Barriers to and Enablers of Childhood Immunization Uptake in First Nations Communities in Canada: A Rapid Review of the Literature

Background and objective Childhood immunization is essential to public health; however, vaccination coverage among First Nations communities in Canada remains suboptimal. To support the broader project aimed at increasing immunization rates among First Nations children in northern Saskatchewan, we conducted a rapid review to examine the current evidence on barriers and enablers to childhood vaccine uptake within Canadian First Nations communities. Methods Following Cochrane Rapid Reviews Methods Group guidelines, we searched the 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. Results We included four studies in this review. We categorized the barriers to childhood immunization into three domains: parental or caregiver factors, healthcare provider factors, and health system factors. Parental barriers included fear of needles, misinformation, safety concerns, scheduling conflicts, transportation challenges, and child illness. Provider-related barriers involved scheduling challenges and perceived disrespect from healthcare staff. System-level barriers included rigid appointment policies, long wait times, and fragmented immunization records. We also identified key enablers such as trust in healthcare providers, culturally safe care, fear of disease outbreaks, on-reserve service delivery, data-sharing agreements, flexible service models, and community engagement. Conclusion To improve immunization rates in First Nations communities, public health interventions must address cultural, systemic, and logistical barriers. Strategies should prioritize culturally safe care, community engagement, enhanced communication, and flexible service delivery models supported by robust information-sharing systems.