5933 Barriers to compliance with Vitamin D supplementation in unaccompanied asylum-seeking children

Objectives Unaccompanied asylum-seeking children and young people (UASC) face significant health inequalities and complex health needs.1 Contributory factors include stigma, language barriers, unfamiliarity with the NHS, frequent relocation and complex and multiple physical and mental health needs. Despite guidance that asylum-seekers and refugees should take a vitamin D supplement,2 a large proportion of UASC are identified to have deficient Vitamin D levels at initial assessment (unpublished data) and are recommended to start prescribed treatment-dose supplementation as per national guidance.3 We aimed to assess compliance with this recommendation and explore barriers to this. Methods UASCs referred to the Paediatric TB Clinic identified from referral letters as being prescribed vitamin D supplementation to treat vitamin D deficiency were invited to participate. Consent was obtained with an interpreter. A survey was conducted by a researcher, either face to face or by telephone. Data was recorded on Survey MonkeyTM and analysed with Microsoft Excel. Results 20 UASCs consented to participate over a one month period. 15/20 believed taking a vitamin supplement was important or very important. 9/20 were aware they should be taking Vitamin D supplementation, but only 5/20 reported taking it. Of these, only 2 reported understanding why they needed it. 2 further UASCs had discontinued due to running out of supply. Other reasons reported by UASCs for not taking vitamin D included not being able to access the prescription from primary care (reported 4 times), not understanding the rationale (reported 14 times) and not wanting to take it (once). When asked what had helped, or would help them to take it, replies included reminders from a professional (8/20), clear explanation (15/20), use of interpreters (17) and translated resources (14/20) and physical collection of medication by a keyworker (12/20). Conclusion Compliance of UASCs with treatment of vitamin D deficiency by vitamin D supplementation is poor, despite self-reported high awareness of the importance of taking it. Lack of understanding, challenges to accessing medication, and language differences are cited as barriers to taking supplements. It is important, in this vulnerable cohort, to optimise communication, explanation and support to enable improved compliance with important medications. References Armitage AJ, Cohen J, Heys M, Hardelid P, Ward A, Eisen S. Description and evaluation of a pathway for unaccompanied asylum-seeking children. Arch Dis Child. 2022;107(5):456–460. https://www.gov.uk/government/collections/migrant-health-guide. https://www.rcpch.ac.uk/resources/vitamin-d-infants-children-young-people-guidance.