Access-related barriers
| Access | ||
| Barrier | Explanation of barrier | Reviews reporting the barrier (n=21) |
| Time constraints | Busy home life, for example, ‘parents too busy.’28 | 10 |
| Cost of vaccine or service delivery | Cost of the actual vaccines or costs related to vaccine delivery (eg, appointment fees, lost parent wages due to appointment attendance). | 9 |
| Transportation, distance or location | Problems getting to clinic or appointment, or distance from household to health facility. | 9 |
| Fragmented care | Having multiple different healthcare providers, lack of coordinated care. | 5 |
| Waiting times | Having to wait a long time at the health facility. | 5 |
| Childcare challenges | Needing to find childcare for additional children when attending vaccination appointments. | 4 |
| Impermanent residence | Frequent moves impacting engagement with healthcare services or frequent changes of people overseeing care. | 4 |
| Social or health system exclusion | Receiving inadequate support from healthcare structures due to poverty, discrimination and social exclusion. | 4 |
| Lack of vaccine availability | Inability to get vaccines as needed. | 4 |
| Appointment time difficulties | Limited/inflexible clinic hours and inconvenient appointment times. | 3 |
| Lack of health insurance | Financial burden of the vaccine/service for those without health insurance. | 3 |
| Cost of transportation | Cost 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 | ||
| Barrier | Explanation of barrier | Reviews reporting the barrier (n=19) |
| Poor quality provider communication/interaction | Poor communication encounters with unpleasant, patronising, judgemental or insensitive providers. | 10 |
| Poor administration and record-keeping | Lack of recall/reminder systems, incomplete or inconsistent patient immunisation records, eg, ‘problems with name changes and IT systems’.34 | 7 |
| Problematic clinic practices and structure | ‘Reluctance to open a new vial’,28 delays in clinic, disorganisation of health facilities. | 5 |
| Lack of vaccination recommendation | Lack of clinician recommendation/ discussion or negative recommendation. | 4 |
| Poor facility quality | Poor quality of health facility building and/or equipment, concern of being ‘exposed to pathogens in clinics’.40 | 3 |
| Unsupportive health system structures | Health service not adequately funded, monitored or politically supported. | 3 |
| Cultural or linguistic barriers to healthcare delivery | Lack of culturally appropriate healthcare or language barriers with health workers. | 2 |
| Provider lack of knowledge or negative attitudes | Problematic health worker attitude or knowledge. | 2 |
| Provider missed opportunities to vaccinate | Incorrectly applied contraindications, lack of screening for vaccinations at other appointments. | 2 |
| Poor relationship with provider | Lack of relationship or a lack of perceived clinical support from a healthcare provider. | 2 |
| Provider reluctance to vaccinate | ‘Physicians reluctant to administer vaccinations’.17 | 1 |