Health system barriers to vaccination among Ukrainian economic migrants in Poland

Abstract Background Before Russia's aggression, Ukrainians were the largest migrant group in Poland. However, data on health system barriers to vaccination in this vulnerable group were not collected. The study aimed to explore barriers to child MMR/HPV vaccination and related access to Polish healthcare services. Methods Between December 2021-January 2022, a qualitative study of Ukrainian migrants (UM) living in Poland, recruited through a snowball sampling method, was conducted as a part of RIVER-EU project. 8 focus groups were held with 49 UM aged 16-44 years, followed by interviews with 12 health care providers (HCP). Results UM and HCP experienced communication barriers despite language similarities. HCP reported that since a UM is not willing to register at a GP practice he cannot be reached by the Polish vaccination system. UM experienced challenges in navigating the system and accessing credible information in Ukrainian, no official local health authority vaccination material existed either. UM complained that there are no translated versions of vaccination materials accessible at the PHC facilities and they are not adequately informed about the possible side effects of vaccines; HCP reported the lack of time provided by the system for health promotion. UM were not familiar and rather hesitant regarding self-paid vaccines, such as HPV vaccine. In Poland and Ukraine this topic is not targeted at school curriculum neither by information campaigns. UM reported that HPV vaccine is not of interest for them due to the high cost, however they might consider it for their daughters, if the cost was fully refunded. Conclusions The study identified main health system barriers to child vaccination regarding economic UM in Poland, seen from the perspective of migrants and HCP and pinpointed issues for improvement. This can serve as a starting point to confront vaccination related challenges in the context of Ukrainian refugee crisis Poland is currently dealing with.


Background:
Before Russia's aggression, Ukrainians were the largest migrant group in Poland. However, data on health system barriers to vaccination in this vulnerable group were not collected. The study aimed to explore barriers to child MMR/HPV vaccination and related access to Polish healthcare services.

Methods:
Between December 2021-January 2022, a qualitative study of Ukrainian migrants (UM) living in Poland, recruited through a snowball sampling method, was conducted as a part of RIVER-EU project. 8 focus groups were held with 49 UM aged 16-44 years, followed by interviews with 12 health care providers (HCP). Results: UM and HCP experienced communication barriers despite language similarities. HCP reported that since a UM is not willing to register at a GP practice he cannot be reached by the Polish vaccination system. UM experienced challenges in navigating the system and accessing credible information in Ukrainian, no official local health authority vaccination material existed either. UM complained that there are no translated versions of vaccination materials accessible at the PHC facilities and they are not adequately informed about the possible side effects of vaccines; HCP reported the lack of time provided by the system for health promotion. UM were not familiar and rather hesitant regarding self-paid vaccines, such as HPV vaccine. In Poland and Ukraine this topic is not targeted at school curriculum neither by information campaigns. UM reported that HPV vaccine is not of interest for them due to the high cost, however they might consider it for their daughters, if the cost was fully refunded.

Conclusions:
The study identified main health system barriers to child vaccination regarding economic UM in Poland, seen from the perspective of migrants and HCP and pinpointed issues for improvement. This can serve as a starting point to confront vaccination related challenges in the context of Ukrainian refugee crisis Poland is currently dealing with.

Background:
People from marginalized Roma communities often experience poverty, limited access to education, employment, housing, and health care (HC). The aim of the study was to explore the perceptions of people from marginalized Roma communities and health professionals regarding health system (HS) barriers to HPV vaccination.

Methods:
A qualitative study was conducted in the Kosice region as a part of the RIVER-EU project. Semi-structured interviews with marginalized Roma parents (N = 18), children (N = 15), and health professionals (N = 18) were audio-recorded and thematic analysis of the transcripts was performed in MAXQDA.

Findings:
Four main themes were identified regarding HS barriers: 1. Lack of information (lack of culturally and linguistically appropriate information, lack of information provision from HC providers, unreliable and conflicting information on the internet), 2. Restricted access to HC providers (lack of capacities, work overload, long wait in the waiting room, distance, traffic connection), 3. Financial and organizational barriers (limited coverage of vaccination expenses from health insurance, picking up prescribed vaccines in a pharmacy by parents, parental consent), 4. Attitudes and behaviours of HC providers (neglect of care, double standard, inappropriate behaviour and communication, prejudices, racism).

Conclusions:
The reasoning and perception of several barriers to HPV vaccination differ among groups of respondents. Nevertheless, HPV is not viewed as a priority by both -marginalized Roma and health professionals. HS fails to reach marginalized Roma with appropriate information about HPV and HPV vaccination. Moreover, the lack of capacities and motivation of HC providers to address these topics lead to a lack of awareness. Organization and health insurance coverage of vaccination pose additional barriers to HPV vaccination.

Background:
Migrants have lower vaccination rates compared to the general population and report multiple barriers in accessing related services. We explored practices and perceptions regarding MMR & HPV vaccinations in migrant children & adolescents from third countries to inform the development of tailored interventions to increase vaccination coverage. Third country nationals for the RIVER-EU project are migrants arriving to the EU from countries beyond Europe (the Middle East, Asia & Africa) escaping civil conflict, war, and poverty.

Methods:
A qualitative study was conducted in the wider Athens area as part of the RIVER-EU project. Four Focus Groups and 23 semi-structured interviews were conducted with health care professionals, children and parents with a migrant background. Data were analysed using thematic content analysis. Findings: Identified barriers relate to the lack of standard operational procedures at system level that would define a schedule of vaccinations for migrants. Migrant vaccinations are subject to availability of vaccines (MMR as opposed to HPV) and potential threat of outbreaks (MMR vs HPV). There iii78 European Journal of Public Health, Volume 32 Supplement 3, 2022