Precarity, agency and trust: Vaccination decision-making in the context of the UK asylum system
Background: Individuals living in initial asylum accommodation are at increased risk of vaccine-preventable disease, yet confidence in vaccination may be low in these settings. Our aim was to understand the influence of experiences within the UK asylum system on vaccine confidence and decision-makin...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-06-01
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| Series: | SSM: Qualitative Research in Health |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2667321524001240 |
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| author | Anna Deal Maha Salloum Sally E. Hayward Alison F. Crawshaw Felicity Knights Jessica Carter Isra Al-Sharabi Reem Yahia Stephanie Fisher Beatriz Morais Oumnia Bouaddi Lucy Jones Anna Miller Sandra Mounier-Jack Sally Hargreaves |
| author_facet | Anna Deal Maha Salloum Sally E. Hayward Alison F. Crawshaw Felicity Knights Jessica Carter Isra Al-Sharabi Reem Yahia Stephanie Fisher Beatriz Morais Oumnia Bouaddi Lucy Jones Anna Miller Sandra Mounier-Jack Sally Hargreaves |
| author_sort | Anna Deal |
| collection | DOAJ |
| description | Background: Individuals living in initial asylum accommodation are at increased risk of vaccine-preventable disease, yet confidence in vaccination may be low in these settings. Our aim was to understand the influence of experiences within the UK asylum system on vaccine confidence and decision-making from a sociological perspective. Methods: In-depth semi-structured interviews were carried out on views and experiences around vaccination (09/2020-08/2021) with individuals seeking asylum or having recently been granted asylum (<10 years in the UK). Interviews were audio-recorded, transcribed and analysed in NVivo 12 using a reflexive thematic analysis through an inductive approach. Results: 25 participants were interviewed (mean age: 37 years, mean time in UK: 6 years, 72% female), of whom 13 were living in asylum accommodation at the time of interview. Analysis generated three main themes: 1) the detrimental impact of trauma and fear, both within the UK asylum system and prior, on perceptions of risk and vaccination decisions, 2) the effect of marginalisation, discrimination and neglect within the asylum system on an individual's trust and 3) the structural violence and restricted agency imposed on asylum seekers and its effect on ability and motivation to vaccinate. Past trauma or negative experiences since arriving in the UK, such as feeling forced to receive ‘invasive’ healthcare interventions in asylum accommodation may lead to distrust, increased perception of danger and avoidance of perceived ‘risks’ such as vaccination. Participants described how their struggle to cover basic necessities, social isolation and precarious living conditions imposed by the asylum system left them with more pressing priorities than vaccination. Participants who perceived that they had been cared for with empathy in the healthcare system or who described feeling empowered to make their own decision about vaccination often suggested they would be likely to accept vaccination if offered. Conclusions: Asylum seekers and refugees have often experienced substantial trauma and precarity and have a lack of agency directly imposed on them by the asylum system. These factors are likely to impact trust and decision-making around vaccination, with some also representing systemic or structural barriers to accessing services. Formative experiences in the UK are key to establishing trust in healthcare settings; a trauma-informed approach should be central in developing vaccination interventions for these groups, particularly in asylum accommodation. |
| format | Article |
| id | doaj-art-e1dfa15a43bd4b02b006c12da0abdf8d |
| institution | Kabale University |
| issn | 2667-3215 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | SSM: Qualitative Research in Health |
| spelling | doaj-art-e1dfa15a43bd4b02b006c12da0abdf8d2024-12-25T04:21:39ZengElsevierSSM: Qualitative Research in Health2667-32152025-06-017100515Precarity, agency and trust: Vaccination decision-making in the context of the UK asylum systemAnna Deal0Maha Salloum1Sally E. Hayward2Alison F. Crawshaw3Felicity Knights4Jessica Carter5Isra Al-Sharabi6Reem Yahia7Stephanie Fisher8Beatriz Morais9Oumnia Bouaddi10Lucy Jones11Anna Miller12Sandra Mounier-Jack13Sally Hargreaves14The Migrant Health Research Group, City St George's, University of London, UK; Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UKThe Migrant Health Research Group, City St George's, University of London, UKThe Migrant Health Research Group, City St George's, University of