Exploring Community Perspectives on Barriers and Facilitators to Childhood Immunization among First Nations Peoples in Northern Saskatchewan: A Qualitative Sharing Circle Study

Abstract Childhood vaccination is vital for disease prevention intervention, yet some Northern Saskatchewan First Nations communities have immunization coverage below the 95% target. We aimed to explore community perspectives on the barriers and facilitators of childhood immunization uptake in First Nations communities in Northern Saskatchewan. We used a qualitative design informed by Indigenous methodologies and community-based participatory approaches to engage three First Nations communities and conducted sharing circles to gather rich, culturally grounded perspectives on childhood immunization. We purposefully recruited parents, caregivers, an Elder, and a community leader. We audio-recorded and transcribed one sharing circle (5 participants) discussion, then analyzed data thematically with Indigenous research principles, ensuring community collaboration and ethical stewardship throughout the study. The results were validated through a community feedback session. Participants described several structural and social factors that limited access to immunization, including transportation barriers, limited clinic hours, geographic isolation, and reduced services during the COVID-19 pandemic. Caregiver mental health issues, substance use, and unstable home environments were identified as barriers to immunization uptake. Language barriers, lack of health literacy, and historical trauma also shaped vaccine hesitancy. Key enablers identified included establishining trusting relationships with local healthcare providers, use of mobile clinics, peer support, tailored communication strategies, community events that incorporated immunization programs rooted in cultural practices, and involvement of Elders and local leadership in planning and delivery. Our findings show that vaccine uptake in Northern Saskatchewan First Nations communities reflects a complex set of contextual factors, shaped by structural conditions and historical experiences. We recommend policy and practice approaches that support culturally safe, community-led immunization programming. Strengthening trust, expanding flexible service models, and integrating First Nations knowledge systems into public health planning can help improve childhood vaccination coverage and contribute to health equity in northern and remote settings.