Program Delivery Research Articles

Description and outcomes of a staff-assisted peritoneal dialysis program in the United States.

Staff-assisted peritoneal dialysis (PD) can help overcome barriers to self-care but is not yet available in the United States (US). We developed and implemented a staff-assisted PD program that fits within current regulatory and cost restraints in the US healthcare environment. Patient care technicians (PCTs) were trained on PD procedures and troubleshooting common problems. The program expanded from two centers in August 2020 to sixteen by October 2022. We described the logistic elements of program delivery, and patient and treatment outcomes for patients discharged by end of April 2023, with a cohort follow up until October 2023. A total of 121 patients were referred to the program. The most common indications for referral were physical function limitations, cognitive impairment, and psychosocial challenges. Staff assistance was provided for 73 patients. Mean age was 72 (standard deviation 14) years. A total of 604 visits were delivered, with a median 5 (interquartile range [IQR] 3-10, range: 1-49) visits per patient. Median duration of assistance was 8 (IQR: 2-21, range: 1-84) days. Assistance was most frequently needed for PD treatment setup and for observing and directing the technique. No peritonitis events or exit-site infections were reported. Sixty-eight patients (93%) were discharged on PD without staff assistance. The 6- and 12-month survival of PD without assistance was 71% and 57%, respectively. Staff-assisted PD for limited time periods is operationally feasible with PCTs in the US and can support transitioning and maintaining patients on PD.ClinicalTrials.gov Identifier: NCT04319185.

Accuracy, Acceptability, and Burden of an Integrated Screening Approach to Facilitate the Delivery of Tailored Sexual Assault Prevention in the U.S. Air Force

ABSTRACT This paper examines accuracy, acceptability, and respondent burden of integrated screening to facilitate tailored sexual assault (SA) prevention program delivery in a basic military training (BMT) environment. Trainees (n = 5,951) received tailored prevention content based on self-reported sex, sexual orientation, prior SA victimization and perpetration, and past-month post-traumatic stress symptoms. Bivariate analyses examined trainee-reported screener accuracy, acceptability, and burden, including differences by tailoring-targeted subgroups (e.g. men/women). Overall accuracy and acceptability were high (>90%) despite significant subgroup variability. Screening time averaged 10.55 (SD = 1.95) minutes; individuals with prior SA took longer. Missingness increased linearly throughout the screener. Integrated screening is an accurate, acceptable way to deploy tailored SA prevention in BMT. Findings inform data-driven screening improvements and novel applications.

Protocol for a realist review of case-based learning in undergraduate medical education

Case-based learning has become increasingly adopted as a pedagogical approach in health professions education. The successful implementation of case-based learning programmes can be impacted by factors including resources, organisational attitudes and cultural dynamics. This protocol outlines a methodology for a realist review which aims to elucidate the mechanisms and contexts that influence the implementation of a case-based learning programme in health professions education. This study aims to understand the underlying causal mechanisms and contextual factors which can lead to the success or failure of case-based learning programmes. This review will involve a systematic literature review on case-based learning in health professions education, under a realist synthesis framework. A realist synthesis was chosen as the approach as it is suited to the review of such complex interventions, such as the implementation and delivery of a case-based learning programme. Through an iterative literature search and analysis, relevant literature will be explored in order to develop an understanding of the contextual elements and mechanisms which may affect the success of a case-based learning programme. This review will employ thematic analysis to synthesize findings across studies, iteratively refining a programme theory explaining how case-based learning programmes work, for whom, and in what contexts. This realist review protocol provides a systematic and rigorous approach to examining the complexities of case-based learning and the outcomes produced by its underlying mechanisms and contexts. This review aims to offer valuable insights for educators, curriculum developers, and policymakers to optimize the implementation of case-based learning interventions in medical education.

Availability and Opportunities for Expansion of Buprenorphine for the Treatment of Opioid Use Disorder.

There is an urgent need to expand access to treatment for persons with opioid use disorder (OUD). As neurologists may frequently encounter patients with chronic pain who have developed OUD, they are in a position to serve as advocates for treatment. Buprenorphine is the most scalable medication for OUD in the United States, yet expansion has plateaued in recent years despite growing treatment needs. Reluctance of providers to establish treatment with new patients, challenges with rural expansion, stigma related to buprenorphine-based care, and pharmacy pressures that incentivize low dispensing and inventories may have stalled expansion. This review introduces these challenges before outlining actionable and evidenced-based strategies that warrant investigation, including methods to improve patient access to care (remotely delivered care, mobile delivery programs, Bridge programs) and provider retention and confidence in prescribing (expert consults, Extension for Community Healthcare Outcomes, a telementoring model, hub-and-spoke services), as well as novel innovations (virtual reality, artificial intelligence, wearable technologies). Overall, fortifying existing delivery systems while developing new transformative models may be necessary to achieve more optimal levels of buprenorphine treatment expansion.

