Designing a 'Deep End' childhood immunisation intervention: a pre-implementation qualitative study.

Abstract

Childhood vaccination uptake is declining in England. Efforts are required to prevent further decline and safeguard against outbreaks of vaccine-preventable diseases (VPDs). Individuals in areas of high socioeconomic disadvantage can face greater barriers to vaccination and, subsequently, be at an increased risk of lower uptake and VPDs. To conduct a pre-implementation evaluation of a proposed childhood 'catch-up' immunisation pilot intervention targeted at North East and North Cumbria 'Deep End' (NENC DE) Network general practices. The NENC DE is a network of general practices serving populations experiencing high levels of socioeconomic disadvantage. The proposed intervention would provide additional staffing capacity (one administrator and two vaccination-trained nurses) to be used discretionally by each NENC DE practice; tasks could include offering an in-home roving vaccination service or identifying children not vaccinated to schedule. Semi-structured qualitative interviews were employed, and a purposive and snowball sampling approach was adopted. Fifteen interviews were conducted in 2023 - the initial commissioning phase of the intervention. Transcripts were analysed using the framework method. The proposed intervention was received with intrigue, especially the roving service, which would reduce some practical access barriers for families. Success could be measured by an increase in childhood vaccination uptake, hopefully among the most vulnerable children. However, concerns regarding physical space and staff safety were raised. We encourage the NENC DE intervention providers to ensure the service remains flexible and customisable. Further research will be required to assess its impact and effectiveness when underway.