- Access to health insurance. Lack of health insurance is prevalent in low-income communities (Szilagyi, 2006). As a result, these individuals may not have access to a regular health care provider. Therefore, they may not receive recommended immunizations to prevent diseases and infections.
- Distrust. Distrust of medical professionals is prevalent among low-income individuals (Abramson, 1995). Individuals who do not trust their health care providers may be less likely to adhere to immunization recommendations.
- Language barriers. Low-income communities tend to have residents from diverse backgrounds. Individuals in these communities may speak a wide variety of languages (Tung, 2005). Language barriers may cause difficulties in interacting with the health care system and lower comprehension of immunization recommendations (Rosenberg, 1996).
- Cost. Cost of vaccines may deter low-income individuals from getting needed/recommended immunizations (Ives, 1994).
- 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 (Wood, 1999). Low-income communities tend to exhibit a general lack of awareness of the need to immunize children under the age of two and misunderstandings about the immunization schedule and side effects Rosenberg, 1995).
- Awareness of resources. Low-income families may not be aware of immunization assistance programs (Luman, 2003).
Strategies to address these considerations:
- Increase access to vaccine programs. Offer free immunizations and health services (Ives 1994). Public- and hospital-based clinics provide immunizations through federal- and state-funded programs that finance the purchase of vaccines for low-income, uninsured and underinsured children (Pickering, 2002).
- Create a trusting environment. Community nurses and an outreach team can be utilized to create a more trusting environment (Abramson, 1995).
- Provide pharmacy-based programs. While many health care providers’ offices have moved away from poor, urban areas, corner pharmacies are more likely to remain and continue to service low-income communities. This provides pharmacists with an opportunity to increase access to vaccines (Hoeben, 1997).
- Address language barriers. Informational materials can be translated to different languages. Health care workers need to be sensitive to the health literacy level of individuals when discussing immunizations and distributing written information (Niederhauser, 2005).
- Develop 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 or street fairs. Presentations may be complemented with periodic outreach conducted directly on the streets of their neighborhoods, when they set up an informational table and passed out informational fliers to passers-by (Rosenberg, 1995).
- Utilize non-traditional settings. Non-traditional opportunities for immunization services can be tried or tested. For example, offering immunizations at places where low-income individuals access services such as WIC offices or in community settings such as housing projects and pharmacies (Niederhauser, 2005). Contact with children and parents in settings like Special Supplemental Food Program for Women, Infants, and Children (WIC), the Aid to Families with Dependent Children (AFDC) and other publicly-funded programs could provide an opportunity to educate parents about immunizations, to screen immunization status, and, at a minimum, to refer children for needed immunizations (Birkhead, 1995).
- Provide education. Education can be used to dispel myths and increase comprehension of immunization recommendations.
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