Identification and tailoring of interventions for vaccine uptake in underserved communities

Abstract Background The project RIVER-EU works with the migrant community in Greece, the Turkish females and Moroccan females in the Netherlands, the Ukrainian minority in Poland, and marginalized Roma communities in Slovakia to remove health system barriers to childhood vaccination, such as a lack of culturally and linguistically appropriate information, financial barriers and insufficient capacities, coordination and delivery of health care. Methods The RIVER-EU project uses a longitudinal process to facilitate sustainable health system change based on the Population, Intervention, Environment and Transfer (PIET-T) models of transferability and principles of participatory action research. To address health system barriers, six useful evidence-based interventions were assessed for their transferability. Based on the final selection in each country, interventions were tailored under consideration of specific needs and contextual conditions for the further implementation process. Results A multilevel intervention approach with selected and trained health promoters from the community is potentially transferable with specific adaptations in all countries. Key elements are principles of trust in the educator, tailored and trustworthy information, help in navigating the health system for vaccination and easy access at no cost. Barriers and facilitators for transferability showed that no evidence-based intervention is transferable as intended and that tailoring to context is essential, requiring specific process guidance. Conclusions The process of understanding health system barriers to vaccination, identification of transferable intervention approaches, tailoring, implementation and evaluation of interventions to enable their transferability needs an in-depth engagement with the communities and their context. RIVER-EU will develop a guideline to assist policy makers, professionals and scientists who aim to remove health system barriers to vaccination in their specific context.