Barriers of Influenza Vaccination Intention and Behavior - A Systematic Review of Influenza Vaccine Hesitancy, 2005 - 2016

Number of medical facilities within driving distance of residence and influenza vaccination status in Japan: A cross-sectional study

Vaccine hesitancy primarily consists of confidence, complacency, and convenience, including geographical accessibility. However, few studies in developed countries have focused on the association between geographical accessibility to vaccination services and vaccination status and previous studies have shown conflicting results. This cross-sectional study aimed to clarify the association between the number of medical facilities within a 15-minute driving distance from the place of residence and influenza vaccination status, using a large nationwide internet survey in Japan (n = 27,440). Postal codes were used to determine participants' place of residence and the number of medical facilities within a 15-minute drive was calculated using geographic information system data. Participants were classified into quartiles based on the number of medical facilities nearby. They reported their influenza vaccination status over the past year. Modified Poisson regression analysis was conducted with influenza vaccination status as the dependent variable and the number of medical facilities nearby as the independent variable, adjusted for covariates stratified by age (under 65 years: or 65 years and older). Among participants aged 65 years and older, those with fewer medical facilities within a 15-minute drive of their place of residence were significantly less likely to have received an influenza vaccination than those with more medical facilities nearby (prevalence ratio in Q1 relative to Q4: 0.93, 95% confidence interval 0.87-0.99). In contrast, no association was observed among participants aged under 65 years. Geographical accessibility to vaccination services may influence vaccine hesitancy among older adults in Japan, a developed country.

Research trends and key contributors in studies on influenza vaccines for children: A 20-year bibliometric analysis

Globally, there are over 3 million severe cases of influenza each year, leading to up to half a million deaths. This study provides a comprehensive analysis of the current status of children's influenza vaccine research over the past 20 years and explores potential future research trends, including improvements in vaccine coverage and strategies to address vaccine hesitancy. We extracted all research data on children's influenza vaccines from 2004 to 2024 using the Web of Science Core Collection (WOSCC). The contributions of various countries/regions, institutions, authors, and journals in this field were assessed, and research hotspots as well as promising future trends were predicted through keyword analysis using CiteSpace and VOSviewer. A total of 2,598 related publications from 2004 to 2024 were identified and collected for analysis. The United States (USA) and England emerged as the leading contributors with the highest number of published papers. AstraZeneca was identified as a key leader among research institutions, and Ambrose Christopher S was recognized as the most productive author in this field. The journals Vaccine and Human Vaccines & Immunotherapeutics stood out as the most prominent publications in this area. The keyword analysis highlighted that international research collaboration maybe a promising strategy for bridging global gaps; Addressing vaccine hesitancy could potentially increase vaccination coverage; Live attenuated vaccines, intranasal administration and universal vaccines are promising directions for future development. These insights highlight potential avenues for improving influenza vaccine coverage and inform strategies to mitigate vaccine hesitancy, crucial for protecting children and enhancing public health.

Knowledge, attitudes, and beliefs of pharmacists regarding vaccinations against influenza and pneumococci - a systematic review

Pharmacists' knowledge, attitudes, and beliefs regarding vaccination can significantly influence patients' willingness to receive vaccinations. This study aims to assess the level of knowledge, attitudes, and beliefs of pharmacists toward influenza and pneumococcal vaccinations. On February 17, 2024, a systematic search was conducted in the Medline (via PubMed), Embase (via Ovid), and The Cochrane Library databases, following PRISMA guidelines. Before analyzing the results, the study protocol was registered in the PROSPERO database (CRD42024566984). Of the 1,209 studies identified, 24 publications met the inclusion criteria for analysis. Most of these (n = 22) were cross-sectional studies using proprietary questionnaires. The studies found that pharmacists possess unsatisfactory knowledge about influenza and pneumococcal vaccinations. Shortcomings in attitudes and beliefs about vaccination safety were also evident, along with a deficiencies of promotion of vaccinations to patients.

Enhanced influenza vaccination for older adults in Europe: a review of the current situation and expert recommendations for the future

INTRODUCTION

Influenza causes considerable morbidity and mortality in Europe, particularly among older adults due to comorbidities, as well as immunosenescence and inflammaging, which contribute to a diminished immune response. Vaccination remains the most effective way to prevent poor outcomes; however, uptake is suboptimal and many countries recommend standard vaccines despite evidence supporting better protection with enhanced (adjuvanted and high-dose) vaccines.

AREAS COVERED

A multidisciplinary group of experts reviewed the burden of influenza in Europe and evaluated data on enhanced vaccines, providing recommendations for their use in older adults. The group discussed barriers to vaccination and strategies to increase uptake.

EXPERT OPINION

Improving protection of older adults against influenza relies upon increasing vaccine uptake and ensuring access to vaccines that overcome age-related immunological decline. Achieving higher uptake requires national policies that facilitate equitable access and clear communication about vaccine eligibility. Based on available evidence, enhanced vaccines offer better protection than standard vaccines against hospitalization and complications in older adults. National recommendations should prioritize the use of enhanced influenza vaccines over standard vaccines in older adults. Limitations to interpretation of evidence include discrepancies in reporting of influenza-related medical encounters and underreporting of influenza-related complications.

Unveiling the complexity of vaccine hesitancy: A narrative review focusing on dengue vaccination

Dengue vaccines face significant challenges, including safety concerns, which contribute to vaccine hesitancy. Addressing this complex issue requires targeted strategies to overcome existing barriers. Through an extensive review of current evidence, we identified key factors contributing to vaccine hesitancy and explored strategies to enhance global vaccine uptake. Four conceptual models and five assessment tools were identified to understand and measure vaccine hesitancy. Among the factors, "confidence" emerged as the most influential, followed by "complacency." Vaccine acceptance rates varied widely, ranging from 53% to 95%, depending on the region and population. Key determinants included population characteristics, concerns about efficacy and safety, among others. A comprehensive understanding of these factors is essential to improve vaccine acceptance, support dengue prevention efforts, and ensure public health success.

