'It Was Just the Given Thing to Do': Exploring Enablers for High Childhood Vaccination Uptake in East London's Bangladeshi Community - A Qualitative Study

"...the value of building multilevel trust, providing culturally tailored vaccination services, propagating positive community-level messages, implementing a rigorous call and recall programme and issuing vaccination records..."

Despite being an underserved ethnic minority group, characteristics that have been associated with low vaccine uptake, the Bangladeshi community in the United Kingdom (UK) exhibits high childhood vaccination uptake for several vaccines, compared with several ethnic groups. This study explored key enablers for early childhood vaccination uptake among the Bangladeshi community in East London, UK. This research may generate learning that can inform strategies for improving vaccination uptake among other underserved populations with low uptake.

This qualitative study used the Social Ecological Model (SEM) as a theoretical framework to guide data collection and analysis. The SEM acknowledges the multi-level influences on vaccination uptake at the individual, interpersonal, organisational, community, and policy level. During data collection, the researchers used the SEM to guide the domain of the questions in the topic guides. During analysis, the SEM informed the categorisation of coding, interpretation, and presentation of the themes.

Between March and May 2022, one-to-one semi-structured interviews were conducted with 23 Bangladeshi parents, 11 primary healthcare professionals (HCPs), and 5 community service providers (CSPs) involved in delivering childhood vaccination services, predominantly in the East London borough of Tower Hamlets. A Bangladeshi interpreter facilitated interviews with parents who had an English language barrier, verbally translating information and questions into Bengali or Sylheti.

Almost all parents reported their child(ren) had completed the recommended vaccination schedule to date. Multilevel vaccination enablers identified by parents, HCPs, and CSPs across the different levels of the SEM included:

• Individual level: established parental trust in the immunisation programme and HCPs; transparency regarding the vaccination ingredients and provision of information regarding suitable alternatives as a means of navigating religious concerns; and limited impact of the measles, mumps, and rubella (MMR) controversy, which falsely claimed association between the MMR vaccine and autism.
• Interpersonal level: encouragement from family and friends.
• Organisational level: call, recall, and monitoring systems that are tailored to those with literacy and language barriers; and the availability of culturally appropriate and accessible vaccination services (e.g., translated vaccination leaflets and non-porcine-containing vaccines); and delivery of high-quality, patient-centred health care.
• Community level: the normalisation of receiving childhood vaccinations within the Bangladeshi community, including positive community dialogue on childhood vaccinations.
• Public policy level: universal provision of a 'Personal Child Health Record'; and free, accessible vaccinations.

Notably, these findings diverge from those reported in studies of Bangladeshi families in other high-income settings, particularly among recent migrants. For example, research including Bangladeshi families who recently migrated to Canada highlighted a lack of culturally tailored, accessible vaccination information and inadequate cultural competency among HCPs, which negatively affected vaccination experiences.

In contrast, this study found healthcare providers in East London were attuned to the Bangladeshi community's needs, thus facilitating uptake. The Bangladeshi community, despite being an ethnic minority group nationally, is the largest ethnic group in Tower Hamlets and a settled population. Over time, their healthcare utilisation needs have become well understood by service providers, enabling the delivery of needs-tailored health care. Furthermore, large concentrations of an ethnic minority population may experience increased social cohesion and capital, which may be protective against vaccination hesitancy.

Based on the study, the researchers recommend using existing trusted community networks to disseminate tailored vaccine information and actively reminding parents about due vaccinations to promote uptake amongst other underserved, ethnic minority communities with low uptake in high-income settings. Further research involving non-immunising parents is recommended to gain more comprehensive insight into vaccine decision-making within this community.

In conclusion, this study highlights how "multi-level trust in a vaccination programme can propel positive vaccine uptake in an underserved, ethnic minority population....[C]ulturally sensitive, person-centred delivery of vaccination services, alongside leveraging community dynamics and trusted social networks, are imperative to meeting the informational, linguistic and cultural needs that facilitate vaccine uptake within the Bangaldeshi community."