Honours nursing students’ research on the use of intersectionality theory in immunization uptake studies published in peer-reviewed journal, Vaccine

Eunah Cha and Vidhi Vyas

During their final year of the University of Alberta honours nursing program, Eunah Cha and Vidhi Vyas noticed gaps in vaccine coverage in Canada. With oversight and mentorship from Applied Immunization (Aimm) team members Keith King, Laura Reifferscheid and Shannon MacDonald, the two students set out to see if Canadian researchers were using an intersectionality framework in their research on immunization uptake.

According to the Intersectionality Research Institute, intersectionality is the concept that all oppression is linked and people are often disadvantaged by multiple sources of oppression. Some examples might include race, gender identity, sexual orientation, socio-economic status, geographic location, education and age, among others.

Using an intersectionality lens in vaccine research can identify barriers to immunization uptake and help inform the development of strategies that enable equal access for everyone. 

“I had previously worked as a diversity and inclusion intern with the University of Alberta Residence Services, which sparked my interest in EDI work,” says Cha. “I saw that Dr. MacDonald’s area of research included vaccine equity and decided to reach out.”

“We wanted to know if intersectionality was used in previous research,” Vyas adds, “to find those gaps, address those inequalities and see if there has been any movement towards addressing those barriers.”

The results of their research — Inclusion of intersectionality in studies of immunization uptake in Canada: A scoping review — was recently published in the prestigious, peer-reviewed journal Vaccine.

Highlights of their findings

• Intersectionality theory is rarely applied in vaccine coverage studies in Canada: Of the 78 studies looked at, only 20 used intersectionality in their analysis.

• No Canadian vaccine coverage studies explicitly describe using intersectionality theory: While the term “intersectionality” was first coined by feminist critical race scholar and UCLA Law School professor Kimberlé Williams Crenshaw in 1989, it’s still considered a new concept. “It’s been thrown around in research a little bit but it hasn’t been used in-depth within vaccine research in Canada and there’s no clear definition for how researchers can use it,” says Vyas.

• Individual-level characteristics are most studied in Canadian vaccine coverage studies: “Most studies would measure uptake based on a single characteristic,” says Cha. “For example, a study might reveal that age group X had a certain percentage uptake and age group Y had a certain percentage uptake. However, there are various factors, both on an individual and societal level, that influence one’s access to vaccines. An intersectional lens would consider how these factors interact in the context of systems of power or oppression to affect vaccine uptake.”

• Sex and gender are often incorrectly applied in vaccine coverage studies in Canada: Cha explains that “sex and gender are two different factors that contribute to unique health outcomes, so it’s important that we apply these terms correctly.” Vyas adds that incorrectly applying the terms sex and gender can lead to mistrust of the health-care system. The students also noticed that “male” and “female” (which are descriptors for sex) were often the only gender-identity options. “This further perpetuates a cis-heteronormative view and fails to produce research that is applicable to everyone,” says Cha, “including those whose gender identity exists outside the binary.”

Why intersectionality in research is important

Vyas saw the effects of low immunization uptake for rural citizens first-hand when she was working in public health in Wetaskiwin after graduation. “It was more rural and there were more socio-demographic factors that determined if an individual received immunizations,” says Vyas. “They couldn’t get to the clinic, or they didn’t have child care for their five older children,” she adds, “so they couldn’t just come in with their baby, but would have to bring everyone.”

Cha explains further with the following example. 

“A single POC (person of colour) mother working full time in a rural community will experience vaccine access differently than a white university-educated male living in an urban setting. Even if they are the same age, their other social locations interact and lead to different health outcomes. When researchers use an intersectionality framework, they can better scrutinize the intersecting contributors to low vaccine uptake and implement better strategies to advance health equity.”

“Many individuals face barriers in accessing life-saving vaccines,” says Cha. “I hope our research draws attention to the need (and urgency!) for intersectionality-informed research.”

About Vidhi

Vidhi Vyas is now working in Edmonton as a public health nurse. Her current focus is on reducing barriers for school-aged children to get caught up on their routine vaccinations in the wake of the COVID-19 pandemic. She finds the work rewarding and purposeful. 

“It’s like a domino effect,” says Vyas, “The littlest thing we do can make a great impact on the community as a whole, which is why I like public health. I like empowering individuals to make informed decisions for themselves so they can take control of their own health care.” 

With a love for both nursing and teaching, Vyas is considering returning to school to pursue a master of nursing degree with a focus on education.

About Eunah

Currently working as a registered nurse in both a cardiovascular intensive care unit and a neonatal intensive care unit, Eunah Cha says she enjoys the unique position a nurse has in a patient’s journey. “It’s a team effort with the patient and their family and the greatest feeling when you can help them achieve their goals — definitely a rewarding career,” she says.