Tailoring immunisation programmes: Using behavioural insights to identify barriers and enablers to childhood immunisations in a Jewish community in London, UK

Louise Letley*, Vanessa Rew, Rehana Ahmed, Katrine Bach Habersaat, Pauline Paterson, Tracey Chantler, Maria Saavedra-Campos, Robb Butler

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

29 Citations (Scopus)


Introduction: Due to regular vaccine preventable disease outbreaks and sub-optimal immunisation uptake in the London borough of Hackney, home to the largest Charedi Orthodox Jewish community in Europe, it was decided, in consultation with the community, to implement the WHO Tailoring Immunization Programmes approach (TIP). Design: The WHO Tailoring Immunization Programmes (TIP) approach was used. TIP provides a framework based on behavioural insights methodology to identify populations susceptible to vaccine preventable diseases, diagnose supply and demand side barriers and enablers to vaccination and recommend evidence-informed responses to improve vaccination coverage. Results: The results of the formative research and behavioural analysis challenged the assumption that a cultural or religious anti-vaccination sentiment existed within the community. Critical issues related to access to and convenience of immunisation services. Service providers in the area have challenges due to having to deliver immunisation services to the large numbers of children without additional resource. Where mothers were choosing to delay or refuse vaccinations their reasons were broadly similar to the wider population. The behavioural analysis identified potential categorisation of subgroups within the community enabling a more tailored approach to addressing concerns and meeting parents’ needs. Conclusion: The TIP approach was an effective way of investigating factors linked to sub-optimal immunisation within the Charedi community. The use of behavioural insights enabled the categorisation of subgroups so that more targeted interventions could be developed. The comprehensive stakeholder engagement which is a key pillar of the TIP approach ensured a deeper understanding of the barriers and enablers to vaccination as well as increasing the level of ownership in the community. TIP should be considered as a useful approach to identify main facilitators and barriers to vaccination in communities with suboptimal immunisation uptake.

Original languageEnglish
Pages (from-to)4687-4692
Number of pages6
Issue number31
Publication statusPublished - 25 Jul 2018

Bibliographical note

Funding Information:
The authors would like to thank all the local immunisation providers and Charedi community members who were involved in this study. In particular we would like to acknowledge the General Practices, the parents who completed the questionnaire and the parents and key informants who took part in the interviews. We would also like to thank Rabbi Avrohom Pinter and Naomi Freeman for all their valuable insights and continued support. This work was supported by the WHO Regional Office for Europe, Public Health England, NHS England and the National Institute for Health Research Health Protection Research Unit in Immunisation. Thanks to Nalini Iyanger and and Sarah Addiman for their advice and support especially during the early stages of the project.

Publisher Copyright:
© 2018


  • Access to vaccines
  • Behavioural science
  • Health-seeking behaviour
  • Tailoring immunisation programmes
  • Vaccination coverage
  • Vaccine demand


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