Underserved Communities Research Articles

Surgeon Workforce in Underserved Communities

This cohort study evaluates the Health Professional Shortage Area Surgeon Incentive Program to determine how it may have changed the surgeon workforce in designated areas.

Using the Person-Based Approach to Co-Create and Optimize an App-Based Intervention to Support Better Sleep for Adolescents in the United Kingdom: Mixed Methods Study.

Poor sleep is a common problem in adolescents aged 14 to 18 years. Difficulties with sleep have been found to have a bidirectional link to mental health problems. This new research sought to involve young people in the co-creation of a new app, particularly those from underserved communities. The Sleep Solved app uses science-based advice to improve sleep-related behaviors and well-being. The app was developed using the person-based approach, underpinned by the social cognitive theory and the social-ecological model of sleep health. Young people (aged 14-18 y) were recruited from across the United Kingdom to contribute to patient and public involvement (PPI) activities. In partnership with our peer researcher (MHJ), we used a multitude of methods to engage with PPI contributors, including web-based workshops, surveys, think-aloud interviews, focus groups, and app beta testing. A total of 85 young people provided PPI feedback: 54 (64%) young women, 27 (32%) young men, 2 (2%) genderfluid people, 1 (1%) nonbinary person, and 1 (1%) who reported "prefer not to say." Their levels of deprivation ranged from among the 40% most deprived to the 20% least deprived areas. Most had self-identified sleep problems, ranging from 2 to 3 times per week to >4 times per week. Attitudes toward the app were positive, with praise for its usability and use of science-based yet accessible information. Think-aloud interviews and a focus group identified a range of elements that may influence the use of the app, including the need to pay attention to language choices and readability. User experiences in the form of narrated audio clips were used to normalize sleep problems and provide examples of how the app had helped these users. Young people were interested in using an app to better support their sleep and mental health. The app was co-created with strong links to theory- and evidence-based sleep hygiene behaviors. Future work to establish the effectiveness of the intervention, perhaps in a randomized controlled trial, would provide support for potential UK-wide rollout.

Health disparities in cirrhosis care and liver transplantation.

Morbidity and mortality from cirrhosis are substantial and increasing. Health disparities in cirrhosis and liver transplantation are reflective of inequities along the entire spectrum of chronic liver disease care, from screening and diagnosis to prevention and treatment of liver-related complications. The key populations experiencing disparities in health status and healthcare delivery include racial and ethnic minority groups, sexual and gender minorities, people of lower socioeconomic status and underserved rural communities. These disparities lead to delayed diagnosis of chronic liver disease and complications of cirrhosis (for example, hepatocellular carcinoma), to differences in treatment of chronic liver disease and its complications, and ultimately to unequal access to transplantation for those with end-stage liver disease. Calling out these disparities is only the first step towards implementing solutions that can improve health equity and clinical outcomes for everyone. Multi-level interventions along the care continuum for chronic liver disease are needed to mitigate these disparities and provide equitable access to care.

Lifting the Gate: Evaluation of Supplemental Instruction Program in Chemistry

College-level introductory chemistry has a high impact for predicting students’ early success and long-term academic outcomes. Students from traditionally underserved communities are disproportionately held back in this course. To improve student success, the Supplemental Instruction (SI) program at a public four-year Hispanic-serving institution was revamped from a voluntary option to a co-requisite for the introductory chemistry course. The study evaluates the effectiveness of the new format of SI program and explores associated factors contributing to the impacts of the program. Students with or without SI were compared through multiple quantitative metrics, including course GPA, final exam score, DFW rate, and pass rate. Data analysis showed that students who completed SI with credit obtained 0.9 higher average course GPA than their counterparts and performed significantly better on all the other metrics. More importantly, the equity gaps between underserved and better-served students were narrowed down. Furthermore, students who took introductory chemistry with SI still obtained 0.3 higher average course GPA in their subsequent General Chemistry I course than those without it. The findings suggested that incorporating the SI into introductory chemistry as co-requisite is necessary and effective to improve students’ success and narrow down the equity gaps in gateway chemistry courses.

