Exploring Vaccination Challenges among Syrian Refugees in Jordan: Insights from Camps and Communities, and Perceived Parental Barriers to Childhood Vaccination Uptake

"...aim to empower parents with the information and support needed to make informed decisions regarding childhood vaccinations, ultimately contributing to the broader mission of promoting health equity among those who have been disadvantaged by the complex circumstances of displacement and migration."

Studies have consistently shown that refugees have a higher burden of vaccine-preventable diseases (VPDs) compared to their host populations. This study seeks to identify and understand the multifaceted barriers that Syrian refugees in Jordan confront when it comes to seeking vaccination services for their children. The insights gleaned from this research hold the potential to inform the development of targeted and effective VPDs policies and interventions.

A survey questionnaire was administered through structured interviews to a sample of 332 Syrian refugees (aged from 18 to 67) residing inside the Al-Zaatari camp and in various urban areas across Jordanian communities. The survey covered the following sections: demographics, vaccine hesitancy, and barriers to vaccination. The latter section was categorised into six categories: (i) access barriers (issues related to physical access and availability of vaccination services); (ii) clinic or health system barriers; (iii) concerns and beliefs about vaccination; (iv) health perceptions and experiences barriers; (v) knowledge and information barriers; and (vi) social or family influence barriers.

The most commonly reported perceived barriers were primarily linked to social and family influence (48.9%), with the main barrier cited being related to gender norms regarding responsibility of child vaccination follow-up schedules (50.9%). Next were perceptions about health and vaccines (40.5%) - e.g., belief there is no need to take the vaccine due to the mild severity of illness or invulnerability of children - and concerns and beliefs regarding immunisation (40.4%) - e.g., feelings of regret and hesitancy about future vaccines when side effects of current vaccines occur. In addition, lack of information and proper knowledge (38.2%), difficulties in accessing healthcare (38%), and various barriers related to the healthcare system and facilities (33.1%) were also reported. Specific barrier-related findings:

• Sociodemographic disparities regarding barrier perception were evident among participants. Middle-aged adults (older than 32), males, and those with a monthly income less than $US200 scored significantly higher on barrier perceptions across all categories (p < 0.05).
• In-camp residents were less likely to face vaccination barriers compared to those living outside the camps (p < 0.001).

The survey section on hesitancy included a 15-item tool derived from the "5C model" of psychological factors influencing vaccination: confidence, complacency, constraints, calculation, and collective responsibility. Specific findings related to hesitancy:

• Younger individuals had significantly higher scores in complacency, calculation, and constraints (p < 0.05).
• Participants with lower income had lower constraints and calculation scores (p < 0.05).
• In-camp residents had significantly higher scores in complacency, constraints, and calculation constructs compared outside camps counterparts (p < 0.05).
• Participants with no formal education had higher scores in complacency and constraints, and those with less than a 12th-grade education and higher education degrees scored significantly higher on the collective responsibility construct (p < 0.05).

In discussing the findings, the researchers note that reducing VPD rates among refugees and increasing their vaccination rates requires strategies to tackle the different barriers encountered by this population. Efforts to promote vaccination among refugees should consider the specific challenges faced by this population, including financial barriers, healthcare access inequalities, and the impact of living arrangements. Multiple studies have shown the positive effects of educational programmes implemented in school and community settings in resigning awareness regarding vaccinations. Simple technological tools, such as smartphone applications, have been used to facilitate vaccination appointments and follow-up visits. Publicly funding vaccination campaigns and arranging organised door-to-door immunisation programmes with local actors and non-governmental organisations have resulted in the successful delivery of vaccine doses, studies report.

In conclusion: "Ultimately, by addressing the perceived parental barriers to childhood vaccination in the Syrian refugee population, we can contribute to achieving greater health equity among those who have been disproportionately affected by the complexities of displacement and migration. This study serves as a foundation for future research and policy development in this important area of public health."