Population-Based Analysis of Vaccination Status and Post-Vaccination Adverse Events in Adults Aged 55 and Older

Background/Objectives: Older adults face increased vulnerability to infectious diseases such as influenza, pneumococcal infections, and COVID-19. Vaccination remains a key public health strategy, yet coverage and adverse event data in this group are limited. This study aimed to assess the prevalence of vaccination and the occurrence of post-vaccination adverse events among individuals aged 55 and older in Płock, Poland, with particular attention to gender and age differences. Methods: A population-based cross-sectional study was conducted between January and November 2022 among 2040 adults aged ≥ 55 years. Participants completed a structured questionnaire on vaccination history (past 3 years) and adverse events following immunization (AEFI). Cognitive eligibility was assessed using the MMSE (≥27). Statistical analyses included t-tests, chi-square tests, and Pearson correlation coefficients with a significance level of p < 0.05. Results: COVID-19 vaccination was reported by 86.9% of participants, influenza vaccination by 45.5%, and pneumococcal vaccination by 15.1%. Women reported significantly more adverse events following COVID-19 vaccination compared to men (16.1% vs. 8.8%, p < 0.001). A weak negative correlation was observed between age and number of vaccinations received (r = -0.088, p = 0.001), while age was positively correlated with adverse events following COVID-19 vaccination (r = 0.175, p < 0.001). Influenza vaccination was more common among men than women (50.7% vs. 43.4%, p < 0.05). Conclusions: Vaccination coverage among older adults in Płock was highest for COVID-19 but remained suboptimal for influenza and pneumococcal vaccines. Women reported adverse events more frequently than men. These findings highlight the need for targeted vaccination strategies and gender-sensitive communication approaches.

Factors Associated With Repeat Pediatric Influenza Vaccination Among Inconsistent Vaccinators

Promoting consistent vaccination practices may help improve suboptimal influenza vaccination rates. This study evaluated the prevalence and correlates of repeat influenza (flu) vaccination among children who had previously received the vaccine inconsistently. An online survey study was conducted in 2022 among parents of commercially insured children ages 3 to 19 years who were previously inconsistently vaccinated. Of 317 respondents, 85% reported that their child received a flu vaccine in the 2021 to 2022 flu season. Among these parents, 61% reported concern that their child would get sick from flu as the most important reason for vaccinating. Repeat vaccination was less likely among parents who reported that school/daycare requirements were a reason for vaccinating in the prior season (odd ratio [OR] = 0.17, 95% confidence interval [CI] = 0.05-0.55). Our findings suggest that school policies may improve vaccination rates among inconsistent vaccinators.

A Latent Profile Analysis of COVID-19 and Influenza Vaccine Hesitancy among Economically Marginalized Hispanic Mothers of Children under Five Years of Age in the US

Rates of COVID-19 and influenza vaccine coverage among Hispanic young children continue to be low in comparison to other racial and ethnic groups in the United States. This study utilized a person-centered approach to understand COVID-19 and influenza vaccination hesitancy for young children under the age of five among 309 economically marginalized Hispanic mothers. Drawing on the cultural health belief model, in 2022, following FDA approval of the COVID-19 vaccine for young children, a latent profile analysis was conducted from which three profiles emerged. The Low Acculturation group (Profile 1), was notable for lower acculturation, moderate cultural medical mistrust, lower access to vaccines, and higher financial security. Compared to Profile 1, the two remaining profiles had higher acculturation and lower levels of financial security, but differed in that the High Acculturation group (Profile 2) had higher vaccine accessibility and the Moderate Acculturation group (Profile 3) had higher cultural medical mistrust. Relative to other profiles, Low Acculturation mothers were more likely to plan to vaccinate their child against current and seasonal COVID-19 and seasonal influenza, report that their child's health provider recommended the COVID-19 shot and reported lower COVID-19 and influenza vaccine mistrust. However, they also reported lower vaccine accessibility and moderate levels of cultural medical mistrust. The study highlights the importance of developing person-centered public health strategies that draw on Hispanic cultural values and consider diversity within lower income Hispanic populations to increase future pediatric COVID-19 and flu vaccination coverage among young Hispanic children.

The Roles of Acculturation and Pre-migration Experiences in Influencing the Confidence of Vietnamese Parents in Vaccine Use Among Adolescents

Vaccine confidence is a critical antecedent of vaccine uptake. Little research has examined vaccine confidence among Asian communities, particularly the associations with acculturation and pre-migration experiences. We explored this issue among U.S. Vietnamese parents. Our study uses an explanatory sequential mixed-methods design to investigate the influence of American acculturation, Vietnamese acculturation, and pre-migration experiences on U.S. Vietnamese parents' vaccine confidence for their adolescents. A cross-sectional web-based survey (n = 408) was followed by semi-structured interviews (n = 32). Quantitative analysis showed that many participants reported high or complete trust in scientists involved in vaccine development (61%), federal agencies responsible for vaccine safety monitoring and licensure (53%), the CDC (62%), and the FDA (58%). High or complete trust in scientists was associated with a higher Vietnamese acculturation score [aRR = 1.20 (1.03-1.40)], while trust in federal government agencies was associated with English medical proficiency [aRR = 1.42 (1.15-1.76)]. Qualitative findings provided deeper insights, with many parents expressing trust in vaccine efficacy, safety, and the rigorous development and approval process. Pre-migration experiences in Vietnam had mixed influences on vaccine confidence. Some participants cited positive experiences with the national immunization program, while others were influenced by negative vaccine-related injury stories. Newer immigrants reported limited familiarity with U.S. health authorities. Language preferences (Vietnamese versus English) for vaccine information varied. Our study highlights the complex interplay of acculturation, cultural identity, language, and historical experiences in shaping vaccine confidence among U.S. Vietnamese parents and emphasizes the need to take these factors into account with tailored public health strategies.