Centering equity, diversity, and inclusion in youth digital mental health: findings from a research, policy, and practice knowledge exchange workshop

BackgroundYouth mental health service organizations continue to rapidly broaden their use of virtual care and digital mental health interventions as well as leverage artificial intelligence and other technologies to inform care decisions. However, many of these digital services have failed to alleviate persistent mental health disparities among equity-seeking populations and in some instances have exacerbated them. Transdisciplinary and intersectional knowledge exchange is greatly needed to address structural barriers to digital mental health engagement, develop and evaluate interventions with historically underserved communities, and ultimately promote more accessible, useful, and equitable care.MethodsTo that end, the Digital, Inclusive, Virtual, and Equitable Research Training in Mental Health Platform (DIVERT), the Maritime Strategy for Patient Oriented Research (SPOR) SUPPORT (Support for People and Patient-Oriented Research and Trials) Unit and IWK Mental Health Program invited researchers, policymakers, interprofessional mental health practitioners, trainees, computer scientists, health system administrators, community leaders and youth advocates to participate in a knowledge exchange workshop. The workshop aimed to (a) highlight local research and innovation in youth-focused digital mental health services; (b) learn more about current policy and practice issues in inclusive digital mental health for youth in Canada, (c) participate in generating action recommendations to address challenges to inclusive, diverse and equitable digital mental health services, and (d) to synthesize cross-sector feedback to inform future training curriculum, policy, strategic planning and to stimulate new lines of patient-oriented research.ResultsEleven challenge themes emerged related to white-colonial normativity, lack of cultural humility, inaccessibility and affordability of participating in the digital world, lack of youth and community involvement, risks of too much digital time in youth's lives, and lack of scientific evidence derived from equity-deserving communities. Nine action recommendations focused on diversifying research and development funding, policy and standards, youth and community led promotion, long-term trust-building and collaboration, and needing to callout and advocate against unsafe digital services and processes.ConclusionKey policy, training and practice implications are discussed.

A conceptual framework for digital health marketing strategies to enhance public health outcomes in underserved communities

This paper proposes a conceptual framework for integrating digital health marketing strategies with public health initiatives to enhance healthcare access and outcomes in underserved communities. The framework focuses on leveraging digital marketing tools such as social media, mobile applications, email campaigns, and search engine optimization to disseminate critical health information, promote preventive measures, and engage communities in healthier behaviors. It addresses the persistent challenges faced by underserved populations, including limited healthcare access, low health literacy, and cultural barriers, by utilizing the accessibility and broad reach of digital channels. The proposed framework incorporates three core components: (1) Health Information Dissemination, which explores the use of targeted digital campaigns to provide culturally relevant and accessible health education; (2) Community Engagement, which leverages interactive platforms such as social media and mobile apps to foster participation in preventive healthcare initiatives and healthy lifestyle practices; and (3) Behavioral Change Promotion, which emphasizes using digital tools to influence health behaviors through personalized messaging, reminders, and virtual support groups. By integrating digital marketing strategies into public health programs, the framework aims to improve healthcare outcomes by increasing awareness of preventive measures, enhancing early diagnosis, and promoting disease management. It also underscores the role of data analytics in refining outreach efforts by identifying specific health needs, tracking engagement, and measuring the effectiveness of interventions. This conceptual framework holds promise for healthcare providers, policymakers, and digital marketers seeking to enhance public health outcomes in underserved communities. It provides a structured approach to combining the strengths of digital marketing with public health goals, creating more inclusive, accessible, and effective health interventions. Future research and case studies can build on this model to refine digital health marketing strategies and assess their long-term impact on public health in underserved populations.

Personalized customer journeys for underserved communities: Tailoring solutions to address unique needs

In today's diverse marketplace, creating personalized customer journeys for underserved communities is essential for fostering inclusion and promoting equitable access to services. This review explores the significance of tailoring solutions to address the unique needs of these communities, emphasizing the role of personalized experiences in enhancing customer satisfaction and loyalty. Underserved communities often face systemic barriers, including limited access to resources, information, and services. Traditional customer journey models may overlook these specific challenges, leading to ineffective engagement and unmet needs. By adopting a personalized approach, businesses can better understand the distinctive characteristics, preferences, and pain points of these communities. This understanding allows for the development of targeted strategies that resonate with individuals' cultural, social, and economic contexts. The framework for personalized customer journeys involves several key components. First, comprehensive data collection is crucial for identifying the unique demographics and psychographics of underserved communities. Utilizing qualitative and quantitative research methods, businesses can gather insights on customer behaviors, preferences, and challenges. Next, leveraging advanced analytics and artificial intelligence can enhance the personalization of interactions, ensuring that offerings align with the specific needs and aspirations of these communities. Additionally, fostering collaboration with community organizations and leaders is vital. Engaging with local stakeholders helps businesses build trust and credibility, facilitating the co-creation of solutions that genuinely address the community's needs. This collaborative approach can lead to the development of tailored products and services, targeted marketing strategies, and supportive customer service frameworks. Ultimately, personalized customer journeys for underserved communities not only improve customer satisfaction but also drive business growth and social impact. By prioritizing equity and inclusion, businesses can enhance their brand reputation, foster customer loyalty, and contribute to the economic empowerment of these communities. In conclusion, a commitment to understanding and addressing the unique needs of underserved communities through personalized customer journeys is essential for fostering inclusive growth and creating lasting positive change.

