Publication Date
Spring 5-20-2026
Document Type
Article
Executive Summary
As part of a health promotion initiative in the community, our leadership team of seven nursing students is partnering with an agency that supports families experiencing housing instability by providing transitional housing. According to agency staff, some families have limited health literacy regarding vaccinations. Common concerns include illness following a vaccination, perceived risks of autism, and attention deficit hyperactivity disorder. To address these concerns, we have developed a vaccine education binder containing materials in handout form. To accommodate language accessibility, we provided handouts in the four most spoken languages including English, French, Amharic, and Tigrinya. Through this initiative, we aim to increase vaccine literacy among families at our partnered agency, helping parents feel more confident in their decision to vaccinate and reduce the incidence of vaccine- preventable illnesses.
Background
The population of focus for the vaccine education binder are families participating in a transitional housing program through an agency in the Greater Seattle area. To promote financial and career independence, the agency program requires adult participants to secure employment while their children are enrolled in school or child care. Vaccines are important to this community because schools and child care programs require certain vaccinations for enrollment (Washington State Department of Health, n.d.). Many East African migrant and refugees face fear, confusion, and language barriers (Rojas- Venegas, 2022). This creates difficulty navigating the healthcare process, which can limit vaccinations and related education access. Due to these barriers to healthcare, migrant and refugee populations are 50% less likely to have their vaccinations compared to non-migrant populations (Alarcon, 2022). Social determinants of health, agency representative reports, and community demographic research guided the focus and considerations of our intervention. Based on the information gathered from a variety of sources, our team has decided that culturally appropriate and translated vaccination education would be the most effective intervention for the community.
Activities with Rationale
Conversations with agency staff members revealed that, although staff are hesitant to provide medical advice, they do feel comfortable offering pre-created resources to help educate participants at the agency. We discussed effective educational methods with staff and determined that simplified and translated handouts have historically been successful. Translating materials helps to bridge the health literacy gap that is often experienced by individuals with limited English proficiency and low socioeconomic status (Chu, 2022). The handouts were developed at a sixth-grade reading level to ensure they are understood by the community (Kim et al., 2020). To accomplish this, we utilized a readability formula to guarantee that the handouts were at the appropriate health literacy level (Readability Formulas, n.d.). Additionally, we collaborated with multiple bilingual individuals to proofread our materials and ensure our translations were accurate.
The handout we created begins with general vaccine information. This briefly overviews what a vaccine is, the safety of vaccines, expected reactions, and signs of an emergency. Mandated vaccine schedules were added to give the participants an expected timeline of the vaccines that children will be expected to receive according to their age. The next section of handouts addresses frequently asked questions and common concerns, including uncertainties that the participants previously expressed to staff when vaccinating their child. We chose to include a separate handout that was curated by King County’s Public Health Department explaining the common misconception about the connection of vaccines and autism (King County, n.d.). The last handouts address exemptions to vaccine requirements. They include information on what an exemption is and the social outcomes of vaccine exemptions that families may experience. These were added to the binder based on the agency staff reporting past situations where this would have been beneficial. The materials are organized in a binder format, allowing staff to easily access and distribute extra copies in each language for participants to take home. In addition, the agency will be provided with a portable document format (PDF) version of the handouts to support easy printing and duplication of pages as needed.
Outcomes
The desired outcomes of this project were to improve vaccine literacy among families at the agency and provide accessible, culturally appropriate education that staff could continue to provide to families. Overall, our group successfully met these outcomes by creating language accessible handouts in a vaccine education binder. Feedback from the program manager and staff suggested that this binder would have been beneficial to utilize in previous situations. Going forward, we expect it to improve participant understanding of vaccines and help staff feel more prepared when answering vaccine-related questions from families. To evaluate the effectiveness of the binder, we developed a questionnaire; but were unable to provide participants with the opportunity to review the binder and receive their feedback. In the future, we recommend an in-person meeting with the participants to evaluate the effectiveness of education using the teach-back method.
Another desired outcome was reducing language barriers in vaccine education due to many resources not being available in the most common languages used in this community. The handouts were translated into these languages and then the accuracy was verified by multilingual individuals. A limitation was that we were unable to have the resources reviewed by an agency-specific member that is also bilingual. This would have been an additional way to validate the accuracy of translations.
Long-term success of the project may be impacted by continued experiences of fear and mistrust related to vaccines, cultural beliefs, and misinformation. In addition, staff are limited in the amount of medical guidance they can offer to participants due to lack of medical training. Despite these barriers, the binder provides a sustainable resource that will continue supporting vaccine education and improving access to reliable information within the agency.
Conclusion
The lack of accessible multilingual vaccination education materials is an area of focus that our group has identified for improvement within the community. The vaccine education binder we created includes handouts about general vaccine information, common concerns, vaccine schedules, and information on school exemption form requirements. The finished binder and questionnaires for participants were left at the agency for further evaluation. Recommendations we encourage include evaluating the resource effectiveness within the community and the accuracy of the translated material. Additionally, an editable PDF copy was provided to ensure resources could continue to be utilized in the future. Ultimately, the focus for the community is to use our vaccine education binder as an intervention to improve health outcomes, vaccine literacy, and accessibility for families participating in transitional housing.
References
Alarcon F. J. (2022). The migrant crisis and access to health care. Delaware Journal of Public Health, 8(4), 20–25. https://doi.org/10.32481/djph.2022.10.006
Chu, J. N., Sarkar, U., Rivadeneira, N. A., Hiatt, R. A., & Khoong, E. C. (2022). Impact of language preference and health literacy on health information-seeking experiences among a low-income, multilingual cohort. Patient Education and Counseling, 105(5), 1268–1275. https://doi.org/10.1016/j.pec.2021.08.028
Feinberg, I., O’Connor, M., Khader, S., Nyman, A. L., & Eriksen, M. P. (2023). Creating understandable and actionable COVID-19 health messaging for refugee, immigrant, and migrant communities. Healthcare, 11(8), 1098. https://doi.org/10.3390/healthcare11081098
Kim, W., Kim, I., Baltimore, K., Salman Imtiaz, A., Sudhin Bhattacharya, B., & Lin, L. (2020). Simple contents and good readability: Improving health literacy for LEP populations. International Journal of Medical Informatics, 141, 104230. https://doi.org/10.1016/j.ijmedinf.2020.104230
King County. (n.d.) Vaccines & autism. https://kingcounty.gov/en/dept/dph/health-safety/health-centers- programs-services/immunizations
Readability Formulas. (n.d.). Readability Formulas. https://readabilityformulas.com
Rojas-Venegas, M., Cano-Ibáñez, N., & Khan, K. S. (2022). Vaccination coverage among migrants: A systematic review and meta-analysis. Semergen, 48(2), 96–105. https://doi.org/10.1016/j.semerg.2021.10.008
Washington State Department of Health. (n.d.). School and childcare immunizations information for families. https://doh.wa.gov/community-andenvironment/schools/immunization/families
Recommended Citation
Olaes, Isaac; Sandoval, Alexia; Solano, Kassandra; Termure, Rachael; Webber, Sydney; West, Jordan; and Parman, Maya, "Bridging the Vaccine Gap: Multilingual Vaccine Education for Families in Transitional Housing" (2026). Nursing Leadership in Community Engagement Projects. 71.
https://digitalcommons.spu.edu/shs_nlce/71
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