Table 5 Descriptions of low-barrier, culturally responsive COVID-19 vaccination services for newcomer refugees and immigrants in Calgary and area (2021–2022) with verbatim quotes

Community locations and on-site vaccination services:

Key informants emphasized that refugees and newcomers are frequently based with barriers to access in the form of geographic and transportation issues. As a result, populations who wanted to be vaccinated were unable to reach clinics because public transportation was unreliable, irregular and not well-connected. Informants and clients also lamented the political inflexibility to offer vaccines in accessible locations such as schools or nearby clinics. Geography was also a main barrier for rural, TFWs

“Well, the biggest thing was that we were located at a hotel where a lot of the refugees were, that was their first stop in Calgary and Canada. So, the access, the convenience was right there; we were at their fingertips. So most of the refugees came through the clinic right at the hotel and then you know the ones that were hosted at a different hotel we ended up going to them. [We used] one of the conference rooms, so that they wouldn't have to bus or coordinate rides or transit anything like that.” (Key informant 03)

“We went to various spots like [example of a cultural centre] and did it in their setting with their support with translation and them helping, [to] find all the people that needed it and get them through.” (Key informant 02)

Evening and weekend hours:

Informants emphasized that newcomers are likely to be working outside of traditional hours or be unable to afford time off for vaccine appointments, or have employment that does not allow it. Therefore, flexible hours and evening and weekend availability for appointments was a primary strategy to increase access

“People are working hard and hours are different. They start work at seven in the morning till seven in the evening, so they can't go to the clinics. And that's why it was decided that going to a place where the people are, or where the clients are, to give vaccination, that'll be the best thing… Similarly at [a large leisure centre] registration was done over the weekend, so they were open […] from nine-to-nine Saturday, Sunday…As far as [my] clinic is concerned, we have normal hours but I did in my clinic some Saturdays or Sundays solely for vaccination. We booked right away.” (Key informant 11)

“I think their main barriers, as I mentioned earlier, are timings for people whether they can get in or not. [If someone] has a bigger family, two or three generations in one home and how to get them and if one person drives and he can bring other people, especially weekend work better for them or after hours, that was the best thing for them.” (Key informant 11)

Attention to clinic atmosphere:

Recognizing the importance of a positive clinic experience, and the potential for past system trauma, models were designed with patient comfort in mind. Modified elements included imagery, seating, wayfinding and signage (from the parking lot to the interior), staff layout, music, entertainment for children, and other elements related to the ambiance

“We had music playing all the time, we had a video screen up, we created an environment that was very calming. Families could sit together at big tables. Sometimes we had ten chairs at one vaccinator’s table, and [the nurse] would vaccinate all ten family members together. We didn't want to be inefficient, but we wanted to be welcoming and so there was a very strategic design to make that happen and to make it feel comfortable. We spread out the appointments so […] you never had to wait very long. You got greeted in a parking lot and shown where to park and then you got walked to the door and then you got walked to the next point. There was always a human to guide you through.” (Key informant 02)

Culturally responsive staff:

Model partners hired and/or assigned key personnel and volunteers based on their lived experience and language spoken, to specifically work with newcomer and refugee groups (T2, Q31). This supported trust-building and the linguistic and cultural translation of medical information

“I think what's been like we've been lucky that we've always had people [internally] who speak the language so as an agency we're very diverse. And so I think just the nature of working in such an environment you learn how to be a little bit more culturally sensitive and you also learn from other cultures, because your colleagues are from the same cultures that your clients are from.. So they really understood the clients, they understood what they had been through.” (Key informant 06)

First language information and service delivery:

Models provided written and oral translation services to meet the needs of patients (T2, Q32), through means such as certified health translators by phone, on-site staff and volunteers, vaccine navigators and various technologies such as Google Translate. The preferred services for staff and refugees were trained face-to-face translators such as vaccine navigators. Models provided materials and services to patients before and after receiving vaccinations in multiple languages. These could be in face-to-face and/or virtual settings

“You have people, imagine you have a 60-year-old man that does not speak English, and somehow, he ended up in Canada and he cannot go to the clinic. It's difficult for him. And learning a new language is not achievable that much for him, he just can't do it. It's just age and whatever is going on, it's not an achievable thing. They are not understanding. […] Yeah, that's why at the beginning, I always keep them (interpreters) for the vaccination. I keep with me at least 2 interpreters, 2 to 3 interpreters must be there.” (Key informant 01)

Other examples of culturally responsive design:

• Availability of private rooms for vaccine administration

• Availability of same-gender doctor/nurse

• Whole-family appointments

• Same-gender nurses available

• On-site community service booths

• Integration of vaccine navigators

Other examples of low barrier design:

• Provision of transportation to clinic, leveraging the capacity of NGOs

• Clinics in locations accessible by public transportation

• Provision of health care numbers on site (rather than requiring a number for booking)

• Mix of booking options including telephone booking, online booking, and walk-in appointment

• Capacity to make bookings for groups/ families instead of one by one

• Booking support

• Appointment reminder calls

• Integration of vaccine navigators