The Role of Communities in Nurse-Led Clinics, 1965-2000: Lessons From History.

Since the 1960s, nurses have worked to improve access to health care services among underserved communities through the establishment of community-based nurse-led clinics (NLCs). Evidence demonstrates NLCs' effectiveness in delivering high quality and cost-effective primary care services to underserved communities. However, few studies have analyzed the role and meaning of community within NLCs. This article uses historical research to analyze and evaluate the roles played by communities in three community-based NLCs established between the 1960s and 1990s. This research shows that how nurses entered the communities they intended to provide care, the degree to which they collaborated with community members to conceptualize, operationalize, and maintain NLCs, and how they balanced community needs with academic imperatives are critical to understanding and addressing the difficulties NLCs have encountered delivering sustained, community-centered care. This research also addresses the impact on communities when NLCs fail, making clear the need for policy interventions that address the financial and political factors undermining NLCs' sustainability, particularly limitations on nurse practitioners' practice authority and credentialing as Medicaid providers, and reduced reimbursement rates for nurse practitioners. Ultimately, it argues that NLCs' engagement with underserved communities should be historically informed and integrate community expertise, robust community engagement, and community-centered definitions of quality care.

Transforming library systems in Africa: advancing literacy and cultural preservation through digital innovation

Transforming library systems in Africa is essential for advancing literacy and preserving cultural heritage in an increasingly digital world. The integration of digital innovation into African libraries has the potential to revolutionize access to information, promote lifelong learning, and safeguard indigenous knowledge. This review explores the role of modern technologies, such as digital archiving, e-libraries, and mobile platforms, in enhancing literacy rates and preserving Africa's rich cultural traditions. By transitioning from traditional, print-based models to digital systems, libraries can bridge the educational gap in underserved communities, offering wider access to educational resources and promoting literacy at all levels. Additionally, digitization facilitates the preservation of local languages, oral histories, and cultural artifacts, ensuring that future generations can engage with Africa's diverse heritage. The challenges of digital transformation in African library systems, including limited infrastructure, funding, and digital literacy, are also discussed. The review emphasizes the need for strategic investments in technology, capacity building, and policy frameworks to create a sustainable digital ecosystem. By harnessing digital innovation, African libraries can evolve into dynamic centers of learning and cultural preservation, contributing to both socio-economic development and the protection of African identities. This transformation is critical to fostering a more educated, culturally aware, and globally connected African society.

Exploring the impact of obesity and community health programs on enhancing endometrial cancer detection among low-income and native American women through a public health lens

This review examines the intricate relationship between obesity, endometrial cancer detection, and the role of community health programs, with a particular focus on low-income and Native American populations. Obesity is identified as a significant modifiable risk factor for endometrial cancer, disproportionately affecting vulnerable communities, which exacerbates existing health disparities. The paper explores the epidemiological link between obesity and endometrial cancer, highlighting disparities in detection and the compounded risks faced by underserved populations. It also reviews the effectiveness of public health initiatives aimed at improving cancer screening rates and obesity prevention among these groups. Despite the progress made through various community health programs, substantial gaps remain, particularly in ensuring culturally competent, accessible, and sustainable care. A lack of longitudinal studies evaluating the long-term impact of these programs on cancer detection and obesity management underscores the need for more robust research. Additionally, social, psychological, and systemic barriers continue to hinder screening uptake, further perpetuating health inequities. This review concludes by emphasizing the need for integrated public health approaches that combine obesity prevention with cancer screening, as well as policy reforms to enhance healthcare access and provider availability in underserved communities. Recommendations are provided for future research that addresses these gaps, with the goal of improving early detection and overall health outcomes for low-income and Native American women.

