Table 1

Access-related barriers

BarrierExplanation of barrierReviews reporting the barrier (n=21)
Time constraintsBusy home life, for example, ‘parents too busy.’2810
Cost of vaccine or service deliveryCost of the actual vaccines or costs related to vaccine delivery (eg, appointment fees, lost parent wages due to appointment attendance).9
Transportation, distance or locationProblems getting to clinic or appointment, or distance from household to health facility.9
Fragmented careHaving multiple different healthcare providers, lack of coordinated care.5
Waiting timesHaving to wait a long time at the health facility.5
Childcare challengesNeeding to find childcare for additional children when attending vaccination appointments.4
Impermanent residenceFrequent moves impacting engagement with healthcare services or frequent changes of people overseeing care.4
Social or health system exclusionReceiving inadequate support from healthcare structures due to poverty, discrimination and social exclusion.4
Lack of vaccine availabilityInability to get vaccines as needed.4
Appointment time difficultiesLimited/inflexible clinic hours and inconvenient appointment times.3
Lack of health insuranceFinancial burden of the vaccine/service for those without health insurance.3
Cost of transportationCost of transportation to healthcare facility or indirect cost of time to take transport.1
Access or cost: not otherwise specified‘Financial costs’ and ‘low access,’ not further explained.10
Clinic or health system
BarrierExplanation of barrierReviews reporting the barrier (n=19)
Poor quality provider communication/interactionPoor communication encounters with unpleasant, patronising, judgemental or insensitive providers.10
Poor administration and record-keepingLack of recall/reminder systems, incomplete or inconsistent patient immunisation records, eg, ‘problems with name changes and IT systems’.347
Problematic clinic practices and structure‘Reluctance to open a new vial’,28 delays in clinic, disorganisation of health facilities.5
Lack of vaccination recommendationLack of clinician recommendation/ discussion or negative recommendation.4
Poor facility qualityPoor quality of health facility building and/or equipment, concern of being ‘exposed to pathogens in clinics’.403
Unsupportive health system structuresHealth service not adequately funded, monitored or politically supported.3
Cultural or linguistic barriers to healthcare deliveryLack of culturally appropriate healthcare or language barriers with health workers.2
Provider lack of knowledge or negative attitudesProblematic health worker attitude or knowledge.2
Provider missed opportunities to vaccinateIncorrectly applied contraindications, lack of screening for vaccinations at other appointments.2
Poor relationship with providerLack of relationship or a lack of perceived clinical support from a healthcare provider.2
Provider reluctance to vaccinate‘Physicians reluctant to administer vaccinations’.171