# Factors associated with vaccine adherence among an underserved population: the adult Travellers in Nouvelle-Aquitaine, France

## TL;DR

This study explores factors influencing MMR vaccination adherence among adult Travellers in France, identifying key determinants and offering strategies to improve vaccination rates.

## Contribution

The paper introduces a conceptual framework and structural model to understand MMR vaccination adherence in an underserved Traveller population.

## Key findings

- The declared MMR vaccination rate among adult Travellers was 74.0%.
- Vaccination adherence was significantly linked to favorable attitudes and satisfactory information received on vaccination.
- 72.4% of participants were favorable to vaccination, highlighting potential for improvement.

## Abstract

A measles epidemic affected the Nouvelle-Aquitaine region from November 2017 to May 2018 with clusters among Travellers. This indicates that measles vaccination rates among Travellers remain lower than in the general population. The objective of this study was to estimate the ‘declarative vaccination’ against measles, mumps and rubella (MMR) and to propose a conceptual framework to help identify determinants of MMR vaccination uptake among adult Travellers in Nouvelle-Aquitaine in 2019–20.

A cross-sectional study using random sampling was performed and included 612 adult Travellers from 1 November 2019 to 31 March 2020. A conceptual framework to model vaccination adherence was tested among this underserved population by using structural equation modelling. This model included five latent variables: health literacy, attitudes toward preventive measures, stigma, accessibility to care and perceived needs and five measured variables: information received on vaccination, perception of barriers, support for administrative documents, social support and housing conditions.

Individuals who did not answer all the questions linked to the variables included in the model were excluded, thus 347 adults were included in the final sample. The declared vaccination rate against MMR was 74.0%, and 72.4% of the participants were favorable to vaccination. Vaccination adherence was significantly correlated with favorable attitudes toward preventive measures such as having a history of MMR vaccination and not having already refused a recommended vaccine and finally satisfactory information received on vaccination.

To improve vaccination adherence, health authorities should lean on personal history with vaccination and on transmitting information on vaccination.