Yarning about Vaccinations: Empowering Individuals to Have Supportive Conversations with Aboriginal Peoples about Vaccinations, Using a Community-engaged Approach

"Addressing vaccine hesitancy through culturally considered and sensitive approaches...has the potential to build resilience against threats to public confidence, such as anti-vaccine campaigns and misinformation, contributing to improved vaccine uptake."

Aboriginal and Torres Strait Islander people are a priority population for Australia's immunisation programmes due to historically lower vaccination coverage and higher rates of vaccine-preventable diseases. Factors influencing Aboriginal and Torres Strait Islander people's acceptance of vaccines include: the ongoing impacts of colonisation and systemic racism; mistrust in health services; lack of targeted, trusted, and timely information; and poor engagement with Aboriginal Health Workers (AHWs) in the development and implementation of health programmes, which can lead to culturally inappropriate and unsafe immunisation services. This study assessed the effectiveness of Aboriginal-led vaccine workshops ("Keeping Mob Safe: Yarning about vaccination") to enhance knowledge, confidence, and supportive conversations regarding scheduled and recommended vaccinations for Aboriginal and Torres Strait Islander people in Hunter New England, New South Wales, Australia.

This study was led by four Aboriginal members of the research team, enabling control over data and honouring Indigenous Data Sovereignty principles. They applied Indigenist research methodologies; participatory action research (PAR) to review, refine, and revise the workshop content and format; and mixed-method approaches (i.e., both surveys and yarns).

The researchers adjusted and indigenised an existing vaccine conversation programme by, for example,  adapting a figure (see above) relating to the spectrum of people's positions on childhood vaccination for use in the workshops. They recruited 70 Aboriginal and Torres Strait Islander and non-Indigenous people to workshops delivered either online or face to face. The workshops were facilitated and led by Aboriginal public health staff, in collaboration with non-Indigenous public health experts with backgrounds in immunisation, public health, and social science.

During the workshops, Different types of yarning, an Indigenous form of conversation, were incorporated to understand context and participants' experiences. "Research yarning" gauged participants level of understanding of the topic. "Social yarning" was used to understand local issues and to build rapport and trust, allowing time for questions and feedback. "Collaborative yarning" enabled participants to share ideas, explore issues, and make suggestions for future workshops. These elements in decolonising research practices uphold the principles of self-determination and empowerment.

Workshops were structured into four sections and included culturally informed activities that aimed to engage participants and promote learning.
 

• Introductions: enabled participants to "(re)connect and yarn". Facilitators introduced themselves and invited participants to share "what's your name, where you're from, who's your mob". An Acknowledgement of Country showed respect for the traditional owners of the land on which the workshops took place.
• Parts 1 and 2: provided updates of current COVID-19 and influenza activity, explored key vaccine-preventable diseases, vaccine development, safety and monitoring, and the New South Wales immunisation schedule and recommended vaccines for Aboriginal and Torres Strait Islander people.
• Part 3: addressed reasons for vaccine hesitancy and behavioural and social drivers for vaccine uptake. Existing vaccine conversation scripts were adapted and shown as two video role plays: (i) unsupportive conversation; and (ii) supportive conversation (using positive communication practices).
• Part 4: included information, resources, and strategies to encourage participants to become vaccine advocates.

Five key themes were identified in the course of the 3 online and 2 face-to-face workshops, which were held between June 2023 and November 2023:
 

1. Information, knowledge, and education: Participants said lack of education and information about vaccines was a barrier to Aboriginal people getting vaccinated. They emphasised the importance of education, suggesting that community-led peer education could improve knowledge and perceptions about vaccinations, noting that it's "good to see mob talking to mob about vaccines".
2. Trust and mistrust: Participants discussed how misinformation and conspiracy theories on social media influence people's vaccine decisions and reinforce concerns about vaccine safety. Participants mentioned that vaccination incentives at community events were sometimes seen as bribes rather than genuine efforts to increase uptake.
3. Personal, community, and cultural factors: Many participants shared that negative childhood vaccination experiences led to emotional responses, affecting how they and their families engage with vaccination. Participants emphasised the need for community support and education on vaccination, noting that trust in familiar local people administering vaccines builds confidence. They also spoke about the crucial role of Aboriginal women in facilitating vaccination for children and the influence of cultural factors on vaccination attitudes.
4. Access and logistics: Ongoing accessibility and logistical barriers to vaccination were identified in all workshops. Also, cultural safety was discussed, with one participant stating that health services should "make the space less traumatising" and consider ways to deliver vaccines in a way that everyone can walk away with a positive vaccination experience.
5. Communication and connection: Participants emphasised the need for positive, trust-based, culturally appropriate vaccine conversations with Aboriginal people. They stressed the importance of openness, noting that respecting individual concerns and asking permission to discuss sensitive topics are essential components for culturally appropriate conversations. Family, self-protection, and cultural safety were seen as critical in vaccine conversations, particularly in small rural communities. 
    

Of the 70 participants, 41 (59%) completed a post-workshop survey. Most participants reported high satisfaction with the workshop content and format, and most reported increased confidence in having vaccine conversations. Post-workshop yarns with 8 participants who all identified as Aboriginal highlighted the positive impact on community knowledge and collaboration. Having local trusted Aboriginal people leading the workshops and other public health experts present the information was an important part of the workshops, from their perspective. A train-the-trainer model was suggested to enable local AHWs to deliver future workshops.

Reflecting on the experience, the researchers suggest that "The 'Keeping Mob Safe: Yarning about vaccination' workshops enabled two-way learning, allowing the research team to share vaccination information whilst listening to participants' perspectives and concerns about vaccination. Guided by PAR and decolonising research approaches, yarning with Aboriginal participants not only captured participants' knowledge and attitudes about vaccines but also provided insights into their lived experiences of immunisation and the healthcare system. This culturally informed approach allowed themes to emerge that might have been overlooked by western research methods alone."

In conclusion: "These findings highlight the need for localised strategies to enhance vaccine understanding with Aboriginal and Torres Strait Islander communities, as well as offering valuable insights to tailor immunisation programs and rollouts of future vaccines."