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Background Gypsies, Travellers and Roma (referred to as Travellers) are less likely to access health services including immunisation. To improve immunisation rates, it is necessary to understand what helps and hinders individuals in these communities in taking up immunisations. This study had two aims.Investigate the views of Travellers in the UK on the barriers and facilitators to acceptability and uptake of immunisations and explore their ideas for improving immunisation uptake;Examine whether and how these responses vary across and within communities, and for different vaccines (childhood and adult). Methods This was a qualitative, cross-sectional interview study informed by the Social Ecological Model. Semi-structured interviews were conducted with 174 Travellers from six communities: Romanian Roma, English Gypsy/Irish Travellers (Bristol), English Gypsy (York), Romanian/Slovakian Roma, Scottish Show people (Glasgow) and Irish Traveller (London). The focus was childhood and selected adult vaccines. Data were analysed using the Framework approach. Results Common accounts of barriers and facilitators were identified across all six Traveller communities, similar to those documented for the general population. All Roma communities experienced additional barriers of language and being in a new country. Men and women described similar barriers and facilitators although women spoke more of discrimination and low literacy. There was broad acceptance of childhood and adult immunisation across and within communities, 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 and described barriers to booking and attending immunisation. Cultural concerns about antenatal vaccines and HPV vaccination were most evident in the Bristol English Gypsy/Irish Traveller community. Language, literacy, discrimination, poor school attendance, poverty and housing were identified as barriers across different communities. Trustful relationships with health professionals were important and continuity of care valued. Conclusions The experience of many Travellers in this study, and the context through which they make health decisions, is changing. This large study identified key issues that should be considered when taking action to improve uptake of immunisations in Traveller families and reduce the persistent inequalities in coverage. Trial registration Current Controlled Trials ISRCTN20019630. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4178-y) contains supplementary material, which is available to authorized users.

BackgroundGypsies, 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.MethodsThree-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.ResultsThere 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.LimitationsNo Travellers living on the roadside or on unofficial encampments were interviewed. We should exert caution in generalising to these groups.Future workTo include development, implementation and evaluation of a national policy plan (and practice guidance plan) to promote the uptake of immunisation among Traveller communities.Study registrationCurrent Controlled Trials ISRCTN20019630 and UK Clinical Research Network Portfolio number 15182.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 72. See the NIHR Journals Library website for further project information.

Aims To investigate the barriers and facilitators to acceptability and uptake of immunisation among Gypsy/Traveller communities in the UK. Methods We interviewed 174 Gypsy/Travellers from five communities: Romanian/Slovakian Roma, English Gypsy, Irish Travellers, English Roma, Scottish Showpeople, in four UK cities: Interviews gathered views about the influences on their immunisation behaviours (childhood, adult flu and pertussis vaccines) and ideas for improving uptake in their community. Interview data were analysed using the framework approach. The Social Ecological Model provided the theoretical framework. Results General acceptance of immunisation based on social norms and trust in health professionals was expressed by approximately half of the participants from the English Roma and London Irish Traveller communities in two cities; three quarters of the English Gypsy/Irish Traveller community and Scottish Showpeople; and almost all of the Romanian/Slovakian Roma participants. Concerns about specific vaccines were evident for particular communities e.g. pertussis vaccine in pregnancy for the English/Irish Traveller community in one city, MMR for the Scottish Showpeople. A belief that having the HPV vaccination would imply that Traveller girls are promiscuous was evident for a minority of Travellers in four communities (not Scottish Showpeople). Romanian/Slovakian Roma communities identified language barriers to accessing immunisation services and low literacy across all communities resulted in people being unable to read immunisation leaflets or letters/texts about appointments and struggling to make sense of conversations with health professionals. Relationships with health professionals appeared to be very important. Recall and reminder systems (letters, texts, phone calls) were seen as effective for the majority of participants including those who regularly travel. Most did not appear to have problems with attending appointments for immunisations although some talked about the difficulty of registering with a GP practice without a fixed address and being unable to get an appointment within two weeks. Conclusion Although these Travellers’ accounts of the barriers and facilitators to immunisation have consistency with the wider population, there are some important differences between communities. Immunisation services need to be aware of Gypsy/Traveller communities in their area and tailor services accordingly.