Abstract:
Background: Immunisation coverage for Māori children has been decreasing since the beginning of 2017, with levels of immunisation coverage now well below the threshold needed to achieve population-wide protection against vaccine-preventable disease. Previously eliminated inequities between Māori and non-Māori children have also become re-established at key milestone stages of the childhood immunisation programme. Despite an established body of literature regarding immunisation coverage for children in Aotearoa (New Zealand), there is a paucity of recent evidence that can explain why these changes in immunisation coverage have occurred for Māori. Aim: This research sought to understand the factors associated with immunisation health service delivery in Aotearoa that may have contributed to changing trends in immunisation coverage, and persistent disparities in timeliness of vaccine delivery, for Māori children. Methods: Case study and qualitative research methods, informed by a Kaupapa Māori Research (KMR) consistent methodology, were used in this research to explore the elements of immunisation service delivery that facilitated immunisation uptake, or created barriers to access, for Māori whānau across three case study organisations. Six semi-structured interviews were undertaken with key informants to collect qualitative data, which was then analysed using a thematic analysis approach. Research findings: The findings of this research indicate that a myriad of factors create barriers to accessing immunisations for Māori whānau, evident within the patient, provider, system, policy and wider environmental contexts in Aotearoa. These factors relate to dis-proportionate experiences of socioeconomic deprivation, alienation of Māori cultural values under a Western medical model, growing mistrust in the health system, health provider and service fatigue, increasing accessibility of vaccine misinformation, and failure of immunisation policies to consider the local challenges of immunisation providers. Factors that facilitate immunisation uptake for Māori whānau relate to culturally responsive approaches to engagement and increasing opportunities for immunisation. Conclusion: This research suggests that maintaining high levels of immunisation coverage for Māori children in Aotearoa is possible, however this requires an ongoing commitment to cultural responsiveness and the prioritisation of the dynamic needs of Māori at each level of health system, aligned with notions of health equity.