“If the nurse tells me this is a good thing, I trust her completely” – Exploring health system enablers of MMR vaccine uptake in the Finnish Somali community: A mixed method study

Background: Globally, migrant populations usually experience lower vaccine coverage than the general population. In Finland, the MMR vaccination coverage of Somalis has not been studied specifically, but existing evidence suggests that the MMR vaccination coverage is high. The aim of this study was to examine both vaccination coverage of Somali children and factors associated with the MMR vaccine uptake of Somali children living in Finland. Methods: Twenty-seven mothers and seventeen public health nurses were interviewed using a semi-structured interview protocol. Audio-recorded interviews were transcribed and translated and analysed thematically after coding. The personal identity code of Somali children born in 2015 and 2020 were extracted from the Population Information System (PIS), and their vaccination coverage data was extracted from the national vaccination register (NVR) to calculate MMR vaccination coverage for Somali children. Results: 96 % of Somali children born in 2015 and 81 % of those born in 2020 received their MMR vaccination. In contrast, the national average MMR vaccine uptake for children born in 2015 was 95 %, while 94 % of those born in 2020 were vaccinated against MMR. Somali mothers had poor knowledge of the MMR vaccine and the diseases it protects against. Trust towards the Finnish healthcare system, perceived benefits of vaccinating, positive attitudes towards vaccines, nurses’ systematic approach to vaccine introduction, and nurses taking into account the cultural background of the clients were recognised as enablers positively affecting MMR vaccination uptake. Conclusion: Despite limited knowledge of vaccines, Somali immigrant mothers believe in the benefits of vaccination, and they displayed strong trust towards public health nurses. Further investigation is needed to understand why MMR vaccination coverage has declined among the younger Somali population.