Vaccination readiness among adults in Norway: A cross-sectional survey using the 7C model

BACKGROUND

Maintaining high vaccination readiness is key to sustaining high vaccination coverage. In this study, we aim to estimate the vaccination readiness of the Norwegian adult population and explore its associations with sociodemographic characteristics and the intention to be vaccinated.

METHODS

A representative sample of the adult Norwegian population were surveyed with the validated 7C questionnaire on general vaccination readiness, which contains items about seven components of vaccination readiness (confidence, complacency, constraints, calculation, collective responsibility, compliance and conspiracy). Participants were also asked about sociodemographic background and their intention to be vaccinated against COVID-19 and influenza. We assessed associations involving vaccination readiness in linear and logistic regression models.

RESULTS

A total of 4137 individuals participated in the survey (overall response rate 50.5 %). Our study sample was comparable to the Norwegian population in terms of sociodemographic characteristics. On a scale from 1 to 7, the mean overall 7C vaccination readiness score was 4.82. Low overall vaccination readiness was associated with sociodemographic characteristics such as male sex, younger age, low education, low income and living alone. Overall vaccination readiness was strongly associated with intention to receive a booster dose of COVID-19 vaccine among those aged 18 years or older (adjusted odds ratio (aOR) 10.23, 95 % confidence interval (95 %CI) 8.38 to 12.49)), and with influenza vaccination among those aged 65 years or older (aOR 7.38, 95 %CI 4.51 to 12.10)), as were each of the seven vaccination readiness components when regressed on vaccination intention.

CONCLUSION

Overall general vaccination readiness was relatively high in the adult population in Norway. However, it differed between sociodemographic groups. Component and overall vaccination readiness scores were associated with intention to be vaccinated, and these associations were stronger for booster vaccination against COVID-19 than against influenza. The observed 7C estimates enable tracking of vaccination readiness over time and help identify themes and populations that can be targeted to improve compliance with vaccination program recommendations.

Disentangling behavioral determinants of seasonal influenza vaccination in post-corona era: An integrated model approach

Seasonal influenza vaccination (SIV) is influenced by various factors, including sociodemographic characteristics and socioeconomic status of the recipient. Nevertheless, in the post-COVID-19 era, the importance of vaccination and group immunity has grown. Therefore, applying an integrated model to identify behavioral determinants of vaccination is needed. This study aimed to identify contextual factors affecting SIV by applying Andersen's model. We utilized secondary national datasets (n = 14,535) from the 2022 Community Health Survey conducted by the Korea Disease Control and Prevention Agency. Predisposing factors were gender and age. Enabling factors were income, educational attainment, and marital status. Need factors were presence of chronic disease, health risk behaviors (smoking and/or drinking alcohol), physical activity, and coronavirus disease 2019 (COVID-19) vaccination status. Dependent variable was influenza vaccination status. Multiple binomial logistic regression analyses were performed to identify predictors of influenza vaccination status among Korean adults, stratified by gender and age. According to the results, in men, higher education increased the likelihood of influenza vaccination by 1.089 times (95% CI: 1.000-1.185), while being married increased it by 1.619 times (95% CI: 1.413-1.856); however, smoking and binge drinking reduced the likelihood by 0.822 times (95% CI: 0.732-0.923) and 0.749 times (95% CI: 0.650-0.864), respectively. Among young men, marriage (OR=1.480, 95% CI: 1.131-1.935) and physical activity (OR=1.381, 95% CI: 1.053-1.811) were significant positive factors, while among older men, chronic disease presence increased vaccination likelihood by 1.339 times (95% CI: 1.126-1.592). In women, higher education (OR=1.168, 95% CI: 1.075-1.270) and marriage (OR=2.242, 95% CI: 1.965-2.557) were strong positive predictors, while COVID-19 vaccination history consistently increased influenza vaccination likelihood (OR=1.852, 95% CI: 1.712-2.003). Among young women, smoking reduced vaccination likelihood (OR=0.551, 95% CI: 0.359-0.847), while among older women, having a chronic disease increased vaccination likelihood by 1.354 times (95% CI: 1.133-1.619). This study empirically reveals that SIV is affected by predisposing, enabling, and need factors. To effectively intervene in individual health behaviors, it is necessary to identify characteristics of the population, provide segmented messages, and apply customized strategies.

Factors influencing adolescents' decision-making about COVID-19 vaccination: a systematic review with qualitative synthesis

Introduction

Attitudes towards vaccination are influenced by a broad range of factors, yet little is known about the drivers shaping adolescents' vaccination beliefs. The aim of this study was to qualitatively explore the factors influencing adolescents' individual decision-making towards COVID-19 vaccination.

Methods

A systematic review was conducted using Medline, Web of Science, Sociological Abstracts, and Publicly Available Content Database. Studies on attitudes, beliefs, and perceptions of adolescents regarding COVID-19 vaccines were included. The JBI Critical Appraisal Checklist was used for quality assessment, followed by thematic synthesis of the included studies.

