We’re delighted to announce that Mandy Knowles, from the TLCO School Nursing Team, has been shortlisted in the Black Asian and Minority Ethnic (BAME) Nurse of the Year category of the prestigious National BAME Health and Care Awards 2023!
Mandy has been shortlisted for her innovative Stretford High School immunisation project, which led to more than 70 extra consents from parents. From initial research to putting the plan into action, read the full story of the intervention project below…
The Project: Initial Findings
Prior to completing my SCPHN (specialist public health nurse) role, I worked within the South school nursing team, which compared to where I’d previously worked in the North, has a completely different demographical make-up.
When researching my new area of work and possible identification of local requirements, I recognised there was a significant health need for a certain school around the childhood vaccination programme — specifically the area of consent return.
I discovered that due to the introduction of digital consent forms that year, the low number of return rates had gotten even lower.
Historically there has always been an issue with the return rates in the area, and the current intervention when receiving low returns was to call parents to gain verbal consent over the phone, prior to their child receiving the vaccination at a planned session.
Not only was this not cost-effective for staff time management, but it also raised ethical concerns about who was actually giving consent over the phone. Furthermore, it provided little insight into the reasons for low return rates.
I continued with the current intervention of making the calls to parents, however, I decided that I’d use these calls as an opportunity to collate some data about the following points:
- Reasons for non-return of the consent form
- Knowledge and understanding of childhood vaccinations.
- Main languages spoken in the home
- Access to technology to download and complete the consent forms
Following these initial calls, I realised there was a large proportion of parents who either didn’t speak English or spoke it as a second language. This factor had led to a lack of knowledge about the vaccination programme and so parents were unsure what they were actually being asked to consent for.
Additionally, some parents stated they didn’t have access to technology to download the consent forms or that they didn’t have the ability to fill in the forms online.
Combined, these factors had greatly impacted on the year’s return rates. Only 30, out of a possible 170 had been received.
Key Initial Findings
- Misconceptions about HPV Vaccination: Many parents believed the vaccination promoted sexual activity and assumed that their children were not sexually active – therefore did not require the vaccination.
- Confusion with COVID Vaccines: No clear and distinct communication about different vaccines, their purposes, and the diseases they target.
- Digital Poverty and Access to Technology: The rollout of e-consents coincided with suspected digital poverty in the area, resulting in a decreased uptake.
- Language Barriers and Information Accessibility: Some parents were facing language barriers or difficulty in reading the information/consent forms — often with their children acting as interpreters.
- Lack of Information Sources: Parents who had questions about the vaccine often didn’t know who to ask
The Project: Next Steps
After gaining insight into some of the key factors affecting uptake, further research revealed that in Trafford, around 1 in 3 children belong to an ethnic minority.
Despite this, we did not have vaccination information in additional languages to send out to our non-English speaking parents, which would offer them the opportunity to make an informed choice about their child’s health.
The next steps were to research existing strategies and identify potential partners to decide how this public health issue could be addressed more effectively — primarily with a focus on language barriers and digital poverty.
After liaising with local and North West immunisation teams (who had a similarly diverse population and demographical makeup) and finding that there were no specific person-centred interventions, I contacted the school’s head teacher and administration staff to help me gain an overall insight into the school.
Focusing on ethnic background, languages spoken and the demographical makeup of the school’s population, these conversations allowed me to identify that the main four spoken languages were Urdu, Gujarati, Punjabi and Arabic.
Preventive interventions and addressing inequality are vital to increase and build trust within the community. I realised the importance of working in partnership to achieve this, so I decided my work had to be alongside the school, the local community and other healthcare providers.
To really address the inequalities, I needed to obtain health literature in multiple languages, ensuring it was easily understandable. It was also important to support this with a person-centred approach, so I decided that language interpreters would further help in informing and educating parents about immunisations.
I arranged a meeting with our trust service managers to discuss possible funding for interpreters for a health promotion event within the school and was given the budget. I also reached out to national and global companies that work in partnership with local initiatives to increase vaccination rates for all populations.
Through a meeting with the MSD Northwest Healthcare Optimisation team, I was able to obtain health promotion literature and vaccination literature in the 4 main languages I had identified as being an area of need.
The Project: Health Promotion Event
After getting funding for the interpreters and the health education literature, I spoke to the school’s head teacher about the most effective way to disseminate the information and tackle these inequalities.
It was agreed that I’d attend the next year 7 and 8 parents’ evening with the support of our school immunisation team — providing the educational materials with interpreters present.
As a ‘Health Promotion Event’, the evening was hugely successful. The use of the literature in the identified languages as well as information on upcoming vaccinations in the academic year broke down communication barriers, addressed misconceptions and offered parents/caregivers the chance to make an informed decision. The efforts resulted in over 72 consents received during the event!
Additionally, the project’s successful outreach extended to another local Islamic girls’ school, resulting in three outstanding consents received and one already returned for the year 2023.
These successes would not have been possible without amazing help throughout. From the school nursing team who supported the event, to the advice and funding from service managers and of course Kimberley Barnes — my SCPHN practice assessor who was there every step of the way. Thank you all.
Looking ahead, the plan is to continue collecting data over the next academic year (2023/24) and assess the sustained impact of the intervention. The project is being replicated by our immunisation team, with the hopes that similar successes can be achieved.
For the hugely successful project, which managed to tactfully and effectively provide reassurance and support to parents of children from BAME backgrounds, Mandy has been nominated for Nurse of the Year at the National BAME Health and Care Awards!
School Nursing Team Leader Helen McNulty said, “We are delighted that Mandy has been nominated for this award. She identified a health inequality, came up with a plan to address this, put the plan into operation and has taken the learning from this project to inform future service delivery. Mandy has had a challenging year, she has undertaken a university degree, alongside working and being a Mum, but does all this with a smile on her face and boundless enthusiasm. Well done Mandy, we are very proud of you!”
The National BAME Health & Care Awards celebrate BAME staff and networks across health and social care who are forging better healthcare initiatives for their communities. The awards ceremony takes place on the 28th September in London, so please keep your fingers crossed for Mandy!
To learn more about the National BAME Health & Care Awards and to view all of the categories and nominations, please follow the link: bamehcsawards.org