Defining the determinants of under-vaccination in migrant populations in Europe to improve routine and COVID-19 vaccine uptake: a systematic review

Diverse migrant populations in Europe are at risk of under–immunisation and have recently shown lower levels of COVID–19 vaccination intent and uptake. Understanding the determinants of vaccine uptake in migrants is critical to address immediate COVID–19 vaccination inequities, and longer–term will help improve coverage for routine vaccinations, aligning with the goals of the new Immunisation Agenda 2030. We did a systematic review following PRISMA guidelines and using a PICOS framework (PROSPERO CRD42020219214; MEDLINE, CINAHL, PsycINFO databases, 1 January 2000 to 14 September 2021) exploring barriers and facilitators to vaccine uptake and determinants of under-vaccination in migrants in the EU/EEA, UK, and Switzerland. We categorised barriers/facilitators using the 5As Determinants of Vaccine Uptake Taxonomy. 5259 data sources were screened, with 67 studies included from 16 countries, representing 366,529 migrants. Access barriers were most commonly reported (language, literacy and communication barriers; practical and legal barriers to accessing/delivering vaccination services; service barriers, including lack of specific guidelines and knowledge of healthcare professionals) for key vaccines including MMR, DTP, HPV, influenza, polio, COVID–19 vaccines. Acceptance barriers were mostly reported in Eastern European and Muslim communities for HPV, measles, and influenza vaccines. We identified 23 determinants of under-vaccination in migrants, including geographical origin (where 25/26 (96%) studies showed significance) – particularly African/Eastern European origin; recent migration; being a refugee/asylum seeker; higher income; parental education level; no healthcare contact in the past year; and lower language skills. Facilitators of migrants′ vaccine uptake included tailored vaccination messaging, community outreach and nudging interventions. Migrants′ barriers to accessing healthcare are already well documented, and this review confirms their role in limiting vaccine uptake. These data hold immediate relevance to strengthening vaccination programmes in high–income countries, including for COVID–19. Our findings suggested that targeted, evidence–informed strategies are needed to address access and acceptance barriers to vaccination in migrants, including the development of migrant–sensitive and adaptable vaccination services and systems, unambiguous public health messaging, and coproduction of tailored interventions.

Review of Reduced Salt, Snow, and Ice Management Practices for Commercial Businesses

Chlorides (frequently sodium chloride) are used to improve safety and access to roads and other surfaces in winter. However, chlorides also pose risks to aquatic life and raises human health concerns as they move to surface waterbodies and infiltrate groundwater. In response, many government bodies have adopted winter maintenance best management practices (BMPs) that reduce the amount of chlorides used while providing service and safety. Commercial businesses maintaining parking lots, driveways, and other surfaces have been shown to contribute as much as 50% of the chloride loads to local waterbodies in some areas, but less is known about the potential benefits of private contractors to implement similar BMPs. In addition, many existing resources on the topic are designed for municipal audiences, creating a knowledge gap about the feasibility of private companies to adopt these practices. The authors identified 14 BMPs common to municipal plans with the potential to be adopted by private contractors through a literature review. These practices aim to increase the efficiency of salt applications, and/or decrease environmental impacts while delivering a similar level of service and cost over time. The authors considered potential barriers and benefits to private contractors adopting and using these BMPs. Benefits included reduced liability (e.g., risk of lawsuits), costs, environmental impacts, and improved service. Barriers included additional staff time and training, increased materials, equipment, and maintenance costs. Additional research is needed to ground-truth these predicted motivations and barriers; a greater understanding of private contractor behaviors can enhance educational efforts that promote reduced salt practices.

Barriers and facilitators to accessing health and social care services for people living in homeless hostels: a qualitative study of the experiences of hostel staff and residents in UK hostels

IntroductionThe number of people living in homeless hostels in the UK has steadily increased over the past decade. Despite people experiencing homelessness often having considerable health problems and a range of complex needs frequently in association with addictions, the experiences of hostel staff and residents especially in relation to accessing health and social care support have seldom been explored. The aim of this paper is to identify the barriers and facilitators to accessing health and social care services for people living in homeless hostels.DesignExploratory qualitative baseline data were collected as part of an intervention to facilitate palliative care in-reach into hostels.Setting/participantsInterviews were conducted with 33 participants; 18 homeless hostel managers/support staff and 15 people experiencing homelessness, from six homeless hostels in London and Kent.ResultsThree themes were identified (1) internal and external service barriers to health and social care access due to stigma, lack of communication and information sharing from services and assumptions around capacity and the role of the hostel, (2) the impact of lack of health and social care support on hostel staff leading to burnout, staff going beyond their job role and continuous support given to residents, (3) potential facilitators to health and social care access such in-reach and support from those who understand this population and hostel staff training.DiscussionResidents have multiple complex needs yet both hostel staff and residents face stigma and barriers accessing support from external services. Positive relationships were described between hostel residents and staff, which can be an essential step in engaging with other services. People experiencing homelessness urgently need better access to person-centred, trauma-informed support ideally via in-reach from people who understand the needs of the population.

Development of and Preliminary Evidence for a Psychological Service Barriers Measure Among College Sexual Assault Survivors

Sexual assault is a widespread problem on college campuses, and survivors rarely use campus supports. However, there is no established measure of service barriers for this population. This study develops and provides preliminary evidence for a measure of psychological service barriers. Data were collected from 100 college sexual assault survivors. Results provide evidence for three factors: social-emotional barriers, negative treatment barriers, and minimization barriers. Additional tests offer evidence for consistency and reliability in these factors over time and across campus supports. This work offers preliminary evidence for the psychometric properties of this measure and lays the groundwork for future validation research.

