Title: Understanding uptake of Immunisations in Travelling and Gypsy communities (UNITING)
Funder: Department of Health (England)

Abstract: AIMS:1. To investigate the barriers and facilitators to acceptability and uptake of immunisations amongst six Traveller communities (comprising five distinct ethnic/cultural groups) across four UK cities; 2. To identify possible interventions to increase uptake of immunisations in diverse Traveller communities to test in a subsequent feasibility study.DESIGN: This is a 3-linked phase qualitative study. Phase 1: Qualitative individual/group interviews with Travellers. Phase 2: Qualitative individual interviews with health and community workers who work with the Traveller communities. Phase 3: Feedback Workshops with a sub sample of participants from Phases 1 and 2 at which we will refine and produce a prioritised list of potentially feasible and acceptable interventions. This proposed research is the first ‘intervention development’ phase of the MRC framework for developing and evaluating complex interventions. It is framed within a Social Ecological Model which recognises that behaviour is affected by and effects multiple levels of influence.SETTING AND TARGET POPULATION: PHASE 1: Travellers from each of six communities (comprising five distinct ethnic/cultural groups) located in four cities: York (English Roma) Bristol (English Gypsies Eastern European Roma) East London (Irish Travellers) Glasgow (Eastern European Roma Occupational Travellers). Within each community in each city: Men and women across generations of families including adults eligible for the flu vaccine (pregnant over 65 with specified long term medical conditions e.g. asthma bronchitis); pregnant women eligible for the pertussis vaccine girls aged 13 to 18 years and mothers of pre-school children/women planning families. PHASE 2: Health community third sector and advocacy workers with responsibility for local policy making and/or providing services for these Traveller communities. PHASE 3: Sub sample of participants from Phases 1 and 2.HEALTH TECHNOLOGY: We will focus primarily on the UK childhood immunisation schedule. However to better understand issues relating to adult immunisation we will also explore views on flu and pertussis vaccinations in adults either identified ‘at risk’ of developing serious complications of flu themselves or in the case of pertussis vaccine to prevent potentially life threatening infection in their newborn infants. MEASUREMENT OF OUTCOMES: PHASE 1: We will explore Travellers’ views on the intrapersonal interpersonal institutional community and policy influences on their immunisation behaviours and ideas for improving uptake in their community. PHASE 2: We will investigate health and community workers’ perspectives on the barriers and facilitators (across all five levels of influence) to childhood and adult flu/pertussis immunisations for the Traveller communities with whom they work as well as their ideas for appropriate interventions. Vignettes using verbatim quotes from the interviews with Travellers in Phase 1 will be used to trigger discussion. PHASE 3: The findings from Phases 1 and 2 including ideas for interventions will be fed back discussed and prioritised. With participants’ permission we will digitally record the interviews. The data collected in Phases 1 and 2 will be analysed using the Framework approach. We will use Nominal Group Technique in Phase 3. SAMPLE SIZE: PHASE 1: 24 to 32 participants in each Traveller community (total 144-192). PHASE 2: 6 to 8 health and community workers in each city (total 24-32). PHASE 3: 10 to 12 participants from Phase 1 and 3 to 4 Phase 2 participants for each community (total 78-102). In Bristol and Glasgow we are planning to engage with two Traveller communities and so will run two Workshops in these cities. These sample sizes have been estimated to draw out meaningful comparisons within and across Traveller communities vaccines (childhood adult) and professional roles to allow robust conclusions to be made. OUTPUTS:(1) A prioritised list of potentially feasible and acceptable interventions for increasing immunisation uptake for the six Traveller communities. (2) Comprehensive in-depth findings on the barriers and facilitators to uptake and acceptability of childhood /adult flu and pertussis immunisation both within and across the six Traveller communities. (3) Methodological development in undertaking research with diverse Traveller communities. (4) Development of a multi-disciplinary research team working across multiple locations and links with local Traveller communities in preparation for securing funding and delivering a subsequent feasibility study.PROJECT TIMETABLE AND RECRUITMENT RATESA 26 month project commencing 1 September 2013. Months -3 to -1: Ethics and Research Approvals. WAVE 1: Months 1 to 12: York and Bristol. M1-2 set up M2-5 Phase 1 M5-8 Phase 2 M6-11 within-community analysis M12 feedback workshops. WAVE 2: Months 8-19: Glasgow and London. M8-9 set up M9-12 Phase 1 M12-15 Phase 2 M13-18 within-communityanalysis M19 feedback workshops.M20-23 Cross-community synthesis. M21-26 write report. M25-26 Dissemination.We have allowed four months in each city to engage with communities gain their trust and do 24-32 interviews per community. To locate and interview 6-8 health and community workers in each location we have allowed 4 months (1 month overlaps with interviews with the Travellers). These estimates are based on the considerable experience within our research team of working with the Traveller communities and recognise the time it takes to gain the trust of communities.


Research activity codes: 3.4 VACCINES
Health categories: INFECTION