A pilot study of a brief and scalable psychosocial intervention for children and adolescents following disasters.

Following disaster exposure, a significant proportion of children/adolescents will develop levels of post-traumatic stress symptoms (PTSS) that do not meet diagnostic threshold for PTSD, but which cause ongoing distress. This paper describes the development and pilot testing of a brief, scalable, psychosocial intervention. SOLAR-Kids/Teens has been designed to be delivered by non-mental health professionals ('coaches') to children/adolescents experiencing moderate levels of PTSS following disasters. An international collaboration of experts developed The Skills fOr Life Adjustment and Resilience (SOLAR) for Kids and Teens programs. The programs were piloted-using a pre-post mixed methods design-with 10 children and adolescents (8-18 years), with the aims of examining the feasibility of the program's delivery model as well as the program's potential usefulness. The pilot data indicated that after 1 day of training and with ongoing supervision, the SOLAR program was safe and feasible for coaches to deliver to children/adolescents experiencing PTSS. Coaches reported increased knowledge (p = .001), confidence (p = .001) and skills (p = .006). The programs were acceptable to coaches, children/adolescents and parents. Parents and children/adolescents reported reductions in trauma and anxiety symptoms from pre- to post-treatment, with moderate to large effect sizes. The preliminary findings demonstrate that the SOLAR-Kids/Teens program is feasible, acceptable and safe to be delivered by trained non-mental health professionals to children and adolescents experiencing PTSS and anxiety following disaster exposure. Randomized controlled trials are required to evaluate the efficacy of the SOLAR-Kids/Teens programs.

A theoretical explanation for how a nutrition counseling and medically tailored meal delivery program benefitted participants living with lung cancer

PurposeThe purpose of this study was to assess participants’ perceptions and experiences while participating in a Food is Medicine medically tailored meal plus intensive nutrition counseling intervention to create a theoretical explanation about how the intervention worked.MethodsThis interpretive qualitative study included the use of semi-structured interviews with active participants in a randomized controlled trial aimed at understanding how a medically tailored meal plus nutrition counseling intervention worked for vulnerable individuals with lung cancer treated at four cancer centers across the USA. During the 8-month long study, participants in the intervention arm were asked to be interviewed, which were recorded, transcribed verbatim, and analyzed using conventional content analysis with principles of grounded theory.ResultsTwenty individuals participated. Data analysis resulted in a theoretical explanation of the intervention’s mechanism of action. The explanatory process includes three linked and propositional categories leading to patient resilience: engaging in treatment, adjusting to diagnosis, and active coping. The medically tailored meals plus nutrition counseling engaged participants throughout treatment, which helped participants adjust to their diagnosis, leading to active coping through intentional self-care, behavior change, and improved quality of life.ConclusionsThese findings provide evidence that a Food is Medicine intervention may buffer some of the adversity related to the diagnosis of lung cancer and create a pathway for participants to experience post-traumatic growth, develop resilience, and change behaviors to actively cope with lung cancer. Medically tailored meals plus intensive nutrition counseling informed by motivational interviewing supported individuals’ adjustment to their diagnosis and resulted in perceived positive behavior change.

Perceived acceptability and appropriateness of a web-based program targeting risk for anxiety in young children and their parents

Abstract Objective This mixed-methods study examined perceived acceptability and appropriateness of a novel digital mental health program targeting anxiety risk (i.e., perfectionism or error sensitivity) in 5-to-7-year-old children and their parents. Methods Parent–child dyads participated in a modular, web-based cognitive-behavioral program targeting negative overreactions to making mistakes. The program, “Making Mistakes”, consisted of a 6-month series of short video clips, journaling activities, and weekly reminders, and modules were delivered to caregivers and children separately. 86 dyads completed self-report measures, 18 of whom participated in semi-structured interviews, following completion of the primary program module. A standard thematic analysis was used to elucidate themes from the parent and child interview content. Results Our quantitative and qualitative results were generally aligned. Children and parents viewed the novel digital mental health program as acceptable and appropriate, favoring the cognitive behavioral strategies such as modeling positive reactions to mistakes, responding positively to child mistakes, and emphasizing effort over outcome. Participants also provided helpful feedback related to program content, delivery, and engagement, as well as suggestions to enhance the program. Conclusions Findings have implications for design and content features of parent-based and dyad-based programs, as well as digital mental health programs focused on reducing anxiety risk.