Integrating trauma-informed practices in U.S. educational systems: Addressing behavioral challenges in underserved communities

Integrating trauma-informed practices in U.S. educational systems: Addressing behavioral challenges in underserved communities

Decentralized Clean Energy for Rural India: The Role of Small Modular Reactors

India's rapid development and expanding population have intensified the need for sustainable energy solutions. This is particularly significant in addressing the growing disparity in energy access between urban and rural communities. As the country shifts from traditional fossil-fuel-based power generation to cleaner technologies, nuclear energy is poised to play an increasingly vital role. Small Modular Reactors (SMRs) represent a promising option to meet these energy demands in a decentralized and environmentally friendly manner, especially in rural regions. In this perspective article, we explore the technological, economic, social, and environmental advantages of deploying SMRs in rural India. SMRs offer the potential for faster and cheaper build, as well as stable and reliable power, which is essential for driving economic growth in underdeveloped areas. However, several challenges need to be addressed, including regulatory and legislative hurdles that could impede the integration of SMRs into the existing energy mix. This article also suggests solutions such as leveraging India’s existing reactor technology expertise, utilizing the mature supply chain framework, co-locating SMRs with renewable energy sources, and advocating for necessary regulatory and legislative reforms. These would help SMRs serve as a crucial bridge in facilitating a smoother transition from fossil fuel plants to clean energy technologies, particularly in underserved rural communities.

Sustainable education for underserved U.S. communities: Empowering students through environmental literacy and green job pathways

This research paper explores the integration of environmental literacy and sustainability-focused education within underserved U.S. communities, aiming to empower students and promote pathways to green jobs. As these communities often face significant educational disparities and limited economic opportunities, the study highlights the importance of environmental literacy as a critical component of education that fosters essential skills such as critical thinking, problem-solving, and civic engagement. The paper discusses best practices for developing and implementing sustainability-focused curricula, effective teaching strategies, and the significance of local partnerships between educational institutions and industry stakeholders. Furthermore, it emphasizes the potential for green jobs to drive economic growth while aligning with national efforts toward environmental justice and sustainable development. The findings underscore the necessity of a multifaceted approach involving policymakers, educators, and community leaders to create equitable opportunities and foster a sustainable future for underserved communities.

An alcohol-related liver disease multi-stakeholder hub (ARMS-Hub) to enhance research activity in underserved communities in the UK

Background Alcohol use is the third leading risk factor of death and disability in the UK and costs the NHS £3.5 billion per year. Despite the high prevalence and healthcare burden of Alcohol-related Liver Disease (ArLD), there has been minimal research addressing prevention, morbidity and mortality. Reasons for this include stigma and lack of interest from public, charitable and commercial funding bodies. The objectives of this project were to identify and develop interdisciplinary partnerships, to explore stigma in ArLD, to develop a representative Patient and Public Involvement and Engagement (PPIE) group, to build research capacity, and to develop interdisciplinary research proposals targeting key research priorities. Methods ArLD networks were identified by members of the Project Steering Group. Health Care Professionals (HCPs) from different backgrounds were invited to join the ARMS-Hub. PPIE representatives were invited through charities and support groups. Research areas were identified, discussed, prioritised and ranked. Research questions were refined during an in-person symposium. A mentorship programme was created to encourage and facilitate networking and knowledge exchange for early career researchers. Results We established the ARMS-Hub with 31 HCPs and 40 PPIE members. There were five stakeholder meetings, which included PPIE representation. Three virtual and three in-person PPIE meetings took place. Topics relevant to stigma in ARLD identified during the meetings were education and awareness, language, and access. Priorities identified were the disconnect between mental health and liver services, education around the wider harms of alcohol, and education of HCPs regarding stigma. We established a mentorship network that regularly meets to support development of new research ideas. Conclusions Stigma is central to lack of research engagement from professionals and PPIE. The main priority identified relates to the disconnect between mental health and liver services. This collaborative study has allowed development of a research agenda to address this priority.

Embedding voices of under-served communities in Health Research Priority Setting in Thailand

Health research is needed to develop new treatments, diagnostic methods and prevention strategies for many diseases, but resources are limited particularly in low-and middle-income countries (LMICs). Our proposed project involves in-depth engagement with community advisory boards and existing community groups in healthcare research priority setting in Thailand. We will use Wellcome’s “Responsive Dialogues” engagement approach, focusing on “underserved” groups, as their voices are seldom heard in healthcare research priority setting. We estimate that we will engage with 6–8 community groups involving 48–80 participants. Our objectives are firstly, to contribute to the health research agenda setting in Thailand for government, non-governmental actors, academia, and others who conduct health research in the next 5 to 10 years. Secondly, we aim to identify ethical and practical issues related to healthcare research priority setting, specifically in relation to involving under-served communities.

