I can't tell you about literature on the subject but I can tell you of one
experience I've had with offering clinics in nontraditional sites.

Around 5 years ago I was teaching community health nursing in Buffalo. I
had a group of RN nursing students completing their degree and working out
of a community centre of lower West Side Buffalo. The population in that
area is largely Puerto Rican and, according to statistics we could get,
preschool children had exceedingly low immunization rates. During the term
we were there, one of the large HMOs and a drug store partnered with the
health department to offer free immunizations across Buffalo. The people at
the community centre thought it would be a great idea to offer a clinic
there and so we did. For legal protection, we worked under the auspices of
the health department, they provided the supplies and vaccine, and each of
the students and myself undertook a course to be certified to immunize
(required by NY State law). Advertisements were sent home from school with
older children, posted in grocery stores and located on buses, billboards
etc. It was widely advertised in English but we were able to influence some
Spanish advertising as well. I tell you all of this to stress that this was
a highly visible campaign, albeit with some flaws, and there were numerous
sites from neighbourhood health clinics, the Children's Hospital, to
ours-located right in the community, at a community centre the people of
the neighbourhood frequented, and requested by community leaders at the
centre. We planned to accommodate about 200 children.


Well, the big day came, and Dennis Gorski dropped by for a photo op. It was
a good thing he came when he did, first thing in the morning, because one
family showed up with one child; he/she was immunized and had a picture
taken with a smiling politician and for the next 6 hours we sat there
wondering what went wrong. All day we only immunized one child.

Of course, I tended to take the failure personally and searched my soul for
where we had gone wrong. When the final reports were in, a total of 13
children in the Buffalo area had been immunized in the multiple sites. Many
sites had not had even one person respond.
Why is a matter of conjecture only. But, I suspect that people in our
neighbourhood had not developed any relationship with health care providers
that would encourage immunization. There are no neighbourhood public health
nurses to support new families and provide health information. I would
guess that only a few regularly see a health care provider because of being
un- or underinsured. In the short period of one semester, students were not
there long enough to develop sufficient trusting relationships within this
community.

I had always thought that cost of immunization was the key factor; it was
clearly not cost, nor was it location. I think it had much more to do with
the differential disadvantages a largely privately-funded health care
system has on low income families. There is a pattern of chronic
inaccessibility to a consistent health care care provider in un- or
underinsured families. Often the contact such families have with the health
system is in the Emergency Room, where they see a different provider each
time and treatment is focused on a presenting problem.  Add to that the
likelihood of encountering not only a different value system but also often
cultural, class, and/or gender biases, and you have families who have never
internalized information that immunization of their children can protect
them. Of course, when the children reach school age, they are required by
law to have the immunizations so they eventually do. Unfortunately, many
are not protected when they are young and some of these diseases are likely
to be the most devastating.

Long story, I'm not sure how useful it is. I don't know how relevant it is
to Canada and I'm not sure where you're writing from. I think what I
learned is that before I would even consider a neighbourhood clinic again,
I would make sure the ground work had been done. That is families had
received information to make decisions about immunization by knowledgeable
people with whom they had deveIoped trusting relationships. When that has
happened, I think neighbourhood clinics might provide a useful service in
some communities.



At 12:59 PM 10/10/99 -0400, you wrote:
>I am wondering if anyone has information on the effectiveness of influenza
>immunization clinics that have been held in alternative sites (e.g.,
>pharmacies, supermarkets, churches), particularly in relation to health
>education.  I have been searching for literature on this topic, but haven't
>come up with much.  Most of the literature seems to concentrate on more
>traditional sites, such as doctor's offices and local health departments.
>Thanks!
>
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"This is the future: to fight in favor of change or to fight in favor of
keeping the present" Freire