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- Appelqvist, Emma, et al.
(författare)
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Exploring nurses' experiences of a tailored intervention to increase MMR vaccine acceptance in a Somali community in Stockholm, Sweden : a qualitative interview study
- 2023
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 13:2, s. 067169-067169
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To explore nurses' experiences of a tailored intervention that supported them with knowledge and tools to use during encounters and dialogue with parents with low vaccine acceptance. DESIGN: A qualitative study with in-depth interviews conducted in 2017. Data were analysed using thematic analysis. SETTING: This study was part of a multicomponent intervention targeting Somali parents and the nurses at child health centres in the Rinkeby and Tensta neighbourhoods of Stockholm. An area with documented low measles, mumps and rubella (MMR) vaccination coverage. Previous research has revealed that Somali parents in the community delayed MMR vaccination due to fear of autism despite lack of scientific evidence. The interventions were implemented in 2015-2017. PARTICIPANTS: Eleven nurses employed at the child health centres involved in the intervention participated in interviews. The tailored intervention targeting nurses included a series of seminars, a narrative film and an information card with key messages for distribution to parents. RESULTS: The qualitative analysis revealed an overarching theme: perception of improved communication with parents. Two underlying themes were identified: (1) feeling more confident to address parents' MMR vaccine concerns and (2) diverse tools as useful support to dispel myth and reduce language barriers. CONCLUSION: From the nurses' perspective, the tailored intervention was useful to improve communication with parents having vaccine concerns. Nurses have a crucial role in vaccine uptake and acceptance. Interventions aiming to strengthen their communication with parents are therefore essential, especially in areas with lower vaccine acceptance.
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| 2. |
- Godoy Ramirez, Karina
(författare)
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Flow cytometric methods for assessment of cell-mediated immune responses
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to develop and improve flow cytometry-based methods for assessment of cellmediated immune responses (CMI) induced by natural infection or vaccination. Traditionally, the measurement of anti genspecific cellular immune responses has been based on the use of complex, labourintensive, and less informative bulkresults assays (51Cr-release, 3 3H-thymidin uptake and Limiting dilution assay, LDA). Alternative techniques for assessment have been developed (tetramer-staining, ELISspot, intracellular cytokine staining, ICS), with pros and cons for each system. We have focused on the assessment of cytokine production and cytolytic capacity, two activities of importance for evaluation of CMI to viral infections, especially HIV. Flow cytometry technology offers the possibility for simultaneous analysis of multiple characteristics and functions of single cells at high rate. We have developed two lytic assays for the assessment of natural killer (NK) cell mediated and HIV-antigen-specific Tcell mediated cytotoxicity (FC-CTL). In the NK cell assay, the cell populations are separated by post-culture immunophenotyping and cell death is detected by uptake of propidium iodide (PI), which permits the combined assessment of NK cell lysis and conjugate formation between target and effector cells. The assay is sensitive, very easy to perform and more informative than other lytic assays. The FC-CTL is based on dual staining with 5-(and -6)carboxyfluorescein diacetate succinimidyl ester, CFSE (for tracing target cells) and PI (for cell-death), which permits identification of several cell populations including viable and dead target cells at different stages of cell-death; live and dead effector cells; and also enumeration of lysed 'not-detectable' target cells. Determination of HIV-specific cytolysis is based on the enumeration of viable target cells rather than percentage of dead cells as commonly used for other assays. The FC-CTL is well correlated to, but more sensitive than the conventional 51Cr-release assay. The standard procedure for ICS is based on short-term (6h) activation of PBMCs or undiluted whole blood. We performed kinetic studies of cytokine production with regard to incubation time and dilution of whole blood samples for specific and non-specific activation. We consistently recorded higher frequencies of responding T-cells in samples of diluted blood (115-1 A 0) cultured for several days (long-term (LT-ICS), as compared to short-term incubation. The increased levels of cytokines, in particular IFN-gamma with peak detection at 72h, are due to expansion of the antigen specific cytokine-producing cells. The new assays (LT-ICS and FC-CTL) and conventional methods (ELIspot and Cr-release) were subsequently applied for a study of HIV-1 infected (>5 years) treatment-naïve individuals with CD4+-cell counts >400 and with low or high viral load. The levels of IFN-gamma responses and cytolytic activity were consistently higher in subjects with low viral load, against all HIV-antigen tested (Gag, Nef and avipox-based antigens), as assessed by all methods employed. By the LT-ICS (48h), the difference between the two patient-groups was statistically significant for CD4+ T-cell responses against all HIV-antigens tested. The strong HIV-specific cell-mediated immune responses found in subjects with stable CD4+ T-cell counts and low viral load, support the idea that strong HIV-1 -specific cellular immunity is protective. Both cytolytic assays and the LT-ICS can be further expanded for simultaneous assessment of several different molecules expressed on cell-surface or present intracellular, especially if the 3-4-laser flow cytometers with ability to detect up to 18 colours are utilized. The new assays presented in this thesis will be valuable tools for research regarding evaluation of CMI against viral infections such as HIV and for monitoring in vaccine studies, in particular if immune responses may appear at low levels. The NK cell cytotoxicity assay has been further developed for use of whole blood and is now employed for a study of the role of innate immunity for control of herpes simplex infection, and the LT-ICS will be used as one of the assays for evaluation of CMI in a phase 1 HIV- 1 vaccine trial in Stockholm.
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| 3. |
- Jama, Asha, et al.
(författare)
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Design and implementation of tailored intervention to increase vaccine acceptance in a Somali community in Stockholm, Sweden - based on the Tailoring Immunization Programmes approach
- 2022
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Ingår i: Public Health in Practice. - : Elsevier BV. - 2666-5352. ; 4
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Sweden has had a high and stable vaccination coverage for measles-mumps-rubella (MMR) vaccine (>96%) through the national immunization program (NIP), but coverage rates highlight local pockets of lower vaccination coverage. This project addressed low MMR vaccine acceptance among parents in a Somali community, in Stockholm. The objective of the intervention was to increase vaccine confidence and MMR-vaccine uptake and also to inform practices addressing vaccine acceptance. Study design: This paper describes the design and implementation of a multi-component intervention based on the Tailoring Immunization Programmes (TIP) approach, developed by the WHO European Regional Office. Methods: The theoretical underpinning of TIP is the Capability, Opportunity, and Motivation Model (COM-B model) and Behaviour Change Wheel framework (BCW), adapted for vaccination. The COM-model was used to identify barriers and drivers to vaccination and intervention types. The TIP-phases described in this paper are: pre-TIP (planning), three succeeding TIP phases (situational analysis, formative research, intervention design) and the post-TIP phase (implementation). Results: The situation analysis and formative research revealed that parents feared the MMR vaccine due to autism or that their child would stop talking following vaccination, despite lack of scientific evidence for an association between autism and MMR vaccines. Barriers were linked to their associated COM-B factors and mapped to appropriate intervention types for two target groups: Somali parents and nurses at the Child Health Centres (CHC). Selected intervention types targeting parents were education, persuasion and modelling whereas education and training were selected for CHC nurses. The intervention activities included community engagement for parents, while the activities for nurses focused on improving encounters and dialogue with parents having low vaccine acceptance. Following the intervention design the activities were developed, pilot tested and implemented. Conclusion: This study confirm that the TIP approach is valuable for guiding a stepwise working process for a thorough understanding of barriers and drivers for MMR vaccination among parents in this Somali community. It facilitated the design of a theory and evidence-informed intervention targeting parents and nurses.
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