Results

In total, 13 studies were included, revealing 5 key themes: (1) Limited vaccine literacy influences adolescents' attitudes towards COVID-19 vaccines; (2) Family, peers, and community strongly influence adolescents' COVID-19 vaccine decision-making; (3) Different levels of trust in vaccine providers and governments influence adolescents' attitudes towards COVID-19 vaccines; (4) Desire to go back to normality influences adolescents' COVID-19 vaccine attitudes towards vaccine acceptancy; (5) Autonomy influences adolescents' COVID-19 vaccine decision-making.

Discussion

The review findings suggest that vaccine acceptance among adolescents could be improved through tailored and accessible vaccine literacy messaging, addressing structural mistrust, and empowering adolescents to make autonomous health decisions that take into account diverse contexts and populations.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/view/CRD42024512197, identifier CRD42024512197.

The Attitude Toward Seasonal Influenza Vaccine Among Workers of Community Healthcare Centers in Zhejiang Province, China: Barriers and Facilitators

Background: This study was aimed at understanding the attitude on influenza and influenza vaccination among workers of community healthcare centers (CHCs) and investigating the barriers and facilitators for influenza vaccination. Methods: A cross-sectional study was conducted through an anonymous questionnaire to all workers of CHCs in 22 CHCs. Socio-demographic characteristics, reasons for acceptance or refusal of influenza vaccination, influenza vaccination status, and attitude toward influenza vaccination were collected. Suggested strategies for improving influenza vaccine uptake were also surveyed. Descriptive analyses were conducted depending on the distributions of variables. A logistic regression analysis was implemented to examine the association between influenza vaccination status in the 2022/2023 season and the potential predictors. The adjusted odds ratio (AOR) with 95% confidence interval (CI) was calculated. Results: In total, 2205 workers of CHCs participated in this study. Influenza vaccination coverage in the 2022/2023 season was 1.36%. The reason "To avoid influenza" met with the highest level of agreement for acceptance of influenza vaccination (median = 4.36 for 1-5-point Likert scale), while the reason "Not a high-risk group of influenza and possible complications" met with the highest level of agreement for refusal of influenza vaccination (median = 3.72 for 1-5-point Likert scale). The influenza vaccination status was significantly related to professional categories, regular exercise habits, sources of information on influenza vaccination, and attitude on recommending influenza vaccination to patients. The free influenza vaccination and mandatory vaccination policies were the most frequent suggestions for improving influenza vaccination coverage. Conclusions: A lower influenza vaccination coverage was observed in workers of CHCs, and it might be attributed to several risk factors. It was urgent to take actions on improving their understanding of, awareness of, and confidence in influenza vaccination. Free influenza vaccination and vaccination requirement policies might be helpful for enhancing vaccine uptake, especially for physicians and other healthcare workers.

Factors influencing influenza vaccine uptake among adults in Johannesburg, South Africa: A qualitative study

BACKGROUND

Influenza vaccination coverage in South Africa is less than 3 % among the general adult population. We explored factors associated with influenza vaccine uptake using the World Health Organization's Strategic Advisory Group on Immunization (SAGE) 3C (confidence, complacency, convenience) model of vaccine hesitancy.

METHODS

The present study forms part of the Bambisana project, a mixed-methods pre-test-post-test intervention study conducted from 29 April 2023 to 15 April 2024. Participants ≥18 years were enrolled in six Focus Group Discussions (FGDs), stratified by age (≥18-34 and ≥ 35 years). FGDs were audio-recorded, transcribed verbatim, and coded in Dedoose using framework analysis.

RESULTS

Among the 48 participants, most (66.7 %, n = 30) were aged 18-34 years, 65.9 % (n = 29) had completed high school, and 70.2 % (n = 33) were unemployed. Overall, influenza vaccine uptake was associated with three key factors: low confidence, high complacency, and a lack of convenience. Low confidence in the influenza vaccine was associated with negative experiences with COVID-19 vaccines, fear of side effects, vaccine misconceptions, fear of needles, mistrust of public health institutions, and concerns about vaccine effectiveness. Complacency factors included reliance upon traditional and alternative medicines, lack of knowledge about vaccines, and minimising the seriousness of influenza illness. Convenience factors included perceived costs of the vaccine and a lack of influenza vaccine promotion.

CONCLUSION

Addressing confidence, complacency and convenience factors is important to increase influenza vaccine acceptance and uptake in South Africa.

Influenza and pneumococcal vaccine hesitancy in the elderly population: results from two representative surveys in Germany

BACKGROUND

The reasons for low influenza and pneumococcal vaccine acceptance in the elderly population are largely unknown - despite the great need of vaccines in this risk group. While many studies examine the relationship between factors influencing vaccination, such as sociodemographic characteristics and influenza and pneumococcal vaccination intentions and behavior, psychological factors, such as vaccine-specific attitudes, are underutilized in research on vaccination behaviors and intervention strategies. This article assesses the psychological antecedents of influenza and pneumococcal vaccination in the elderly and assesses the predictive power of psychological vs. sociodemographic and other factors surrounding vaccination, on vaccination behavior.

METHODS

A cross-sectional telephone survey, representative of age, gender and rural/urban residence, was conducted with N = 701 German participants > 60 years of age, during the influenza season of 2016-17. Multiple logistic regressions were conducted to identify the relevant determinants of vaccination behavior.

RESULTS

Results show unique patterns in the psychological antecedents: while confidence, the belief in the effectiveness of vaccination and calculation, the need for information, complacency, the lack of risk perception and constraints, and perceived practical barriers to vaccination predicted influenza vaccination behavior, only complacency predicted pneumococcal vaccination behavior. The amount of explained variance in influenza vaccination behavior nearly doubles when psychological antecedents of vaccination are taken into account, beyond other factors surrounding vaccination. However, the effect was smaller for pneumococcal vaccination behavior. The results are compared to a subnational sample.

