Applying Structural Equation Model to Understanding Immunization Inequities among the Hmong Community

Aims: Describe factors related to perception of barriers of immunization in the Hmong community Methods: Community-based participatory research using a standardized, community-based instrument was used to explore barriers to immunization in the Hmong community. A total of 417 Hmong parents and caregivers completed the survey. A structural equation model (SEM) was created to determine factors that contribute to perceived barriers. Results: The SEM included three factors– nativity, socioeconomic position, and use of traditional healthcare (inclusion of shamans and herbalists in healthcare) – as potential predictors of barriers to immunization. Lower socioeconomic position and use of traditional healthcare significantly predicted higher perceived barriers to immunization. However, nativity, as indicated by years in the U.S, age of arrival to the U.S., and English language fluency, did not predict perceived barriers. Conclusions: Despite significant public health efforts to provide universal immunization coverage, inequities persist for children of Hmong origin. Interventions aimed at reducing immunization inequities need to consider distinct sociocultural factors that impact immunization rates among different refugee and immigrant groups. SEM is a useful research tool for understanding the complexities of health inequities in refugee and immigrant groups.