UNderstanding uptake of Immunisations in TravellIng aNd Gypsy communities (UNITING): a qualitative interview study

Background: Gypsies, Travellers and Roma (referred to as Travellers) are less likely to access health services, including immunisation. To improve immunisation rates, we need to understand what helps and hinders individuals in these communities in taking up immunisations. Aims: (1) Investigate the barriers to and facilitators of acceptability and uptake of immunisations among six Traveller communities across four UK cities; and (2) identify possible interventions to increase uptake of immunisations in these Traveller communities that could be tested in a subsequent feasibility study. Methods: Three-phase qualitative study underpinned by the social ecological model. Phase 1: interviews with 174 Travellers from six communities: Romanian Roma (Bristol); English Gypsy/Irish Traveller (Bristol); English Gypsy (York); Romanian/Slovakian Roma (Glasgow); Scottish Showpeople (Glasgow); and Irish Traveller (London). Focus on childhood and adult vaccines. Phase 2: interviews with 39 service providers. Data were analysed using the framework approach. Interventions were identified using a modified intervention mapping approach. Phase 3: 51 Travellers and 25 service providers attended workshops and produced a prioritised list of potentially acceptable and feasible interventions. Results: There were many common accounts of barriers and facilitators across communities, particularly across the English-speaking communities. Scottish Showpeople were the most similar to the general population. Roma communities experienced additional barriers of language and being in a new country. Men, women and service providers described similar barriers and facilitators. There was widespread acceptance of childhood and adult immunisation, with current parents perceived as more positive than their elders. A minority of English-speaking Travellers worried about multiple/combined childhood vaccines, adult flu and whooping cough. Cultural concerns about vaccines offered during pregnancy and about human papillomavirus were most evident in the Bristol English Gypsy/Irish Traveller community. Language, literacy, discrimination, poor school attendance, poverty and housing were identified by Travellers and service providers as barriers for some. Trustful relationships with health professionals were important and continuity of care was valued. A few English-speaking Travellers described problems of booking and attending for immunisation. Service providers tailored their approach to Travellers, particularly the Roma. Funding cuts, NHS reforms and poor monitoring challenged their work. Five ‘top-priority’ interventions were agreed across communities and service providers to improve the immunisation among Travellers who are housed or settled on an authorised site: (1) cultural competence training for health professionals and frontline staff; (2) identification of Travellers in health records to tailor support and monitor uptake; (3) provision of a named frontline person in general practitioner practices to provide respectful and supportive service; (4) flexible and diverse systems for booking appointments, recall and reminders; and (5) protected funding for health visitors specialising in Traveller health, including immunisation. Limitations: No Travellers living on the roadside or on unofficial encampments were interviewed. We should exert caution in generalising to these groups. Future work: To include development, implementation and evaluation of a national policy plan (and practice guidance plan) to promote the uptake of immunisation among Traveller communities

What Next for Social Marketing - Developing ‘Superman’ or a Sustainable System?

Social marketing is being increasingly used within the UK health system to address a range of health inequality issues. The Department of Health for England plans to increase the use of social marketing at both national and local levels. However, this can only be achieved if the correct resources are in place. Currently we have a shortage of skilled social marketing practitioners within the UK. The Department of Health is therefore looking to academia to help increase capacity and skills to fill this gap. Presently, capacity and capability within the academic system are limited. This article is aimed at promoting debate about how academic capacity is grown within the UK. It also aims to reflect the main challenges we are facing in the UK, which may or may not be reflected in other countries

The Loving Support Breastfeeding Campaign: Awareness and Practices of Health Care Providers in Mississippi

Objectives: To evaluate the impact of the national breastfeeding promotion campaign, Loving Support Makes Breastfeeding Work, on health care providers in Mississippi. Design: Cross-sectional study. Setting: The Mississippi WIC (Women, Infants, and Children) program implemented the national Loving Support project for the state. Questionnaires were mailed to all hospitals with obstetric services and WIC clinics and to a random sample of one half of the practicing pediatricians and one third of the practicing family physicians in the state. Participants: Two hundred and two health care providers, including 104 nurses and 98 physicians, responded to the questionnaire. Main Outcome Measures: Health care providers\u27 (a) awareness of the breastfeeding promotion activities in the state; (6) changes in practice in providing breastfeeding advice and referrals to lactation specialists and for breast pumps; and (c) changes in the management of breastfeeding-related problems. Results: A significantly higher proportion of nurses than physicians mentioned breastfeeding benefits to mothers, provided breastfeeding management advice, and referred mothers for breast pumps and to lactation specialists after the campaign. Conclusions: This study showed the positive impact of the campaign on nurses\u27 breastfeeding awareness and practices. More efforts are needed to continue breastfeeding outreach activities for health care providers

European Elections Survey, 1979

Interest in European elections / knowledge about who won seats/ most important issues / r. talked, read about European elections/ attended public meetings/ watched tv, radio programmes. Questions on tv campaign: worthwhile information?/ opinion on amount of time spent on campaign / opinion on European Parliament, unification of Europe / if voted for E.P. what most important: domestic or European matters / reasons not voting / political left, right rating. Background variables: basic characteristics/ residence/ household characteristics/ occupation/employment/ income/capital assets/ education/ politics/ readership, mass media, and 'cultural' exposur