Evaluation of co-designed online teacher training program for providing neuroscience- informed mental health intervention to Japanese children

IntroductionWhile mental health problems are prevalent among children, Japanese schools face challenges in providing effective mental health support to children partly due to a lack of training in mental health intervention. This study aimed to address this problem by evaluating a co-designed online teacher training program to provide a neuroscience-informed mental health intervention (NIMHI) to Japanese children.MethodThe present study evaluated the effectiveness of an online teacher training program by conducting a single-arm trial involving a group of 20 teachers and 245 children aged 8–12 from a regional Japanese primary school. The researcher delivered online training to Japanese teachers, who subsequently administered NIMHI to Japanese children over a 4-week period. The evaluation involved the administration of pre- and post-intervention student questionnaires, pre- and post-training teacher questionnaires, and post-intervention teacher interviews.ResultsAfter the delivery of the training program, 80% of Japanese teachers expressed strong or moderate satisfaction with the training. There were significant improvements in teachers' knowledge, perceived skills, self-efficacy, and acceptability of using NIMHI. Teachers implemented intervention strategies at least twice a week over four weeks. Following the intervention, 70% of teachers reported qualitative changes in students' mental health, such as more stable emotions. However, there were no significant changes in students' emotional problems, school enjoyment, and psychological wellbeing.DiscussionThe findings offer a fresh perspective on the effectiveness of utilizing digital technology, as a modality for delivering training to Japanese teachers. However, the absence of quantitative changes in students' mental health could suggest that the effectiveness of the online teacher-training program may not have been sufficiently robust. Further improvements in the online teacher-training program would be useful, such as providing tablet applications to assist teachers in implementing suitable intervention strategies and teaching a more focused range of strategies.

The importance of group factors in the delivery of group-based parenting programmes: a process evaluation of Mellow Babies

IntroductionThe role of the group has been largely overlooked within evaluations of group-based parenting programmes. Group contextual factors, including size and level of homogeneity, may impact on essential group processes, such as group identification and cohesion, that are necessary to activate interpersonal change mechanisms and attain programme outcomes. This process evaluation of Mellow Babies, a 14-week attachment-based group parenting programme for mothers of infants aged under 18 months, explores how group context affected mother and practitioner experiences of the programme.MethodsIn-depth interviews were conducted with fourteen mothers and three practitioners from three different Mellow Babies groups. Framework Analysis was employed to analyse data, using groups as cases within the framework matrix while preserving individual participants within each case. This allowed comparisons to be made within and between groups.ResultsFour group contextual factors impacted on the quality of programme delivery: (1) group size; (2) level of group homogeneity; (3) pre-existing relationships; and (4) personalities within the group. These contextual factors affected the hypothesised intervention mechanisms: (1) fluid progression through the stages of group development; (2) a safe, non-judgemental, contained space; (3) social identification with group; (4) group cohesion; and (5) a culture of openness, support and empowerment.DiscussionFindings have implications for future delivery and implementation of group-based parenting programmes, for example, the importance of considering group composition during programme recruitment. Practitioners may also benefit from a stronger focus on group processes and enabling group dynamics within training, supervision, and the programme manual.

Feasibility and acceptability of a digital parent group chat intervention to prevent child and adolescent maltreatment in the Philippines.

This study examined the feasibility, acceptability, and preliminary outcomes of MaPaChat, a parent support intervention delivered using Viber group chat to caregivers in the Philippines during the COVID-19 pandemic. Forty caregivers of children aged 4-17 from predominantly low-income households participated in a culturally adapted version of the Parenting for Lifelong Health ParentChat programme. Feasibility was assessed by enrolment, attendance, and dropout rates. Semi-structured interviews with caregivers and programme facilitators explored programme acceptability. A single-group pre-post design was used to explore changes in child maltreatment, positive parenting, parenting stress, and other secondary outcomes. The mean attendance rate was 82% and the dropout rate was 10%. Caregivers and facilitators found the programme helpful in enhancing parenting knowledge and skills and were satisfied with the programme delivery using Viber group chat but also reported experiencing technological challenges. Pre-post comparisons suggested that the intervention has potential in reducing physical and emotional abuse and associated risk factors. The findings suggest that a parenting intervention delivered over digital group chat by trained community service providers may be a feasible and acceptable way to support caregivers in low-resource settings.

