Health Catch-UP!: process evaluation of a migrant multi-disease screening and vaccination tool

BACKGROUND: European migrants face a disproportionate burden of infection (tuberculosis, HIV, hepatitis B/C and parasites), are at-risk of underdiagnosis of non-communicable diseases and are an under-immunised group. Reducing these health inequities is a key public health priority, with the ECDC calling for innovative strategies to deliver multi-disease screening to at-risk migrants. Current strategies in the UK to screen migrants report low uptake despite clear health and cost benefits. Health Catch-UP! is a collaboratively produced innovative digital tool applying UK guidance to identify screening and vaccination requirements of migrants based on country-of-origin. (https://emishealth.vids.io/videos/a49ad1bb1a18e4c72c/health-catch-up-with-requested-editsmp4 METHODS: We did a mixed methods process evaluation of the Health Catch UP! tool in two GP practices, using the Medical Research Council framework for complex interventions. We recorded data on demographics, patients screened, disease detection and catch-up vaccination rates. We conducted qualitative interviews with staff and migrants to explore barriers and facilitators. RESULTS: Outcomes data were extracted for 99 migrants, predominantly from Asia (31.3%), and Sub-Saharan Africa (26.1%). 61.6% of participants were recommended screening, uptake of screening was high with 86.9% were screened for at least one health problem. New diagnoses included: one case of hepatitis C, 6 hypercholesteremia, 4 pre-diabetes and one diabetes. Catch-up vaccination uptake was poor (2.0%). Qualitative data strongly supported the acceptability and feasibility of the tool but recommended clear laboratory and management pathways, financial incentives, and a staff and patient information and training implementation package. CONCLUSIONS: Innovative primary care digital tools like Health Catch-UP! have potential to significantly improve disease detection and effective implementation of screening guidance but require robust testing and resourcing. KEY MESSAGES: • Migrants face disproportionate burden of infectious diseases, screening and vaccination innovations are required to reduce health inequity. • Digital clinical support tools in primary care have potential to improve disease detection and implementation of migrant screening guidance.