Barriers to and enablers of childhood immunization uptake in First Nations communities in Canada: a rapid review of the literature

Childhood immunization is essential to public health; however, vaccination coverage among First Nations communities in Canada remains suboptimal. We conducted our rapid review as the initial phase of a broader project to improve childhood immunization in Canadian First Nations communities using a rigorous, systematic approach often lacking in traditional literature review. We systematically synthesized existing evidence, identified key barriers and enablers, and highlighted critical research gaps, providing a foundation for community-driven research and culturally safe interventions. Following Cochrane Rapid Reviews Methods Group guidelines, we searched Web of Science, PubMed, and Scopus for peer-reviewed studies published between 2003 and 2023. Eligible studies were limited to those published in English and focused on Canadian First Nations populations, reporting on factors influencing childhood immunization. We synthesized findings thematically, identifying patterns in barriers and enabling conditions. We synthesized findings thematically, identifying patterns in barriers and enabling conditions. Four studies met the inclusion criteria. The data revealed three overarching domains: caregiver-related, provider-related, and system-level factors. Barriers at the caregiver level included fear of needle pain, misinformation, safety concerns, difficulty scheduling, transportation issues, and child illness. Provider-related barriers involved communication challenges, limited availability, and perceived disrespect. At the system level, rigid appointment systems, long wait times, and fragmented immunization records were identified as key obstacles. Conversely, enablers of childhood immunization included strong relationships with healthcare providers, culturally respectful care, awareness of disease threats, on-reserve service availability, flexible delivery models, improved data-sharing infrastructure, and community involvement. Addressing these issues requires comprehensive community-based public health strategies that consider cultural, logistical, and systemic dimensions. These interventions should prioritize enhancing cultural safety, engaging communities, improving provider communication, and ensuring accessible, flexible immunization services, supported by robust information-sharing systems.