Fostering collective impact in arts-based interventions and cultural programs for creative well-being of older adults

Despite growing interest in research into how the arts impact older adults’ health and well-being, there are many related complexities that are yet to be fully understood. This is partly due to the fact that documentation and analysis of arts-based interventions and cultural programmes for older adults in the public service domain are relatively new and uncommon. Furthermore, the effective implementation and the delivery of such inter­ventions to ageing people generally involve many stakeholders, often with divergent interests and priorities. This article presents an interview-based study that explores the diverse experiences of professionals from different sectors who have been involved in delivery of arts-based interventions and cultural programmes for older adults in South Korea and Finland. The study maps out similarities and differences in the approaches taken and the challenges faced in such interventions, using the five themes of the narrative interviews that have been conducted. The study findings highlight the need for supporting collective efforts among the diverse stakeholders to provide effective arts-based interventions and cultural programmes for ageing people. We argue that such efforts will ultimately become catalysts for synergetic actions that address the interconnected and encompassing challenges of an ageing society.

“We Have to Charge Levies, Else We Will Close Down the Schools”. Delivering Ghana’s education capitation grant programme within chronic resource constraints: impacts and implications

ABSTRACT Financial barriers to education such as the payment of school fees have long been identified as a key driver of the perennially high out-of-school rates in developing countries. Accordingly, Ghana implemented the education capitation grant (CG) policy in 2005 as part of efforts to universalise access to primary education. At its core, the policy abolishes the payment of school fees and levies and replaces these with a government-funded per capita allocation to every basic school. Despite its critical role in widening access to education, the CG programme has received very little scholarly curiosity. The extant studies have largely focused on the CG programme's impacts on enrolment and retention. The funding component of the programme has generally been under-researched. This qualitative study, therefore, examines the implication of funding challenges for the delivery of the CG programme. Relying on one-on-one semi-structured interviews with 16 head teachers and 16 chairpersons of School Management Committees (SMCs), the article shows how a system of long-lasting funding constraints has compelled school administrators to adopt unsanctioned coping strategies such as charging fees and padding enrolment figures. Ultimately, these coping strategies undercut the CG’s objectives of removing financial barriers to basic education in Ghana and also raise critical questions about the viability of the CG’s goal of addressing the wealth bias that has characterised accessing education.

From educator to facilitator: Healthcare professionals' experiences of, and views about, delivering a type 1 diabetes structured education programme (DAFNEplus ) informed by behavioural science.

The DAFNEplus programme incorporates behaviour change techniques into a modified educational intervention and was developed to help address the glycaemic drift observed amongst graduates of standard DAFNE programmes. As the programme's success will be contingent on staff buy-in, we explored healthcare professionals' experiences of, and views about, delivering DAFNEplus during a clinical trial to help inform decision making about rollout post-trial. We interviewed n = 18 nurses and dieticians who delivered DAFNEplus during the trial. Data were analysed thematically. While many shared initial reservations, all described how their experiences of DAFNEplus programme delivery had had a positive, transformative impact upon their perceptions and working practices. This transformation was enabled by initial training and supervision sessions, the confidence gained from using scripts to support novel programme content delivery, and experiences of delivering the programme and observing DAFNEplus principles being well received by, and having a positive impact on, attendees. Due to these positive experiences, interviewees described a strongly felt ethical mandate to use some DAFNEplus techniques and curriculum content in routine clinical care. While being supportive of a national rollout, they anticipated a variety of attitudinal and logistical (e.g. workload) challenges. This study provides a vital dimension to the evaluation of the DAFNEplus programme. Interviewees found the intervention to be acceptable and expressed high levels of buy-in. As well as offering potential endorsement for a national rollout, our findings offer insights which could help inform development and rollout of future behaviour change interventions to support diabetes self-management.