CONCLUSIONS

Understanding the psychological drivers of vaccination can help to plan interventions effectively.

TRIAL REGISTRATION

Deutsches Register Klinische Studien (German Clinical Trials Register) DRKS00012653. Registered 24.11.2017. Retrospectively registered.

A Qualitative Study of Social Processes, HPV Vaccine Attitudes, and Vaccination Behavior Among Hesitant Adopter Parents

Despite the availability of a highly effective human papillomavirus (HPV) vaccine, uptake remains below Healthy People 2030 targets, particularly in rural areas where HPV-related cancers are more prevalent. This study aimed to explore how social processes influence parents' HPV vaccination decisions, focusing on vaccine-hesitant parents who vaccinated their child(ren) against HPV despite their hesitancy, eg, "hesitant adopters." We conducted a qualitative exploratory analysis of in-depth interviews with hesitant adopter parents (n = 8) to explore how social interactions with trusted interlocutors influenced their decision-making. Hesitant adopter parents identified relevant professional expertise, direct experience with the HPV vaccine, and social proximity to interlocutors as influential factors. We argue that rather than a single moment or decision, vaccination decision-making is a dynamic, ongoing process affected by social processes. This study adds nuance to our understanding of how prior vaccination behavior functions in future vaccine acceptance.

Explanation of intention toward influenza vaccination among cardiovascular disease patients: An application of the extended protection motivation theory

OBJECTIVE

Patients with cardiovascular disease (CVD) are susceptible to influenza virus infection, and influenza vaccination is effective in preventing influenza, but its uptake remains low. This study will investigate the influencing factors affecting patients' intention to receive influenza vaccination based on the extended protection motivation theory (PMT) and explore whether there are differences in this psychological pathway among patients with different levels of illness perception.

STUDY DESIGN

Cross-sectional study.

METHODS

In this study, the extended PMT model was used, which consists of the original construct (threat and coping assessment) and the extended construct (social norms and trust). Based on this, the model used to explain influenza vaccination intentions in CVD patients was constructed. Structural equation modelling was then used to test the extended theory from the overall population, the high-illness-perception and low-illness-perception populations, respectively.

RESULTS

Intention toward influenza vaccination was positively correlated with severity (β = .211), vulnerability (β = .154), response efficacy (β = .243), self-efficacy (β = .154), and social norms (β = .179), while being negatively associated with response costs (β = -.244). Social norms influenced intention by mediating response efficacy and self-efficacy, while trust in information sources was mediated by self-efficacy. Extended PMT had higher interpretative efficacy in patients with high illness perception than in patients with low illness perception (75.1 % vs 35.2 %).

CONCLUSIONS

The study found that the extended PMT is appropriate for explaining the intention toward influenza vaccination of patients with CVD. Patients with different illness perception levels have differences in the paths. It is suggested that patients with different levels of illness perception be subdivided, and intervention strategies should be developed by considering the theoretical models of each subgroup.

Predictors of COVID-19 vaccine recommendation practices among healthcare providers in the US

OBJECTIVE

To understand relationships between COVID-19 vaccine perceptions, confidence, trust, sociodemographic/practice characteristics, and COVID-19 vaccine recommendation practices among US healthcare providers.

METHODS

In November 2021, an electronic survey was administered to nurses and physicians in the US via Qualtrics®. The survey included: (1) COVID-19 perceptions, (2) vaccine confidence, (3) trust, (4) uptake, (5) recommendation practices, and (6) sociodemographic/practice characteristics. Binary logistic regressions were used to obtain unadjusted/adjusted odds ratios in predicting recommendation practices of COVID-19 vaccine.

RESULTS

The survey included 304 participants. In adjusted analyses, not believing that COVID-19 was man-made, not living in southeastern US (as compared to living in southeast), having no concerns about COVID-19 vaccines, having more positive perceptions about the vaccines, and having more trust in healthcare, media, vaccine manufacturers, and public health authorities was significantly (p < 0.05) related to routinely recommending the vaccine for all patients 12 and older. Providers who did not think COVID-19 was man-made had 6.1 (95 % CI = 1.10 - 33.5) times the odds to recommend the vaccine. Providers not practicing in the southeast region had 5.2 (95 % CI = 1.39 - 19.8) times the odds to recommend the vaccine.

CONCLUSION

To increase provider recommendation of COVID-19 vaccines, beliefs about disease origin, concerns, and trust should be addressed.

PRACTICE IMPLICATIONS

Clear, accurate, and trusted information delivery about COVID-19 vaccines to healthcare providers is needed, and in turn this may reduce patient vaccine hesitancy.

COVID-19 vaccine uptake and predictors of hesitancy among healthcare workers in Côte d'Ivoire

Background

Vaccine hesitancy hinders COVID-19 control, especially among healthcare workers (HCWs).

Aim

This study examined factors influencing COVID-19 vaccine uptake and hesitancy among HCWs in Abidjan, Côte d'Ivoire.

Setting

The study was conducted among healthcare workers in Abidjan, the capital city of Côte d'Ivoire.

Methods

A cross-sectional study was conducted from May 2023 to June 2023 in Abidjan. A total of 240 HCWs completed a questionnaire on vaccination attitudes, hesitancy factors and willingness to recommend vaccines. Descriptive statistics and modified Poisson regression estimated adjusted prevalence ratios (aPR) at a 95% confidence interval.

