British Columbia Fraser Health Authority

Project Title:  Immunization Outreach Service
Funding Recipient:  Fraser Health Authority, British Columbia
Project Contacts:  Shovita Padhi, MD MPH FRCPC, Medical Health Officer and Medical Director (Shovita.padhi@fraserhealth.ca)       
Project Period:  January 7, 2019 to March 31, 2021

About the project

The immunization outreach services project aims to enhance access to vaccination services and increase vaccine coverage within the Fraser Health Authority by reducing barriers and improving access to vaccination services among vulnerable populations such as Indigenous families, newcomers, or those with low income. The goal is to increase the number of two-year old children who are up-to-date with their vaccinations and to reach families that may not otherwise have access to vaccination services.  Through a tailored, data-informed approach, the outreach clinics will target geographic areas with low vaccination rates and populations who face barriers to accessing existing services. Data will also be used to characterize under and un-vaccinated families to identify the factors that influence vaccination decisions.

Goal

To increase the number of 2-year olds who are up to date for immunizations and reduce inequities in vaccination coverage.

Objectives

1. Gather and assess information that will permit the tailoring of services to more vulnerable populations with lower immunization rates by:
   • Monitoring inequities in vaccine coverage, including socio-economic and geographic differences in coverage.
   • Identifying reasons why parents are unable to take their children a family doctor or public health unit for immunizations.
   • Identifying specific populations who have lower immunization coverage rates.
2. Develop, implement, and evaluate a model for immunization outreach services that:
   • Offers accessible immunization services in community locations.
   • Targets neighbourhoods with low immunization coverage and vulnerable populations and harder to reach families such as indigenous, newcomer, and low-income families.
3. Develop and share strategies to improve access and reach for populations with lower immunization coverage.

Outcomes

• Short Term:
  • Increase knowledge among public health staff regarding: the barriers that prevent families from getting their children vaccinated; characteristics of communities with low coverage rates; and socio-demographic inequities in vaccine coverage
  • Increased accessibility and availability of vaccination services
• Medium Term:
  • Increase in the proportion of 2-year olds with up to date vaccinations
  • Decrease in differences in vaccination coverage rates among Fraser Health neighbourhoods
  • Increased accessibility of vaccination for vulnerable populations and groups with lower vaccination coverage
• Long Term:
  • Increased 2-year old vaccination coverage rate to 95% by 2025
  • Decreased socio-economic and geographic inequity in vaccination coverage

The challenge that the project addresses

Fraser Health Authority has made significant progress in increasing vaccination coverage by improving operations within public health units, providing text-message appointment reminders to clients, engaging with physicians, and promoting vaccination on their website and through social media. However, some communities and neighbourhoods within the Fraser Health Authority still have low vaccination coverage rates in the range of 67-72%. Increasing vaccination coverage rates in these areas is essential to achieve both provincial and national targets. This project will examine and address the reasons families within the Fraser Health region may lack access to vaccination services or be making the decision not to vaccinate.

Research in Canada has shown that a variety of socio-economic factors are associated with a lower likelihood of vaccination. These include common-law marital status, receiving social assistance, low income, single parenthood, young maternal age, and being the third or later child. Other studies have identified inconvenience, lack of time, transportation costs, difficulty getting an appointment, and difficulty accessing or navigating services as reasons parents delay or do not complete their child’s vaccinations.  This evidence indicates the need to provide vaccination services that:

• Are accessible and convenient for families;

• Build trust and positive rapport between health care providers and families; and,

• Address inequities faced by vulnerable populations.

About the Fraser Health Authority

Fraser Health Authority in British Columbia serves a diverse population of over 1.8 million people located in urban, rural and remote communities.  They serve communities stretching from Burnaby to White Rock to Hope. The Fraser Health Authority delivers a wide range of health care services including acute care, community-based residential care, home health, mental health and public health services.

Demographically, Fraser Health has a relatively young population. It is home to 40% of BC children, and 42 babies are born in the Fraser Health region each day.  This region is multicultural, including approximately 38,100 First Nations people, associated with 32 bands and a large South Asian population. Furthermore, approximately 80-90% of refugees who come to BC settle in this region.

Their vision is better health, best in healthcare with the purpose of improving the health of the population and the quality of life of the people they serve.