Herd immunity and sustainable development goals: role of nurses in strengthening primary health care

Herd immunity has proven as a highly valuable public health concept for dealing with reinfection. It is the immunity developed in a population to an infectious disease through vaccination or previous infection which is contributed by the virulence of the organism, susceptibility of an individual to infection, extent of immunity developed towards the pathogen, occurrence of clinical and subclinical infection in the herd and herd structure. Herd immunity assessment is imperative for continuously monitoring the risk of epidemics. The minimum proportion of the population that needs to be immune to herd effect is called herd immunity threshold which can be achieved through adequate immunization coverage. Immunization contributes to 14 out of its 17 sustainable development goals (SDGs) and is important in reaching SDGs. Nurses play a vital role in strengthening primary health care through vaccination campaigns, addressing vaccine hesitancy, community outreach programs, monitoring and surveillance of diseases, advocacy, and policy development. Nurse practitioners and nurse-led vaccination programs help in reaching underserved communities or groups with vaccine hesitancy and lead to an upsurge in vaccination rates, patient satisfaction, and attainment of community immunity. Thus, vaccination is a powerful, cost-effective public health tool to achieve the eradication of diseases through proper coverage and development of population immunity.

8.N. Scientific session: Transferability and adaptation of vaccination interventions: Learning from underserved communities

Abstract Removing barriers in the health system that make it difficult for cultural, religious or ethnic minorities to access vaccinations is an urgent concern in order to prevent infectious diseases in the future. Childhood vaccine uptake for MMR and HPV in most underserved communities is lower than in the general population. The project RIVER-EU (Reducing Inequalities in Vaccine uptake in the European region - Engaging Underserved communities) engages the migrant community in Greece, females with a Turkish or Moroccan migration background in the Netherlands, the Ukrainian minority in Poland and marginalized Roma communities in Slovakia to remove health system barriers to vaccination. Barriers include, e.g., lack of culturally and linguistically appropriate information, financial barriers, insufficient capacities, coordination and delivery of health care. Based on a Participatory Action Research (PAR) approach we selected and adapted potentially transferable evidence-based interventions in partnership with the communities. First, we pre-selected 6 useful interventions from a realist review on 36 effective vaccine uptake interventions. Second, we assessed them in depth for their transferability. Building a bridge between evidence on interventions and community needs is not an easy task: We involved various stakeholders in a longitudinal process under consideration of contextual conditions in the primary intervention context and the context of the respective underserved community. We co-created knowledge through 25 workshops and 39 interviews or focus groups for decision-making and determining need for adaptation of selected interventions. The aim of this workshop is to present the results of this co-creative process in each country. Special attention is payed to facilitators and barriers for transferability of evidence-based interventions from the perspective of underserved communities, and contextual commonalities and differences that lead to a specific intervention tailoring. This workshop will contribute to an improved understanding of how to consider contextual needs underserved communities have to remove health system barriers to vaccination on the one hand and suitable evidence on interventions to improve their situation on the other hand. The workshop will include five presentations of eight minutes and a questions and answers session to involve the audience. First, an introductory presentation on transferability of interventions for HPV and MMR vaccine uptake to underserved communities in specific contexts will be given. Then each country will present the intervention(s) to address health system barriers adapted to their context. Thereby, we will underline common key elements that have potential for transferability in all countries. After all presentations, we will discuss the need for context-based decision-making on evidence-based interventions and intervention tailoring to improve vaccine uptake for cultural, religious or ethnic minorities. Key messages • Improving vaccine uptake in underserved communities requires local solutions with tailored interventions. Trusted partnerships with various stakeholders are key to reducing health system barriers. • Participatory approaches to evidence-informed decision-making build bridges between evidence on interventions and needs of underserved communities to understand the transferability of interventions.

