Racial and ethnic minorities
- Health insurance. Racial and ethnic minorities are less likely to have adequate health insurance (Kaiser, 2007). Hispanic and African American patients are more likely to receive care in hospital emergency rooms and are less likely than whites to have a primary care provider due to lack of health insurance (Smedley, 2003).
- Cultural incompetence: Health care providers' lack of knowledge and understanding about the culture of the people they are serving, including their traditions, history, values and family systems, can hamper the optimal delivery of care (Smedley, 2003).
- Access to quality health care. Racial and ethnic minorities may have more difficulty obtaining health care due to lack of insurance and lack of access to health care facilities. Even at equivalent levels of access to care, they experience a lower quality of health services and are less likely to receive even routine medical services (Smedley, 2003).
- Language barriers. Studies have demonstrated that language barriers and the inability to comprehend immunization plans can lead to poor compliance and underuse of services (Penchansky, 1981). Low-income urban areas, frequently home to minority populations, face many significant community-based barriers to immunizations due to difficulties in interacting with the health system, especially because of language or immigrant status (Rosenberg, 1995).
- Literacy. Inappropriate health education materials written at an advanced reading level along with confusing immunization schedules can contribute to inadequate immunization (Evers, 2000).
- Immigrant immunization status. Immigrants are a target group for immunizations since they are less likely to have received primary vaccine series as children (Cannarella, 2001).
- Misconceptions. Common misconceptions (e.g., illness is possible after immunization, reuse of needles, vaccine ingredients) and fear of pain contribute to low immunization rates (Lashuay, 2000).
- Cost. Individuals who believe immunizations are costly may be less like to be properly immunized and are less likely to believe that shots are available at no charge for eligible populations (Lashuay, 2000).
Strategies to address racial/ethnic minority population considerations:
- Address language barriers. Informational materials should be translated to different languages (Boyer-Chuanroong, 1997). Pediatric health care workers must be able to efficiently and effectively communicate with people from different racial and ethnic backgrounds. Each provider needs to have a plan in place for providing translation services (Niederhauser, 2005).
- Address literacy barriers. Health care workers need to be sensitive to the health literacy level of individuals when discussing immunizations and distributing written information (Niederhauser, 2005).
- Create trust. Community nurses and outreach teams can be utilized to create a trusting environment (Abramson, 1995). A successful method to foster understanding and trust may be direct contact by an outreach worker. The ideal caseworker would be of the same racial or ethnic background as the population (Evers, 2000). Evidence shows that community organizations can be successful at mobilizing parents to fully immunize their children, particularly in areas where routine approaches have failed. Common outreach strategies utilized by community-based organizations may take the form of informal presentations to groups, such as women gathered at self-service laundries, day care centers or street fairs. Presentations may be complemented with periodic outreach conducted directly on the streets of their neighborhoods, by setting up an informational table and passing out informational fliers to passers-by (Rosenberg, 1995).
- Tailor to culture. Culturally-appropriate, evidence-based interventions selected by intervention sites have resulted in higher adult immunization rates in disadvantaged, racially diverse, inner-city populations. Interventions used were culturally-sensitive in choice of language and images and were implemented by multiracial health center staffs (Nowalk, 2008). Interventions tailored to reflect the culture of a population subgroup may be more effective than those aimed at a population in general (USDHSS, 2000).
- Media advertising. The media is an effective tool for reaching African Americans and other racial minorities. Media can be used to address specific concerns (e.g., clarification of the circumstances and likelihood of getting a mild case of the disease following an immunization, availability of free vaccine, risk of HIV) and this may contribute to increased immunization rates for this population (Lashuay, 2000).
- Increase access. Increase access to free or low-cost immunization opportunities in racial and ethnic minority communities.
- Provide cultural competency training. Strategies to reach racial and ethnic minority populations should be culturally relevant (National Center for Cultural Competency). It may be useful to provide training in cultural competency to individuals who are working with a community so that they can learn more about the differences within and across communities. See Cultural Competence for more information.
- Provide education. Education can be used to dispel myths and increase comprehension of immunization recommendations.
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