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

A big or divided society? Final report of the panel review into the impact of the Localism Bill and Coalition government policy on Gypsies and Travellers

Since the first piece of legislation was passed against 'Egyptians‘ (Romany Gypsies) by Henry VIII in the 1500‘s, Gypsies and other Travellers have had a complex and difficult relationship with the state. For the last five centuries a seemingly unending list of laws have been drawn up to ban, restrict and criminalize them for their way of life, with apparently little recourse to the more universal laws that are supposed to ensure equality and dignity to all. Despite this, they have thrived amongst us, enriching our culture and society through their resilience, tenacity and humor in the face of adversity and exclusion. Perhaps most striking of all is their continued courage and strength against the unrelenting machinery of state in standing up for what they believe in. Once again, Gypsy Roma Traveller face new changes in the law that will affect them directly, forcing them to engage yet again in a campaign to ensure their basic rights are protected. The Travellers Aid Trust has actively supported Traveller law reform for many years. In light of the proposed policy changes being put forward by the new Coalition government and their potential impact on the Gypsy Roma Traveller community, the Trust welcomed the opportunity to facilitate a Panel Review. The Panel has provided a platform that has brought together a wide range of stakeholders enabling them to share their wealth of knowledge and experience in this area. The following Report and recommendations are the result of the time and energy of many and varied people from a range of backgrounds and professions as well as the poignant testimony of Gypsies and Travellers themselves. In compiling and publishing this Report, the Trust hopes to facilitate a better understanding of the implications and intricacies of the proposed policies to those vested with the power to affect changes that will impact directly on the wellbeing of those for whom they are responsible. Susan Alexander - Trust Administrato