Table 4.

Barriers and solutions identified

Barrier	Potential solution	Key messages	Quotes	Professional
Awareness of vaccination programmes for adults	Community engagement, capacity development, investment and partnership-building to raise awareness	Engage with community leaders, faith groups to help GPs and public health systems to improve uptake for vaccines in migrants; provide opportunities for information sharing, outreach, engagement, communication	‘I …hope that the CCG have thought about this and have gone to local communities, through the mosque or through other social avenues to trying get [vaccine] uptake.’	GP 24
Fear of authorities	Community engagement to tackle mistrust; increasing trustworthiness of health and other institutions	Education and raising awareness within communities to overcome fear and enable health-seeking of preventative healthcare; (re)building trust through community engagement and investment	‘We have suggested … that they engage with the churches, that they obviously engage with information and advice, but it’s a hard nut to crack if somebody’s life is built around not trusting the specific institution.’	GP 24
Misinformation about vaccines	Use trusted professionals or other trusted messengers—and ensure they are properly resourced, recognised and compensated (17)	One GP thought that consulting with someone who was felt to be an ‘expert’ in vaccinations would have better outcomes	‘…If [the vaccine advice is from] from a GP…[or] from a consultant… then that tends to have a bit more weight to it… I think it depends on the level of education and understanding…’	GP 25
	System approach—building capacity to recognise and respond to misinformation; developing resources to increase health literacy;	Public health messaging and a national approach	‘I think it’s got to be a national approach…We got the Public Health Department…’	GP 22
	Patient education; develop tailored messages	Patient education and sharing as much information as possible regarding vaccines, from all health professionals involved	‘People just need as much information as possible [about the vaccine], and I think information in particular on side effects etc.’	HCA 1
Lack of training for staff around migrant health	Staff education and training (both clinical and non-clinical staff)	Improving staff understanding of potential issues and communication skills	‘It’s just a bit of understanding… some patients may come across as difficult… [but with ] extra training with staff…[understanding can improve].’	HCA 2
Financial pressures	Financial payments and incentives	Including adult migrant vaccination targets as a financial incentive to ensure migrant adult catch-up programmes are carried out	‘…Unless they actually make [adult catch-up vaccination] something that they want GP surgeries to do, like proactively educate them and give them some renumeration to do it. work is money and we haven’t got enough practice nurses as it is…So it can’t just be expected to be an add on.’	GP 18
Lack of time	Longer appointments	Longer appointments, especially if interpreter is needed	‘We make the appointments longer.’	PN 7
Language barrier	Interpreters; linguistically and culturally tailored information	Use interpreters for vaccine programmes, including written communication	‘We sent out a lot of text messages [about vaccination]. That would be good if we could do those in different languages…’	PN 15
Different vaccine schedules and lack of history	Migrant specific health check	A health check for adult migrants, to gather information about vaccine history	‘[A] template which is specific for patients from different countries, which means that you’re not trawling through evidence.’	GP 20
Pressures on health system	Ensure primary care deliver these vaccination programmes	Make migrant adult catch-up vaccination mandatory for primary care to provide	‘If they were part of QOF, they’re made mandatory… that would definitely make [practices] do it.’	Pharmacist

GP, general practitioner; HCA, healthcare assistants; PN, practice nurse; QOF, Quality Outcomes Framework.