- Tracking immunization status. In area with high turnover of residents, it can be difficult to keep in touch with children to ensure that they completed their immunization courses (Leese, 1992).
- Lack of information. The failure to raise immunization levels in poor, underserved populations is caused in part by the lack of timely and accurate child-specific immunization information for providers and parents. Although immunization rates among children are rising across the country, rates in inner-city areas have remained lower than corresponding suburban or state immunization levels (Wood, 1999).
- Lack of awareness. Rural and urban areas face many significant community-based barriers to immunizations, including difficulties in interacting with the health system and lack of integration with the larger primary care system (Rosenberg, 1995).
- Access to health care. Limited access to health care providers in the more rural areas and lack of Medicaid providers affects immunization rates (Niederhauser, 2005).
- Transportation. Geographic barriers and transportation difficulties in rural and urban areas have been cited as a reason for delayed immunization status (Niederhauser, 2005).
Strategies to address these considerations:
- Improve school-based programs. Researchers have concluded that with sufficient attention to political and logistical dimensions, school-based immunization programs could be successful in large urban schools (Boyer-Chuanroong, 1997). Rural communities may also benefit from the provision of immunizations services in school districts.
- Provide community-based programs. 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, churches 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).
- Address transportation barriers. Primary care providers and agencies involved with families need to be aware of geographic barriers to needed health services both in rural and urban settings. Bus schedules, taxi voucher programs, home visitors and family and neighbors are all resources that a health care provider can explore with individuals (Niederhauser, 2005).
- Mobilize immunization team. In rural and urban settings, a mobile immunization team may be one of the most effective ways to deliver immunization services (Fenner, 1988).
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