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Exploring childhood immunization among undocumented migrants in Sweden - following qualitative study and the World Health Organizations Guide to Tailoring Immunization Programmes (TIP)

Journal article
Authors K. Godoy-Ramirez
E. Bystrom
A. Lindstrand
R. Butler
Henry Ascher
A. Kulane
Published in Public Health
Volume 171
Pages 97-105
ISSN 0033-3506
Publication year 2019
Published at Institute of Medicine, School of Public Health and Community Medicine
Pages 97-105
Language en
Keywords Undocumented, Migrant, Childhood vaccination, Hard-to-reach, Tailoring immunization, vaccine hesitancy, decision-making, mmr, Public, Environmental & Occupational Health, DC Report on migration and infectious diseases in the EU
Subject categories Public Health, Global Health, Social Medicine and Epidemiology


Objectives: National vaccination coverage in Sweden is high. Recurrent outbreaks of measles and rubella however highlight some immunity gaps in the population. Current knowledge about immunization status of undocumented migrant children is scant. The World Health Organization/Europe has developed the Guide to Tailoring Immunization Programmes (TIP) to assist countries in diagnosing barriers and motivators to vaccination in communities with low vaccination coverage. Based on the TIP guide, the objective of this study was to explore determinants to vaccination among undocumented immigrants, using qualitative approach. Study design: The study consisted of three steps: (i) an initial workshop for problem statement; (ii) qualitative research for increased understanding of the vaccination practices of children in the undocumented community; and (iii) a second workshop to incorporate the qualitative interview findings together with data from key stakeholders into a conceptual framework. Methods: This was a qualitative study featuring interviews of seven undocumented parents recruited at non-governmental clinics, three nurses at Child Health Centers, and information from key stakeholders retrieved at workshops as part of the TIP process. Results: The content analysis revealed two main themes: parental fear of being questioned and parental acceptance of child immunization. Undocumented parents had a positive view and attitude toward childhood immunization but expressed strong fear of being asked for identification papers at healthcare facilities. Owing to lack of knowledge on entitlements of the undocumented among health personnel, parents were incorrectly rejected when seeking care for their children. Frequent mobility among undocumented may limit access to complete the immunization schedule. Undocumented parents mistrust healthcare providers and avoid health facilities, further delaying childrens' access to health care, including immunization services. Conclusions: The findings of this study confirm the complexity of barriers that undocumented parents face regarding childhood immunization. The TIP guide offers a valuable process for a deeper understanding of the determinants of immunization challenges among undocumented migrants. (C) 2019 The Authors. Published by Elsevier Ltd on behalf of The Royal Society for Public Health.

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