Preventing Illness in Refugees Resettling in Tennessee: An EBPI Project to Improve Attendance at Adult Refugee Immunization Appointments

Background: Many refugees who resettle in the United States are less likely to complete their vaccination series than persons born in the U.S., costing the country approximately $9 billion. Good and strong evidence suggests that culturally tailored education may improve vaccine uptake in refugees, protecting the health of refugees and the community.

Local Problem: A refugee health clinic in Nashville, Tennessee, noted that 40% of adult refugee patients missed their resettlement immunization appointments. The project’s purpose was to administer an evidence-based educational handout and video tailored to Swahili-speaking refugees. The aims were to reduce no-show rates by 10% and decrease costs.

Methods: Levin’s Evidence-Based Practice Improvement (EBPI) model guided this project. An original, evidence-based handout was developed. Two native speakers translated and culturally validated it into Swahili. An existing, evidence-based educational video in Swahili from a resettlement support agency was utilized. Over seven rapid plan-do-study-act (PDSA) cycles spanning eleven weeks, the intervention was administered to Swahili-speaking adults. The rate of missed appointments and the costs of missed appointments before and after the intervention were measured.

Interventions: The ARI nurse distributed the handout and a QR code directing patients to the YouTube video on their phones. An in-person interpreter was present to facilitate patient comprehension.

Results: Eleven refugees received the educational intervention; eight out of eleven were no-shows to follow-up appointments (72%). A chi-square association test found no statistically significant decrease in no-shows during intervention compared to one year prior 𝜒2(1)= 302.86, p= .876. There was a monthly cost savings of $259.98 associated with missed Swahili-speaking ARI appointments.

Conclusion: Project benefits included clinic cost savings and patient-centered, evidence-based education. Implications for practice indicate that cultural validation of educational materials may improve vaccine uptake in refugees. The video is available in 35 other languages and could be expanded to other refugee groups.