Childhood Vaccination among Underserved Populations in Canada  During the COVID-19 Pandemic: A Sequential Mixed Methods Approach Using  Intersectionality Theory
Creators: Humble, Robin Marie
Publisher: name: University of Alberta Library
Year: 2024

<p>Background. Low routine childhood vaccination coverage and increased incidence of vaccine preventable diseases (VPDs) have been identified within some ethnocultural groups in Canada (i.e., Racialized minorities, newcomers). Inequities have been attributed to systemic barriers to accessing vaccines, and differential constraints associated with one&#39;s social location (i.e., age, education). The socioeconomic impact of the COVID-19 pandemic and disruptions to routine vaccine services created further accessibility challenges. Although a decline in childhood vaccination was reported in Canada early in the pandemic (i.e., 2020 and 2021), few Canadian studies have explored acceptance of childhood vaccines among parents of diverse ethnocultural groups and social locations during the pandemic. Quantitative methodologies measure determinants of routine vaccination within specified populations, and qualitative methodologies have the unique ability to contextualize associations among intersections of ethnocultural identities and social locations. Therefore, my paper-based dissertation project utilized mixed methods to assess how the COVID-19 pandemic influenced Canadian parents’ perceptions and intentions towards routine vaccination, and access to services for their children ≤17 years old, across diverse ethnocultural identities and social locations.<br>
Objectives. There are three dissertation objectives. The first study longitudinally explored parents’ shifting perceptions and intentions toward routine vaccines and access for their children ≤17 years over time, and determined differences across sociodemographic factors. The second study cross-sectionally characterized perceptions and acceptance of childhood vaccination during the pandemic, among parents who self-identified as Indigenous, Racialized minorities, newcomers, those who primarily speak a minority language, and a reference group of parents who did not identify with these ethnocultural identities. The third study descriptively explored more deeply how intersections of ethnocultural identities and social locations influenced parents’ perceptions and acceptance of childhood vaccination.<br>
Methods. There are three distinct methods, each as a stand-alone study; all three studies are complementary and integrative within a sequential mixed methods design. Intersectionality theory guided study development, analysis, and interpretation of results. Study methods included: (1) longitudinal analysis of two national surveys during the pandemic (Dec 2020 and Oct-Nov 2021) using McNemar-Bowker tests to assess changes over time in parents’ perceptions, intentions, and access to vaccines for their children, and differences across sociodemographic factors; (2) regression analysis to assess differences across ethnocultural populations, and a reference group of parents, who reported in survey two (Oct-Nov 2021) about their perceptions of childhood vaccines, including discriminatory experiences; and (3) structured interviews (Feb-Mar 2023) with parents who self-identified with historically underserved groups. Participants described their ethnocultural identity, social locations, and vaccination experiences within and outside of Canada, and contextualized how these influenced vaccine decision-making during the pandemic. Qualitative descriptive analysis focused on emerging themes. <br>
Results. Of the 650 parents in the first longitudinal study, 25.1% with child(ren) ≤6 years and 20.5% with child(ren) 7-17 years perceived that routine childhood vaccines were more important because of the pandemic. Over time parents’ acceptance of routine vaccines increased (82.9% to 86.5%, p=.021), but more parents were undecided about influenza vaccination (12.6% to 20.3%, p=.002). Of the 2531 parents in the second study, 21.8% self-identified as Racialized minorities, 7.7% Indigenous, 23.3% newcomers, and 10.0% spoke minority languages most often. Significant findings included 36.6% of Indigenous parents who reported that routine vaccines were more important because of the pandemic, compared to 16.7% of newcomers. Discrimination when accessing health services was most often experienced by Indigenous (27.8%) and Racialized minorities (20.2%), compared to the reference group (4.8%). Racialized minorities were more likely to report low acceptance compared to the reference group (aOR=2.19, 95% CI: 1.18–4.05). Themes identified through 17 semi-structured interviews with parents of ethnocultural groups in the third study include: (1) accessible vaccination but uncertain processes; (2) ethnocultural diversity protects against racialized discrimination; (3) normalization and socialization of vaccination fosters inclusivity; (4) challenges for newcomers without social supports; and (5) polarized perceptions towards different vaccines.<br>
Conclusions. During the spotlight of COVID-19, parents’ confidence in routine vaccines, engagement in decision-making, and vaccination acceptance increased. Differences in parents’ acceptance of routine and influenza vaccines for their children highlight the need for targeted communication strategies for specific vaccines. Public health decision-makers should ensure equitable access to vaccination that targets inclusion of ethnocultural groups, who may experience disproportionate barriers and resultant low vaccine acceptance. Canada’s multiculturalism fosters inclusive services for parents of ethnocultural groups.</p>