In at the Deep End: Innovative approaches to engaging underserved communities in Northern England

Abstract Background People living in socio-economically deprived communities have greater health needs, but worse access and outcomes from care. A growing international movement of Deep End (DE) general practice networks established to promote health equity, address challenges posed by the inverse care law and advocate for increased research involvement. Researchers, community members and practitioners in the North of England are exploring ways of engaging with underserved communities and addressing low levels of inclusion in research. Methods DE research i) co-designing the North East and North Cumbria (NENC) DE network with practitioners to prioritise service investment, research activities and initiatives for local communities; ii) Deep End Research Alliance Yorkshire and Humber (DERA-YH) and Participatory Action Research to increase research capacity and reflect upon the evolution of a novel primary care Community Research Link Worker role (CRLWs). Results Prioritisation activities in the NENC DE network, uncovered the volume and complexity of clinical and social need, leading to the co-design and evaluation of initiatives to improve mental health care, increase childhood immunisations, tailor deprescribing, support training, and increase patient inclusion in research. In the DERA-YH, the CRLW model increased participation in research from ethnic minority communities regarding prostate cancer, lung health, dementia, and contraceptive services. Community leaders stated that sharing resources and power in the research process builds trust and interest in research in their communities. Conclusions DE networks in Northern England have driven innovative approaches to engage underserved communities in research, fostering empowering and enduring relationships to address health and care inequalities. Co-design methodologies and CRLWs integration into research teams had a transformative impact on the accessibility of research for communities and for the researchers’ positionality. Key messages • Deep End networks are advancing approaches to meaningful engagement and partnership working with underserved communities, to address health, care and research participation inequalities. • We recommend co-design by default and CRLW models to build capacity and embed reflective practice, mutual respect, and power sharing across the research team.

How stop smoking outreach works: a co-inquiry informed, complex intervention model

Abstract Background Across Europe, smoking prevalence is concentrating in underserved communities with high levels of deprivation. And yet, there is little research on how stop smoking services (SSS) can engage these communities. This study presents the findings of a 12-month collaboration involving an external public health research team and staff of an English SSS. Staff worked with community partners (e.g., schools) to raise awareness of the service, which included a newly introduced e-cigarette offer. Methods A complex intervention model was developed and refined through 6 facilitated co-inquiry sessions involving 13 SSS staff. Staff also completed 32 reflection forms on outreach events and rapid ethnography was conducted, by the research team, to evaluate staff’s working assumptions. This included 8 observations of outreach events and interviews with 10 SSS staff and 8 community members, from the service target groups. Data were organised into themes. Findings The model presents a picture of stop smoking outreach as challenging, unpredictable and resource intensive yet often having great impact. The themes enrich this to highlight 1) the appreciation for yet unpredictability of outreach referrals for people disconnected from health services; 2) the importance of staff adopting a person-centred approach; 3) the challenges and opportunities presented by e-cigarettes; and 4) the role of strategic community partnerships in optimising staff time on outreach. Conclusions Stop smoking outreach can generate considerable interest in SSS, particularly when delivered in combination with an e-cigarette offer. Future research should explore the economic and social return on investment in community outreach: while time consuming, referrals generated proactively may become more important for SSS as smoking concentrates in underserved communities. Key messages • Stop smoking outreach is an effective way to raise awareness and generate referrals but must be done non-judgementally and via effective community partnerships. • Staff’s careful discussion of an e-cigarette offer can change the perception of SSS without contributing to recreational normalization.

Transferability of vaccination interventions from a community perspective: One size does not fit all

Abstract Background Removing health system barriers to childhood vaccination is an urgent matter in the migrant community in Greece, the Turkish and Moroccan communities in the Netherlands, the Ukrainian minority in Poland, and the marginalized Roma community in Slovakia. The objective of this study was to select and adapt potentially transferable evidence-based interventions for HPV and MMR vaccine uptake in partnership with the underserved communities. Methods Using a participatory approach, we assessed transferability of six pre-selected interventions with the Population, Intervention, Environment and Transfer (PIET-T) models: All countries investigated two interventions with trained community members to support vaccination as health promoters. Greece and the Netherlands included a school-based vaccination program. The Netherlands added two interventions addressing providers’ HPV vaccine communication, and Slovakia a multilevel intervention. Results We identified barriers and facilitators for successful intervention transfer in each of the target contexts. The transferability analysis showed that an intervention with health promoters is potentially transferable with adaptations in all countries. Principles of trust in the educator, tailored and trustworthy information, help in navigating the health system for vaccination and easy access at no cost are transferable key elements in all contexts. Adaptations refer to the intervention elements that need to be tailored to specific contextual needs. School-based vaccination was nowhere transferable. Health provider training needs to be culturally sensitive and adapted to the Dutch system. The multilevel intervention in Slovakia is not fully transferable. Conclusions Participatory transferability analysis was essential for decision-making and intervention adaptation. All countries independently selected a health promoter intervention as having potential to remove the identified health system barriers in the respective context.