Results

Among participants, 57.5% were female, with a median age of 40 years (IQR: 33-45). HCWs included physicians (26.7%), nurses/midwives (22.5%) and pharmaceutical staff (19.2%). They worked in teaching hospitals (23.3%), general hospitals (30.8%) and community hospitals (45.8%). Vaccine uptake was 73.3%, with 53.3% fully vaccinated and only 4.6% receiving a booster dose. However, 42.1% exhibited vaccine hesitancy, mainly due to concerns about side effects (52.2%). While 55.0% would recommend the vaccine, only 46.3% felt confident addressing patient questions. Age was positively correlated with vaccine uptake: HCWs aged 35-44 years, 45-54 years and 55-65 years were 1.60, 1.68 and 1.78, respectively times more likely to be vaccinated, respectively, compared to those aged 22-34 years.

Conclusion

Vaccine hesitancy (25%) and low booster uptake (4.6%) highlight the need for targeted education and pharmacovigilance. Strengthening HCWs vaccine knowledge and trust is essential for epidemic control.

Contribution

This study underscores the importance of Ministry of Health-led interventions to improve HCWs vaccination rates in Africa.

Determinants of seasonal influenza vaccination uptake, intention and recommendations among Lebanese physicians

The most effective way to prevent influenza infection and its severe outcomes is through vaccination. Influenza vaccination is recommended for high-risk groups, including health care workers who have high occupational exposure. Hesitancy is a major challenge affecting vaccine uptake. This study aims to identify the determinants of seasonal influenza vaccine uptake, intention and recommendation to target groups of physicians in Lebanon. A cross-sectional study was conducted targeting physicians working in Lebanon. Data was collected on Kobo Toolbox using an online questionnaire developed based on the Health Belief Model. A random sample of physicians was selected from the Order of Physicians database. The link to the questionnaire was sent by email or message. Univariate, bivariate and multivariable analyses were performed using R software. The total number of responses was 1019. Half (49 %) of the participants received the vaccine in the 2022-2023 season, and 73 % intend to get it if recommended and offered for free. The perception of vaccine effectiveness was associated with vaccine uptake (adjusted OR = 2.54, 95 %CI = 1.98-3.31), intention to be vaccinated (adjusted OR = 17.5, 95 %CI = 7.21-50.5) and vaccine recommendation. Perception of vaccine safety, type of healthcare facility and physician's specialty were also associated with flu uptake. Other predictors for intention were: perception of disease severity and flu uptake during the previous season. Other predictors for flu vaccine recommendation were: province of residence, number of years in healthcare, specialty and intention to take the flu vaccine (adjusted OR = 21.0, 95 %CI = 7.58-71.3). Influenza vaccine uptake among participating physicians is suboptimal, yet intention to take the vaccine is higher. The study identified several factors associated with the vaccine uptake, intention and recommendation. A multifaceted approach and targeted education activities are needed in a sustainable vaccination program to increase physicians' influenza vaccine uptake.

Impact of Dark Triad personality traits on COVID-19 vaccination uptake and prevention efforts: insights from the European Covid Survey (ECOS)

BACKGROUND

Even though the COVID-19 vaccination roll-out in general can be considered as one of the most successful public health campaigns in the history of medicine, general vaccination hesitancy has remained an issue of concern throughout the world. We add to a deeper understanding of vaccination hesitancy by identifying what drives primary vaccination and booster uptake, as well as adherence to simple preventive measures such as physical distancing by investigating the role of Dark Triad personality traits, i.e. Machiavellianism, narcissism, and psychopathy.

METHODS

We investigate data from Germany and the United Kingdom from the European Covid Survey which was collected from 23 December 2021 to 10 January 2022. Logit regressions and random effects regressions were performed to study the effect of dark personality traits on COVID-19-related prevention.

RESULTS

We find a statistically significant association between Dark Triad personality traits and prevention efforts, primary vaccinations, and booster uptake against COVID-19. Specifically, individuals scoring high in psychopathy are associated with a lower likelihood of having received primary immunization. The marginal effect amounts to 3.31%-points. High narcissistic personality traits are correlated with a substantially higher likelihood (4.52%-points) to refuse booster shots after having received the primary vaccinations. Dark Triad personality traits may be relevant factors associated with vaccine-related decision-making. In addition, individuals with higher psychopathic tendencies report significantly lower engagement in other simple preventive behavior, while higher scores in narcissism are associated with higher reported adherence to simple preventive measures.

CONCLUSIONS

Our findings highlight the crucial role that personality plays in pandemic-related prevention. Policymakers, health professionals, and those in charge of health messaging may take these factors into account when devising communication strategies to improve the vaccination uptake and adherence to preventive behaviors. Future pandemics and public health crises would benefit from targeted, nuanced approaches to public health messaging to promote greater public adherence and public health.

Digital Health Intervention on Awareness of Vaccination Against Influenza Among Adults With Diabetes: Pragmatic Randomized Follow-Up Study

BACKGROUND

Diabetes mellitus significantly increases the risk of severe complications from influenza, necessitating targeted vaccination efforts. Despite vaccination being the most effective preventive measure, coverage remains below the World Health Organization's targets, partly due to limited awareness among patients. This study evaluated a digital health intervention aimed at improving influenza vaccination rates among adults with diabetes.

OBJECTIVE

This study aimed to demonstrate the effectiveness of digital health platforms in increasing vaccination rates among people with diabetes and to emphasize the impact of tailored messaging frequency on patient engagement and health behavior change. We hypothesized that digital tools providing empirical evidence of increased health risk awareness can effectively drive preventive actions.

