of Sweden proposes several targeted communication and education initiatives, including a "peer-to-peer" project, in-depth educational interventions in vaccinology for health care professionals, and targeted information about the importance of being vaccinated with MMR before travelling abroad. A common feature of the studied populations is the need for in-terventions to strengthen the trust between parents and health care professionals. Additional efforts are needed in the anthroposophic and Somali communities to address the hesitancy against the MMR vaccine by providing objective and evidencebased targeted information.
Targeted initiatives spanning diverse areas require the participation and involvement of a variety of stakeholders. Efforts should be performed in close collaboration between the Public Health Agency of Sweden and the Department of Communicable Disease Control and Prevention and Child Health services at the County Councils as well as non-governmental and community organizations.