Mandy Knowles
Specialist Public Health Nurse PgDip Apprentice, Trafford Local Care Organisation (MFT)
Bridging language gaps: Apprentice project boosts immunisation among kids of immigrant families
Meet Mandy Knowles, our Specialist Community Public Health Nursing (School Nurse) Degree Apprentice who won the Outstanding Contribution to Equality, Diversity and Inclusion in Health and Social Care award at the Royal College of Nursing North West Awards 2023.
She was recognised at the award for her innovative High School Immunisation Project, an initiative focused on enhancing healthcare inclusivity in Manchester by breaking language barriers for immigrant families.
Through translating vital information into languages like Urdu and Arabic, her project ensures accessibility for every parent or carer to make informed decisions about their child’s health. This initiative led to over 70 additional immunisation consents.
Mandy was also shortlisted for BAME Nurse of the Year at the National BAME Health & Care Awards 2023. Read more about her apprenticeship journey and the positive impact her project is having on our community.
Choosing a degree apprenticeship
I came into nursing later in life, having previously worked as a personal trainer. My background had always revolved around health promotion, public health, and diet. Due to injury, I decided to requalify as a nurse. In 2014, I successfully completed my nursing degree and began working in acute and A&E settings.
In 2018, I had my son, and this sparked a newfound interest in school nursing. I started in 2020, just as COVID was beginning. I then enrolled onto the Specialist Community Public Health Nursing (SCPHN) PgDip Apprenticeship in 2022 to gain a better understanding of what the role should really look like, outside of COVID restrictions.
I came into school nursing with an adult nursing background, and I wanted to make sure I had all the underpinning knowledge and understanding of the role. The apprenticeship is given me time to reflect on my practice, to see the whole picture and join the dots.
The programme has been challenging but in a good way. It’s pushed me harder than I thought but I’ve met some wonderful teammates, all in different areas with different specialisms.
To have the opportunity to deliver my final project, make an impact on the community, receive recognition for my initiative, and collaborate with MSD, a global company, has been fantastic.
High School Immunisation Project
As part of our final project, we each identified an area of need within our work. I had previously worked in the south of Trafford, which is quite an affluent area. I then moved to the north of Trafford, just five minutes away, but the demographic and health needs are completely different.
When researching this new area I was working in, I discovered there was a significant health need around childhood vaccinations. I noticed the number of returned consent forms was particularly poor within a specific school this year (just 30 out of 170), possibly linked to the introduction of digital consent forms.
Historically, this has always been an issue and the intervention in place at the time was to call parents to gain verbal consent prior to their child receiving their vaccination. This was not cost effective or a good use of staff time.
After phoning a few parents I decided we needed to get to the bottom of the real issues. Looking at the population, one in three children belongs to an ethnic minority, with the Asian population increasing by 64% in 10 years. I realised many of the parents didn’t speak English. Sometimes the parents put the child on the phone to translate, which comes with ethical considerations, among other concerns.
I decided to gather some data; to find out what languages they spoke, what knowledge and understanding they had of HPV and of the vaccinations, and what access they had to electronic devices.
It became clear that we were sending this information out in a language they didn’t understand, in a format they didn’t all have access to, about a vaccine for something of a sensitive nature.
Inclusive healthcare access through language support
I spoke to the Manchester immunisation team and found that although there were areas with a similar demographic, there wasn’t a targeted approach to improving immunisation rates.
The four main languages spoken at the school I work with are Urdu, Gujarati, Punjabi and Arabic. I realised I needed to translate the information for them but wasn’t sure how to go about it.
I started looking for partners who could provide some funding for interpreters. I contacted the North West Optimise Healthcare Group, part of MSD, as they focus on research, vaccinations and communities that are hard to reach. From them, I was able to gain the health literature in the languages I needed.
It was agreed with the school’s head teacher that I could speak to parents at an upcoming year 7 and 8 parents’ evening. HPV, the 3-in-1 teenage booster (Td/IPV), and MenACWY vaccine are given in year 9.
I secured funding to employ interpreters, displayed posters and provided literature in their own languages, and I was there to answer questions. Any consent forms signed on the evening lasted 12 months.
Achieving positive healthcare results
We collected 72 consent forms signed at the parents’ evening, but the impact should reach further than that. People took literature and forms home with them, and some have younger siblings that it will impact in the coming years.
We also spoke to a parent with children at another school, so we were able to go into that school and perform those vaccinations. Word-of-mouth among parents may further boost participation, though measuring the full impact is challenging.
Our efforts are also building trust within the community, focusing on equality and accessibility to reduce the health gap and enhance children’s care.
The school will adopt this successful approach moving forward, using interpreters to broaden accessibility. Additionally, our work raised awareness of the school nurse’s role, prompting inquiries from parents about their children’s health needs and the support we can provide, exceeding our expectations in promoting our services.
By providing an educational health approach, the school nurse can break down misconceptions around vaccines and empower parents and care givers to make informed choices, increase community engagement, and ultimately prevent illness and disease.
Amplifying project impact
I believe the project has potential for expansion, but not every area has the same requirements. There’s been an influx of children coming into Trafford from Hong Kong and China, so the language needs will differ by school.
Now we’ve demonstrated the impact, the budget for translation and interpreters should be more readily available.
Looking ahead, the plan to continue collecting data over the next academic year (2023/24) is an important step in assessing the sustained impact of the intervention. It provides an opportunity to monitor trends and evaluate whether the approach leads to a sustained increase in consent return rates, which is a critical measure of long-term success.
Programme’s contribution to project success
If it wasn’t for the programme, I wouldn’t have had the protected time to execute the project. Each stage of the Empowerment Project was broken down. There were barriers and challenges that the programme team supported us to overcome.
I wouldn’t have done this project without this Apprenticeship, I wouldn’t have known where to start.
What’s been useful about the apprenticeship is meeting people from different areas. I know if I need advice on the LGBTQ+ community, vaping, body image, etc., I can go to one of my colleagues. It’s been really good for networking and partnership working.
Reflecting on Mandy’s work and the positive results, her manager and School Nursing Team Leader, Helen McNulty, commented: “We are delighted that Mandy has [won] this award. She identified a health inequality, came up with a plan to address this, put the plan into operation and has taken the learning from this project to inform future service delivery.”
She also added: “Mandy has had a challenging year, she has undertaken a university degree, alongside working and being a Mum, but does all this with a smile on her face and boundless enthusiasm. Well done Mandy, we are very proud of you!”