London, UK; Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UKThe Migrant Health Research Group, City St George's, University of London, UKThe Migrant Health Research Group, City St George's, University of London, UKThe Migrant Health Research Group, City St George's, University of London, UKThe Migrant Health Research Group, City St George's, University of London, UKThe Population Health Research Institute, City St George's University of London, UKThe Migrant Health Research Group, City St George's, University of London, UKThe Vaccine Institute, City St George's University of London, UKThe Migrant Health Research Group, City St George's, University of London, UK; Mohammed VI University of Sciences and Health, Casablanca, MoroccoDoctors of the World UK, London, UKDoctors of the World UK, London, UKFaculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UKThe Migrant Health Research Group, City St George's, University of London, UK; Corresponding author.Background: Individuals living in initial asylum accommodation are at increased risk of vaccine-preventable disease, yet confidence in vaccination may be low in these settings. Our aim was to understand the influence of experiences within the UK asylum system on vaccine confidence and decision-making from a sociological perspective. Methods: In-depth semi-structured interviews were carried out on views and experiences around vaccination (09/2020-08/2021) with individuals seeking asylum or having recently been granted asylum (<10 years in the UK). Interviews were audio-recorded, transcribed and analysed in NVivo 12 using a reflexive thematic analysis through an inductive approach. Results: 25 participants were interviewed (mean age: 37 years, mean time in UK: 6 years, 72% female), of whom 13 were living in asylum accommodation at the time of interview. Analysis generated three main themes: 1) the detrimental impact of trauma and fear, both within the UK asylum system and prior, on perceptions of risk and vaccination decisions, 2) the effect of marginalisation, discrimination and neglect within the asylum system on an individual's trust and 3) the structural violence and restricted agency imposed on asylum seekers and its effect on ability and motivation to vaccinate. Past trauma or negative experiences since arriving in the UK, such as feeling forced to receive ‘invasive’ healthcare interventions in asylum accommodation may lead to distrust, increased perception of danger and avoidance of perceived ‘risks’ such as vaccination. Participants described how their struggle to cover basic necessities, social isolation and precarious living conditions imposed by the asylum system left them with more pressing priorities than vaccination. Participants who perceived that they had been cared for with empathy in the healthcare system or who described feeling empowered to make their own decision about vaccination often suggested they would be likely to accept vaccination if offered. Conclusions: Asylum seekers and refugees have often experienced substantial trauma and precarity and have a lack of agency directly imposed on them by the asylum system. These factors are likely to impact trust and decision-making around vaccination, with some also representing systemic or structural barriers to accessing services. Formative experiences in the UK are key to establishing trust in healthcare settings; a trauma-informed approach should be central in developing vaccination interventions for these groups, particularly in asylum accommodation.http://www.sciencedirect.com/science/article/pii/S2667321524001240 |
| spellingShingle | Anna Deal Maha Salloum Sally E. Hayward Alison F. Crawshaw Felicity Knights Jessica Carter Isra Al-Sharabi Reem Yahia Stephanie Fisher Beatriz Morais Oumnia Bouaddi Lucy Jones Anna Miller Sandra Mounier-Jack Sally Hargreaves Precarity, agency and trust: Vaccination decision-making in the context of the UK asylum system SSM: Qualitative Research in Health |
| title | Precarity, agency and trust: Vaccination decision-making in the context of the UK asylum system |
| title_full | Precarity, agency and trust: Vaccination decision-making in the context of the UK asylum system |
| title_fullStr | Precarity, agency and trust: Vaccination decision-making in the context of the UK asylum system |
| title_full_unstemmed | Precarity, agency and trust: Vaccination decision-making in the context of the UK asylum system |
| title_short | Precarity, agency and trust: Vaccination decision-making in the context of the UK asylum system |
| title_sort | precarity agency and trust vaccination decision making in the context of the uk asylum system |
| url | http://www.sciencedirect.com/science/article/pii/S2667321524001240 |
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