Condom use increased after a peer group intervention implemented by community volunteers in Malawi

BackgroundHIV prevention remains a global priority, especially in sub-Saharan Africa. Our research team previously developed an evidence-based peer group program for HIV prevention called Mzake ndi Mzake (Friend to Friend). A community-engaged collaboration adapted the program for community ownership and implementation. Here we report whether this HIV prevention program, implemented by community volunteers, increased condom use among sexually active individuals in rural Malawi.MethodsThree communities sequentially rolled out the program. Effectiveness was evaluated using a stepped wedge design. Repeated surveys 11–13 months apart were conducted between 2016 and 2019. At Time 1, no community had offered the intervention. At Time 2, the first community had offered the intervention and two had not (control group). At Time 3, two communities had offered the intervention and one had not (control group). We used two condom use indicators; condom use frequency in the last 2 months (N = 771) and condom use at last sex (N = 880). The analytical sample included all sexually active persons answering that question at one or more time points. Mixed-effects cumulative logit and Generalized Estimating Equation (GEE) models were used to model the two condom indicators over time, controlling for demographic factors, UNAIDS HIV knowledge, safer sex self-efficacy and partner communication.ResultsThis peer group intervention implemented by trained community volunteers increased both condom use indicators at Times 2 and 3. In the final adjusted models with non-significant factors removed, condom use in the last two months increased for the intervention group vs. control group [Time 2: Adjusted Odds Ratio (AOR) = 1.59 (1.15, 2.21); Time 3: AOR 2.01 (1.23, 3.30)]. Similarly, condom use at last sex increased for the intervention group vs. control group [Time 2: AOR = 1.48 (1.08, 2.03); Time 3: AOR 1.81 (1.13, 2.90)]. Other significant predictors of greater condom use were also described. Although the intervention increased UNAIDS HIV knowledge, knowledge did not predict condom use.ConclusionsIn this community-engaged implementation study, an evidence-based peer group program for HIV prevention increased condom use when delivered by trained community volunteers. Community ownership and program delivery by trained volunteers offer an innovative and cost-effective strategy to address ongoing HIV prevention needs without overburdening healthcare systems in sub-Saharan Africa.Trial registrationClinical Trials.gov NCT02765659 Registered May 6, 2016.

Setting research and extension priorities for agronomic crops in California

Agronomic crop production in California, including grains and animal feed, faces multiple challenges that could be addressed by extension support. This means that extension services need to understand priorities for using their limited resources. Until now, a statewide assessment of the most important topics for research and extension was lacking. A survey was conducted by the University of California Cooperative Extension (UCCE) to identify high-priority needs and inform extension programming based on grower, consultant, and allied industry input. Our goal was to compare the importance of different topics with the level of satisfaction regarding UCCE’s delivery of information on these topics. Survey respondents identified integrated pest management, nutrient and irrigation management, and variety testing as high-priority needs, with overall high satisfaction regarding UCCE’s program delivery on these topics. Topics needing more focus (high priority but below-average level of satisfaction) included testing new products, soil health management, and water conservation and storage. Areas of low priority and low satisfaction included niche marketing, emerging crops, organic production, harvest/post-harvest technology, salinity management, compost and manure management, and greenhouse gas emission reductions. To address stakeholder challenges, results from this study suggest that research and extension efforts should prioritize issues directly impacting on-farm crop production. At the same time, areas of low interest reflect a need for more support to engage farmers on these topics, particularly those concerning state environmental regulations and challenges to local and global food production and security.

A systematic review of the mechanisms influencing engagement in diabetes prevention programmes for people with pre-diabetes.

To identify barriers and enablers that influence engagement in and acceptability of diabetes prevention programmes for people with pre-diabetes. The results will provide insights for developing strategies and recommendations to improve design and delivery of diabetes prevention programmes with enhanced engagement and acceptability for people with pre-diabetes. This review used a critical realist approach to examine context and mechanisms of diabetes prevention programmes. Medline, Embase, PsycInfo, Cinahl, Web of Science, Scopus and Pre-Medline were searched for English language studies published between 2000 and 2023. A quality assessment was conducted using Joanna Briggs Institute critical appraisal tools. A total of 90 papers met inclusion criteria. The included studies used a variety of quantitative and qualitative methodologies. Data extracted focused on barriers and enablers to engagement in and acceptability of diabetes prevention programmes, with seven key mechanisms identified. These included financial, environmental, personal, healthcare, social and cultural, demographic and programme mechanisms. Findings highlighted diverse factors that influenced engagement in preventive programmes and the importance of considering these factors when planning, developing and implementing future diabetes prevention programmes. Mechanisms identified in this review can inform design and development of diabetes prevention programmes for people with pre-diabetes and provide guidance for healthcare professionals and policymakers. This will facilitate increased participation and engagement in preventive programmes, potentially reducing progression and/or incidence of pre-diabetes to type 2 diabetes and improving health outcomes.