Oral Health and Dental Care in Older Korean Immigrants: A Qualitative Study

Many segments of the U.S. population continue to experience a disproportionate burden of oral disease and inequities in dental care, and older Asian immigrant populations are among those at high risk. Responding to the needs to attend to ethnic and geographic variations among older Asian Americans and to better understand contextual factors that shape their experiences of oral health and dental care, the present study conducted in-depth interviews with eighteen older Korean immigrants in the Los Angeles Greater area. The qualitative inquiries were theoretically guided by the three core categories of the Andersen’s (1968, 1997) health service model: oral health needs, service barriers, and service outcomes. Using the constant comparison method, themes and sub-themes within each category were derived. The eight themes emerged from the qualitative data were: (1) oral health problems, (2) perceived need, (3) insurance and finance, (4) language barriers, (5) social support, (6) knowledge and belief, (7) satisfaction with service, and (8) areas of improvement. The findings demonstrated varied experiences associated with oral health and dental care of older Korean immigrants and informed the development of services and programs responsive to the identified needs and barriers.

The management of venous leg ulceration post the EVRA (early venous reflux ablation) ulcer trial: Management of venous ulceration post EVRA

Objectives This survey study evaluates current management strategies for venous ulceration and the impacts of the EVRA trial results. Methods An online survey was disseminated to approximately 15000 clinicians, through 12 vascular societies in 2018. Survey themes included: referral times, treatment times and strategies, knowledge of the EVRA trial and service barriers to managing venous ulceration. Data analysis was performed using Microsoft Excel and SPSS. Results 664 responses were received from 78 countries. Respondents were predominantly European (55%) and North American (23%) vascular surgeons (74%). Responses varied between different countries. The median vascular clinic referral time was 6 weeks and time to be seen in clinic was 2 weeks. This was significantly higher in the UK (p ≤ 0.02). 77% of respondents performed surgical/endovenous interventions prior to ulcer healing, the median time to intervention was 4 weeks. 31% of participants changed their practice following EVRA. Frequently encountered barriers to implementing change were a lack of operating space/time (18%). Conclusion Venous ulcers are not managed as quickly as they should be. An evaluation of local resource requirements should be performed to improve service provision for venous ulceration. When interpreting the results of this survey consideration should be given to the response rate.

Training Service Providers to Identify and Overcome Service Barriers in Working with Transgender IPV Survivors

For more than a decade, FORGE has been training victim service providers on how to better meet the needs of transgender, nonbinary, and gender nonconforming survivors of intimate or sexual violence. This chapter synthesizes what FORGE has learned about the barriers between transgender intimate partner violence (IPV) survivors and IPV service providers, and best practices in training approaches and techniques, including why FORGE has chosen not to present an oppression model in its training approach. Particular attention is paid to cognitive adaptations service providers need to make to adapt a service system that is literally based on a traditional gender binary so that it can respectfully serve nonbinary and transgender survivors.

Service Barriers for Gender Nonbinary Young Adults: Using Photovoice to Understand Support and Stigma

The social and health care needs of transgender people is a growing focus within social work literature. Attention to social and physical health disparities suggests that transgender-affirming services are an often unmet need. As ways to improve services are explored, attention must be paid to the diverse identities of transgender people. Although a large number of transgender people identify as nonbinary, the majority of research has examined the experiences of transgender men and women, thus often overlooking the unique experiences of those whose gender is outside of a dichotomous binary. A stronger understanding of the experiences of people who identify as nonbinary is essential for advancing affirming social work policies and practices. This photovoice study examined identity support and stigma faced by nonbinary young adults. Participants identified several themes related to seeking care from service providers and described the presence of assumptions contributing to their identities being pathologized. Findings show that nonbinary young people, like their binary transgender peers, experience discrimination in their interactions with providers and society more generally. However, the binaristic assumptions that are described add an important dimension to existing literature. Overall, the findings call for an increasingly queer understanding of gender among social work scholarship and practice.

Plant-Based Sustainable Development—The Expansion and Anatomy of the Medicinal Plant Secondary Processing Sector in Nepal

There is an increasing global demand for medicinal plants. Nevertheless, the nature and scale of processing in national-level medicinal plant production networks, and how this can contribute to sustainable development, are poorly understood. This study (i) uncovers and explains the emergence of the Nepalese medicinal plant secondary processing sector, (ii) characterises the enterprises and identify the obstacles they face, (iii) quantifies the volumes and values of processed species and end markets, and (iv) discusses the potential to contribute to sustainable economic development. Empirical data were generated from key informant interviews and qualitative (n = 13) and quantitative (n = 79) semi-structured surveys of medicinal plant processing enterprises. In 2014–15, the sector purchased 3679 metric tonnes of air-dry raw materials (across 67 products) for USD 4.0 million, producing 494 tonnes of end-products valued at USD 11.2 million. The sector is characterised by small enterprises. Rising domestic demand drove the increase in the number of enterprises. Key business obstacles were export barriers, low access to technology, infrastructure and service barriers, labour challenges, socio-economic and political instability, and the inefficient bureaucracy. The actions required to change from being a supplier of raw materials and producer of lower-value domestic consumer products to integrating into the global economy as an exporter of higher-value products that are sustainably sourced are discussed.