METHODS

The study leveraged the Dario (Dario Health Corp) digital health platform to retrospectively analyze data from 64,904 users with diabetes assigned by the platform into three groups: (1) Group A received previously studied monthly flu nudge messages; (2) Group B received an adapted intervention with 2-3 monthly messages; (3) Group C served as the control with no intervention. Surveys were conducted at baseline, 3 months, and 6 months to assess vaccination status, awareness of influenza risks, and recollection of educational content. Statistical analyses, including logistic regression, chi-square tests, and t tests, were used to evaluate differences between groups.

RESULTS

Out of 64,904 users, 8431 completed the surveys. Vaccination rates were 71.0% in group A, 71.9% in group B, and 70.5% in group C. Group B showed significantly higher awareness of influenza risks compared with the control group odds ratio (OR; OR 1.35, 95% CI 1.12-1.63; P=.001), while group A did not (OR 1.10, 95% CI 0.92-1.32; P=.27). Recollection of educational content was also higher in groups A (OR 1.29, 95% CI 1.07-1.56; P=.008) and B (OR 1.92, 95% CI 1.59-2.33; P<.001) compared with the control. In addition, a significant correlation between awareness and vaccination rates was found only in group B (χ2(df=1)=6.12, P=.01).

CONCLUSIONS

The adapted digital intervention (group B) effectively increased awareness of influenza risks and recollection of educational content, which correlated with the higher trend in vaccination rates. This study demonstrates the potential of digital health tools to enhance influenza vaccination among people with diabetes by improving risk awareness and education. Further research should focus on optimizing these interventions to achieve significant improvements in vaccination uptake and overall public health outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06840236; https://clinicaltrials.gov/study/NCT06840236.

Patient- and Community-Level Characteristics Associated With Respiratory Syncytial Virus Vaccination

Importance

In 2023, the first respiratory syncytial virus (RSV) vaccines were recommended for US adults 60 years or older, but few data are available about which patients were most likely to receive vaccine to inform future RSV vaccine outreach efforts.

Objective

To assess patient- and community-level characteristics associated with RSV vaccine receipt and patient knowledge and attitudes related to RSV disease and RSV vaccines.

Design, Setting, and Participants

During the first season of RSV vaccine use from October 1, 2023, to April 30, 2024, adults 60 years or older hospitalized with RSV-negative acute respiratory illness were enrolled in this cross-sectional study from 26 hospitals in 20 US states. Sociodemographic and clinical data were abstracted from health records, and structured interviews were conducted for knowledge and attitudes about RSV disease and RSV vaccines.

Exposures

Age, sex, race and ethnicity, pulmonary disease, immunocompromised status, long-term care facility residence, medical insurance, social vulnerability index (SVI), and educational level.

Main Outcomes and Measures

The exposures were identified a priori as possible factors associated with RSV vaccine receipt and were entered into a modified Poisson regression model accounting for state clustering, to assess for association with RSV vaccine receipt. Knowledge and attitudes were summarized with frequencies and proportions.

Results

Among 6746 hospitalized adults 60 years or older, median age was 73 (IQR, 66-80) years and 3451 (51.2%) were female. Among the 6599 patients with self-reported race and ethnicity, 699 (10.6%) were Hispanic, 1288 (19.5%) were non-Hispanic Black, 4299 (65.1%) were non-Hispanic White, and 313 (4.7%) were other race or ethnicity. There were 700 RSV-vaccinated (10.4%) and 6046 unvaccinated (89.6%) adults. Among 3219 unvaccinated adults who responded to RSV knowledge questions, 1519 (47.2%) had not heard of RSV or were unsure; 2525 of 3218 (78.5%) were unsure if they were eligible for RSV vaccine or thought they were not. In adjusted analyses, characteristics associated with RSV vaccination were being 75 years or older (adjusted risk ratio [ARR], 1.23; 95% CI, 1.10-1.38, P < .001), being male (ARR, 1.15; 95% CI, 1.01-1.30; P = .04), and having pulmonary disease (ARR, 1.39; 95% CI, 1.16-1.67; P < .001), immunocompromised status (ARR, 1.30; 95% CI, 1.14-1.48; P < .001), low (ARR, 1.47; 95% CI, 1.18-1.83, P < .001) or moderate (ARR, 1.47; 95% CI, 1.21-1.79; P < .001) SVI, and educational level consisting of 4 or more years of college (ARR, 2.91; 95% CI, 2.14-3.96; P < .001), at least some college or technical training (ARR, 1.85; 95% CI, 1.35-2.53; P < .001), or grade 12 education or General Educational Development (ARR, 1.44; 95% CI, 1.03-2.00; P = .03). RSV vaccination was less likely among residents of long-term care facilities, patients with Medicaid coverage, and uninsured patients.

Conclusions and Relevance

In this cross-sectional study of hospitalized adults, knowledge of RSV disease and RSV vaccine eligibility was low. Older adults and those with certain medical conditions were more likely to have received vaccine, suggesting appropriate prioritization, but sociodemographic differences in vaccine uptake occurred.

[Pneumococcal vaccination in people aged 60 and over: relationships between vaccination intention, knowledge, and psychological reasons for the vaccination decision]

INTRODUCTION

Worldwide, pneumococci are the most common cause of morbidity and mortality from lower respiratory tract infections. Despite recommendations of the Standing Committee on Vaccination (STIKO), the vaccination rate against pneumococci in over 60-year-olds in Germany remains low. This study therefore investigates the associations between psychological reasons for (non-) vaccination, knowledge about pneumococci, age and gender, previous vaccination decisions, and pneumococcal vaccination intention in over 60-year-olds.

METHODS

The analysis is based on data from the study "ALtersspezifische Impfinanspruchnahme VErbessern," in which 1117 patients aged 60 and over were surveyed in 2022. In addition to the descriptive evaluation of the cross-sectional data, a Spearman correlation analysis was carried out. Predictive variables were also identified in a linear regression analysis.