Adaptation and implementation of body project as a universal body image program in Mexico and Latin America

ABSTRACT The Body Project (BP) intervention for body image issues is supported by extensive efficacy and effectiveness research, most of which has been conducted in the United States. The BP uses cognitive dissonance to help participants critique the ideal appearance through written, verbal, and behavioral exercises. This reduces the internalization of the appearance ideal, which in turn decreases body dissatisfaction symptoms and, in some individuals, the onset of eating disorders. To broadly implement this program in Mexico and Latin America, Comenzar de Nuevo (CdN), a non-profit organization for eating disorder treatment, partnered with the Body Project Collaborative in 2014. Together, they created a training and implementation infrastructure. This paper explores the adaptation of BP and its implementation in Mexico and Latin America. We used sustainable business, marketing, and educational models to fulfill CdN’s mission to reduce eating disorder risk factors, including weight stigma, in the Latin American region. By integrating strategies to combat weight stigma within our program delivery, we strive to contribute to a more inclusive and supportive environment. We trained master trainers, regular trainers, and/or group facilitators from Argentina, Bolivia, Colombia, Costa Rica, Chile, Dominican Republic, El Salvador, Guatemala, Mexico, Panama, and Spain; and implemented the BP in 15 public schools supported by sponsorship programs. This paper provides crucial lessons learned, future directions, and implications for dissemination and implementation efforts in this region of the world.

Understanding the delivery of the Falls Management Exercise Programme (FaME) across the U.K.

1) Map FaME delivery across the UK, 2) explore and understand delivery of the FaME programme in practice. Sequential exploratory mixed methods. 1) survey of n=247 Postural Stability Instructor (PSIs) across the UK, 2) purposively sampled n=23 PSIs to take part in interviews. Quantitative data was described descriptively due to low sample size, and qualitative data coded using thematic analysis. Instructors pre-dominantly delivered classes in a community-setting, were mostly White British females with a range of experience. Most respondents were exercise instructors, physiotherapists, or therapist assistants. Only 136 (55.1%) respondents currently delivered the programme. The essential components of the FaME programme that instructors did not implement routinely were backward chaining, floorwork and Tai Chi. Five main themes emerged from qualitative data: individual, delivery and set-up, evidence-based delivery, motivational strategies, and instructor-based factors. Most instructors reported fidelity to most components of FaME and shared barriers and facilitators to delivering classes. This study gives a UK overview of the implementation of FaME. PSIs present a complex picture of the ways set-up and delivery of evidence-based programmes in practice can influence older adults' attendance, adherence and experience of the programme, and barriers and facilitators to delivery of the programme with fidelity.

Evaluation of a 4-week interdisciplinary primary care cardiovascular health programme: impact on knowledge, Mediterranean Diet adherence and biomarkers

BackgroundCardiovascular disease (CVD) is the second-leading cause of death among Canadians. Clinical practice guidelines suggest that improvements to lifestyle, including dietary intake, can reduce the risk of CVD.ObjectivesThe primary aim...

Strengthening life-course immunisation in migrant populations: access, equity, and inclusion.

Adult and adolescent migrants worldwide, and those arriving in Europe, are an under-immunised group for routine vaccinations due to missed childhood vaccines and doses in their countries of origin, and their subsequent marginalisation from health and vaccination systems. Declining population-level coverage for routine vaccines across Europe, which has accelerated post-pandemic, places these and other under-immunised populations at even greater risk of vaccine-preventable diseases. However, despite clear guidelines around the importance of delivering 'catch-up' vaccination throughout the life-course, migrants are rarely effectively incorporated into routine vaccination programmes on arrival to Europe. These populations have subsequently been involved in outbreaks, including measles and diphtheria, and are missing opportunities to receive more recently introduced vaccines such as HPV to align them with European vaccine schedules. WHO's new Immunization Agenda 2030 places a renewed emphasis on equitable access to vaccine systems and integrating catch-up vaccination for missed vaccines and doses throughout the life-course. In addition, lessons learned and innovations from the COVID-19 pandemic merit further consideration in the design and delivery of more inclusive vaccination programmes. We describe current gaps in policy and practice around life-course vaccination in migrant populations, key factors that drive low vaccine uptake and coverage, and explore the benefits of participatory approaches to designing and delivering interventions with impacted communities, to define new strategies to advance vaccine equity across the Region.