Identifying Immunization Barriers Among Asian American Children: Results and Recommendations Asian H

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Identifying Immunization Barriers Among Asian
American ChildrenResults and RecommendationsAs
ian Health Coalition of IllinoisMay 13, 2004
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IBAAC Project-Funding

• Funded by the American Academy of Pediatrics
• Funded through the CATCH Program
• Community Access to Child Health
• CATCH is the area in the AAP that highlights care
  of children in their respective communities

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Asian Health Coalition of Illinois

• Mission
• To improve the health and well-being of
• Asian Americans and Pacific Islander
• (AAPIs) in Illinois.

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Asian Health Coalition

• Areas of work
• Advocacy, technical assistance, education,
• and community-based research
• Members
• Health care providers, community-based
  organizations, social service providers, public
  health departments, researchers, students

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AHCI Programs

• Cultural competence training
• HIV prevention capacity-building assistance
• Tobacco control (cessation and prevention/awarenes
  s)
• Childhood immunization
• Annual conference
• Quarterly membership meetings
• Information, Referral, Listserve

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IBAAC-Background

• Project developed in 2000 in response to data
  indicating a downward trend in immunization rates
  among Asian American children
• Project conducted focus groups in 6 Chicago Asian
  communities

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AAPI Population Percent Increase in 6 Illinois
Counties, 1990-2000
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Who are AAPIs in Illinois? (1 of 2)
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Who are AAPIs in Illinois? (2 of 2)
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Access to CarePercentage of Uninsured AAPIs
(2001)
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IBAAC Project-Advisory Committee

• Principal Investigator
• Dennis L. Vickers,MD,MPH IWS
• Committee Members/ Agencies
• Fred Kviz, Ph.D UIC SPH
• Hong Liu, Ph.D IHEC
• Julie Morita, MD CDPH
• Joanna Su,MSW AHCI
• Virginia Warren,RN,MPH IHEC
• Student Interns
• Richa Aggarwal
• Michelle Choi,RN,MSN

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IBAAC-Partner Agencies

• Cambodian Association of Illinois
• Chinese American Service League
• Indo-American Center
• Korean American Community Services
• Lao American Community Services
• Vietnamese Association of Illinois

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IBAAC Project Methods

• Focus group format
• Trained bilingual bicultural moderators
• Audiotaped proceedings transcribed
• into English
• Written summary report

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Participants

• N67 Range 7-15
• Participants received a 25 stipend
• Discussion centered on 6 questions

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Focus Groups Questions

• 1. What are the good or positive things that come
  to mind when you think about childhood
  immunizations?
• 2. What are the things about childhood
  immunization that you think are not so good?
• 3. What problems have you experienced in getting
  your child immunized?

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Focus Group Questions

• 4. When you take your children to get
  immunizations, what problems have you had in
  communicating with your childrens health care
  provider?
• 5. Do you have any concerns, problems, or
  questions about childhood immunizations?
• 6. What suggestions do you have that might solve
  the problems that we have talked about today?

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IBAAC Results
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Demographics

• All participants were foreign born
• Only 8 identified English as their primary
  language
• 97 reported having a primary care provider for
  their child

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Health Insurance Status

• Insured 90
• Medicaid 36
• KidCare 22
• Private Insurance 31
• Uninsured 10

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Communication with Provider

• 48 reported speaking to their provider in their
  native language
• 26 reported speaking English to their provider
• 17 reported using a friend or relative as an
  interpreter

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Perceptions of Immunizations

• 71 reported being very concerned about the
  effects of childhood diseases

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Identified Barriers

• Cost
• Language
• Information and Records
• Appointments
• Provider Choice

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Cost

• Some participants mentioned that they paid as
  much as 50-60 for each immunization
• Many participants were unaware of how to access
  free immunizations

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Language

• Many participants stated that they had great
  difficulty communicating with their doctors
• Many participants reported difficulty
  understanding written material

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Information and Records

• Doctors do not provide an explanation of the
  immunizations that children are receiving
• Immunization records are confusing
• Concerned that physicians do not have up to date
  records

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Appointments

• Difficulty in scheduling appointments
• Wait-times up to 2 hrs to see doctors
• Walk in appointments
• Scheduled appointments

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Provider Choice

• Some participants complained that it was
  difficult to know which doctors are providing
  quality care

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Recommendations

• Increase access to free immunization services
• Increase awareness of existing free immunization
  services
• Decrease language barriers
• Provide effective immunization materials to
  limited English proficient communities
• Educate communities about provider choice

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As a resultsteps taken
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First Step

• Increase Asian American (AA) community based
  organizations, Public Health, Illinois Chapter of
  the American Academy of Pediatrics and Chicago
  Area Immunization Campaign (CAIC) collaborations

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Increase Access to Immunizations

• AA community-based organizations can schedule and
  promote mobile immunization clinics
• CDPH CareVan
• Identify other sources of free immunization
  services

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Increase Awareness of Free Immunization Services

• CDPH and CAIC can provide materials to AA
  community-based organizations
• Increase awareness of existing free immunization
  programs
• Vaccines for Childrens Program
• CDPH Fasttrack clinics
• CDPH Neighborhood Health Centers
• CDPH, CAIC and AA community-based organizations
  can work with ethnic media as a vehicle for
  disseminating information on free immunization
  services

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Decrease Language Barriers

• CDPH and ICAAP can educate providers
• Obligation to offer interpretation services to
  limited English proficient patients
• Provide interpretation resources to providers
• Availability of translated immunization education
  materials such as Vaccine Information Statements
  (VIS) available from www.immunize.org
• Consider audiotapes and videotapes as a means of
  reaching populations with low literacy

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Decrease Language Barriers

• CDPH, CAIC and AA community based organizations
• Increase awareness of existing translated
  immunization education materials such as the VISs
  available from www.immunize.org
• Translate Vaccine Information Statements into
  additional languages (Hindi and Urdu)
• Translate school immunization requirements

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Provide Immunization Education Materials to AA
Communities

• CDPH, CAIC, and AA community organizations will
  develop a community education curriculum and
  materials
• Overview of disease and immunizations
• Explanation of the childhood immunization records
• Encourage AA parents to ask questions of their
  providers
• Provide ways of evaluating and selecting health
  care providers