Structural barriers to measles, mumps and rubella (MMR) immunisation uptake in Gypsy, Roma and Traveller communities in the United Kingdom

Abstract

Gypsies, Roma and Travellers (GRT) experience a significantly high number of measles cases and have low levels of measles, mumps and rubella (MMR) immunisation. There is little evidence on: why immunisation levels are low; beliefs and practices surrounding the MMR vaccine; or the factors that promote or hinder uptake. This paper presents data from five focus groups with 16 GRT mothers in Kent, South East England. Between them, they had 35 children of whom just under half had not received the course of vaccinations. Focus groups explored the issues GRT parents consider when making vaccination decisions in the context of wider social, ideological, material and practical considerations. Four interrelated themes were identified: way of life and access; engaging with health care staff; perceptions and evaluations of risk; and strategies to minimise MMR-related risks. Our findings provide little support for explanations that emphasise cultural values or practices in shaping immunisation behaviour. Poor service provision, situational constraints related to living circumstances, and multifaceted and severe health issues, which precede and inform decisions over childhood immunisation, were more significant in explaining low uptake.

Resurgence of Measles in Europe: A Systematic Review on Parental Attitudes and Beliefs of Measles Vaccine

“…The most common reason for hesitancy or refusal was concern about adverse effects, revealed in 13 of 20 studies. This was mentioned by participants in relation to fear of autism in 10 studies [22][23][24][25][26][29][30][31][32][33] across three countries (UK, Italy, and Sweden). Rejectors and vaccine-hesitant parents were more likely to perceive adverse effects as highly probable and severe [29,34].…”

“…Participants were mainly mothers [22][23][24][25][26], and also included parents with anthroposophical world views [27,28]; some studies included Gypsies, Roma, and Traveler (GRT) parents [22,24], with a history of nomadism and temporary residency, and longterm resident Somali mothers living in Europe [25]. Most studies used a retrospective design in which attitudes and predictors were assessed after they had made their vaccination decision using subjective self-reported behavior.…”

Learning from patients’ experiences: the case of Travellers and their experiences of using health services for skin complaints

“…Studies of the health and illness experiences of GRT communities have highlighted how discrimination, coupled with a lack of provision for Traveller lifestyles within health services, has contributed to this situation . Our own work has shown that the effects of long‐standing health inequalities experienced by GRT communities shapes their decision‐making around health. For example, as GRT children are frequently ill (relative to the wider population) and their mothers often find it difficult to access services, this means there are very few windows of opportunity where children can receive vaccinations .…”

“…'s research). Often adopting a qualitative approach, these studies explore the day‐to‐day barriers and enablers that people experience in self‐managing conditions, using health services and/or pursuing healthy behaviours as well as how the array of options available in a person's social context shapes their health decision‐making and outcomes . Aligned with this, Gilhooley et al .…”

“…For example, as GRT children are frequently ill (relative to the wider population) and their mothers often find it difficult to access services, this means there are very few windows of opportunity where children can receive vaccinations . This contributes to low levels of childhood immunization in GRT communities – which further perpetuates the health inequalities they experience . Gilhooley et al .…”