title: Addressing low vaccine uptake in rural Massachusetts: Perspectives from local school and public health nurses
Creators: name: O’Reilly, Maureen
name: Ryan, Grace W
Publisher: name: UMass Chan Medical School
Year: 2023

description: Background: Rural-urban vaccine inequities are a longstanding issue across the country, and Massachusetts is no exception. For example, in Franklin County, a rural county in the western part of the state, only 83% of 7th graders and 70% of 11th graders are up-to-date on their school-required vaccine series. Both school nurses and local public health nurses have an important role in vaccine promotion, but we need to better understand their perspectives to identify opportunities to support their efforts.   
Methods: We conducted a semi-structured qualitative data collection with school nurses and local public health nurses to better understand their perspectives and identify actionable opportunities for intervention. In August 2023, we used an online brainstorming software to collect data during a monthly meeting convened by regional school nurse leadership. We designed our data collection to capture perspectives on three key questions: (1) What are your biggest challenges in your current role related to child/adolescent vaccination? (2) What would help you the most in your current role related to child/adolescent vaccination? (3) What do you see as the biggest barriers to raising child and adolescent vaccination rates in your school/community? Individual responses to these three questions were downloaded and we used open coding to determine themes emerging from the data. 
Results: The most commonly reported challenge as related to current role in vaccination was a struggle to maintain up-to-date vaccine records. School nurses are responsible for tracking vaccine compliance, and many reported varied difficulties (i.e., time required, issues reaching parents) in keeping these records updated. For example, one school nurse reported that her biggest challenge is “accessing the information from parents {and} getting parents to forward records” Other challenges identified were lack of knowledge, hesitancy within the community, and competing priorities. One school nurse reported that “immunization is not a high priority while challenges in educational settings are growing.” When asked about facilitators to vaccine promotion, the primary theme that emerged was increased access—both to vaccination services and trusted information about vaccines. As one participant reported “getting school health providers to provide onsite immunizations with other school-based health services...would be great to increase access for COVID-19, HPV.” Finally, the biggest barrier identified was availability and accessibility of primary care, with participants citing specific barriers like the fact that “primary care offices are overwhelmed” to transportation issues to access providers. 
Discussion: It is clear there are multilevel, interrelated challenges affecting vaccination that will need to be addressed to improve vaccination rates in Franklin County. Focusing efforts on actionable and feasible changes will have the biggest impact. For example, developing a strategy to support school nurses in collecting vaccine records more efficiently while disseminating vaccine-promotion information to parents may be feasible, but improving wait-times at primary care offices may be less of an achievable goal. Based on these findings, we are now in the process of developing potential strategies to support school and public health nurses in these efforts, focusing on alleviating barriers and leveraging potential facilitators.