Co-designing a theory-informed, multi-component intervention to increase vaccine uptake with Congolese migrants: a qualitative, community-based participatory research study
Authors: Crawshaw Alison F , Kitoko Lusau Mimi , Nkembi Sarah , Lutumba Laura Muzinga , Hickey Caroline , Deal Anna , Carter Jessica , Knights Felicity , Vandrevala Tushna , Forster Alice S , Hargreaves Sally 
Published: June 2023

ABSTRACTIntroductionInequitable uptake of routine and COVID-19 vaccinations has been documented among intersectionally marginalised populations, including migrants, and attributed to issues of mistrust, access, and low vaccine confidence. Novel approaches which seek to share power, build trust and co-design tailored interventions with marginalised or underserved communities must be explored, to promote equitable engagement with vaccination and other health interventions.MethodsA theory-informed, qualitative, community-based participatory research study, designed and led by a community-academic partnership, which aimed to understand decision-making related to COVID-19 vaccination among Congolese migrants in the UK and co-design a tailored intervention to strengthen their vaccine uptake (2021-2022). Barriers and facilitators to COVID-19 vaccination, information and communication preferences, and intervention suggestions were explored through qualitative in-depth interviews with Congolese migrants, thematically analysed, and mapped to the theoretical domains framework (TDF) and the Capability, Opportunity, Motivation, Behaviour (COM-B) model to identify target behaviours and strategies to include in interventions. Workshops were done in partnership with Congolese migrants to co-design and tailor interventions.Results32 Congolese adult migrants (foreign-born and living in UK; 24 (75%) women, mean 14.3 [SD 7.5] years in UK, mean age 52.6 [SD 11.0] years) took part in in-depth interviews and 16 (same sample) took part in co-design workshops. We identified 14 barriers and 10 facilitators to COVID-19 vaccination; most barrier data related to four TDF domains (beliefs about consequences; emotion; social influences; environmental context and resources), and the behavioural diagnosis concluded interventions should target improving psychological capability, reflective and automatic motivations, and social opportunities. Strategies included behaviour change techniques based on education, persuasion, modelling, enablement, and environmental restructuring, which resulted in a co-designed intervention comprising community-led workshops, COVID-19 vaccination plays and posters. Findings and interventions were disseminated through a community celebration event.ConclusionsOur study demonstrates how behavioural theory can be applied to co-designing tailored interventions with marginalised migrant communities through a participatory research paradigm to address a range of health issues and inequalities. Future research should build on this empowering approach, with the goal of developing more sensitive vaccination services and interventions which respond to migrant communities’ unique cultural needs and realities.Patient or public contributionPatient and public involvement (PPI) were embedded in the participatory study design and approach. An independent PPI board comprising five adult migrants with lived experience of accessing healthcare in the UK were also consulted at significant points over the course of the study.Practitioner pointsResearch has shown that migrants experience a range of health and vaccination inequalities but are not well included in health research nor the design of interventions to address these. Using community-based participatory methods, we demonstrated that underserved communities, such as migrants, are resilient, resourceful, and use community assets to find real-world solutions to their health needs.Our approach shows how practitioners can adapt and use behavioural theory and design thinking within a participatory research paradigm to meaningfully involve underserved populations in co-designing acceptable and culturally relevant health interventions to address a range of health issues and inequalities.