RESULTS

Confidence in the safety of vaccination (β = 0.514, p < 0.001) and receiving the influenza vaccination (β = 0.153, p < 0.001) in the last season are the strongest predictors of pneumococcal vaccination intention. In addition, the perceived risk of pneumococcal infection (β = 0.086, p = 0.002) showed a significant positive correlation with vaccination intention. The regression analysis performed was able to explain 48.8% of the variance in vaccination intention (R2 = 0.488).

DISCUSSION

Confidence and risk perception appear to be decisive factors in the decision to get vaccinated. Measures that address these aspects could increase vaccination intention. A joint administration of the influenza and pneumococcal vaccination could be useful, as receiving an influenza vaccination in the previous season showed a positive effect on the intention to get the pneumococcal vaccination.

Influence of perceived influenza-like symptoms on intention to receive seasonal influenza vaccination

BACKGROUND

The increase in the older adult population over the coming decades emphasizes the importance of vaccinations to prevent infectious diseases among this population. Acceptance of vaccination is crucial for a successful vaccination program and insight in the motives of acceptation is therefore important. This study explores specifically the association between experiencing influenza-like illness (ILI) and other determinants for older adults on seasonal influenza vaccination acceptance. Furthermore, differences in acceptance of pneumococcal, influenza, herpes zoster and pertussis vaccines between various age groups were studied.

METHODS

Three prospective observational studies (2011/2012, 2012/2013 and 2014/2015) were performed in community-dwelling older adults (≥ 60 years) to monitor ILI. During home visits, throat/nose swabs, a blood sample and a questionnaire on demographics and general health were collected. An additional questionnaire was added to the 2014/2015 study on motives and intention of older adults to accept seasonal influenza and other vaccinations, including knowledge statements on vaccination in general (n = 1647). Random Forest analyses were used to identify predictors of intention to accept seasonal influenza vaccination.

RESULTS

Univariate analyses showed that males, persons with limited contact with children, people who have received seasonal influenza vaccination in 2014/2015, persons reporting co-morbidity, persons reporting a lower perceived health and persons with more knowledge about vaccination have a significantly higher intention to accept seasonal influenza vaccination. The univariate and prediction analyses showed no association between having experienced ILI and the intention to receive seasonal influenza vaccination. Previous influenza vaccination had by far the most predictive value; when excluding this factor, age and perceived health were the best predictors. Except for pertussis vaccination, persons aged ≥ 70 years had a higher intention to vaccinate compared to persons aged 60-69 years.

CONCLUSIONS

Our study showed that there is no association between having experienced ILI and the intention to receive seasonal influenza vaccination. Instead, previous influenza vaccination had the highest predictive value. Therefore, efforts should be made to make vaccination a habit to ensure annual vaccination. Healthcare workers, such as general practitioners (GPs) could play an important role in this because of frequent contact between older adults and GPs and the perceived importance of the advice of the GP.

TRIAL REGISTRATION

NTR4818 (30-09-2014).

"It's a risk-benefit analysis": Qualitative perspectives on barriers and enablers to post-treatment vaccination from adults affected by a haematological malignancy in Australia

BACKGROUND

People affected by haematological malignancies are at high risk of morbidity and mortality caused by vaccine-preventable infections. However, vaccination commencement and completion following anti-cancer treatment is sub-optimal for this population. Innovation relating to vaccination delivery and schedules, informed by the needs and preferences of the target population, may improve uptake of vaccinations. This study explored barriers and enablers to vaccinations, novel vaccines and vaccination schedules, from the perspectives of this cohort.

METHODS

A qualitative exploratory study at an Australian specialist cancer hospital. Semi-structured interviews were conducted with patients via telephone or videoconferencing, exploring experiences of, and views regarding, vaccination after anti-cancer treatment, and barriers and enablers to vaccination. Demographic and clinical characteristics were collected prior to interviews and analysed descriptively. Qualitative data were analysed inductively using template analysis, then mapped to the COM-B model of behaviour change, and barriers and enablers identified.

RESULTS

Twenty blood cancer patients participated. Participants described barriers including poor care coordination, travel, time, and financial costs, concerns regarding potential side effects and injury, intervention and appointment fatigue, and concerns regarding vaccine development processes. Enablers included: consultative conversations, information available in various formats, automated appointments and reminders, hybrid and shared models of care, being linked-in with trusted health professionals, confidence in public health advice and vaccine development processes, and seeing vaccinations as central to their recovery.

CONCLUSION

Barriers and enablers to vaccination identified suggest ways in which vaccination services for this population can be improved. While patients receiving vaccinations at their treating centre reported coordinated care that made access straightforward, other participants described being hampered by lack of coordinated care and continuity. A lack of condition-specific information coupled with common vaccine misconceptions resulted in concerns regarding vaccinations. These findings offer opportunities to address barriers to vaccination uptake through targeted service innovation and education and information interventions.

Influenza vaccine uptake in socially deprived areas: A multilevel retrospective population-based cross-sectional study using electronic health records in Liverpool, United Kingdom

BACKGROUND

Seasonal influenza causes around 15,000 deaths yearly in the UK. While vaccination is a useful prevention measure, uptake is low, related to factors such as deprivation, age, sex, and ethnicity. Liverpool is a diverse yet deprived city, with potentially interacting population-level factors which require examination prior to targeted intervention development.

METHODS

A retrospective cross-sectional analysis of electronic health records in Liverpool used meta-analysis to examine associations between vaccine uptake and deprivation, sex, age group, and ethnicity.

RESULTS

Overall prevalence rates for vaccination between September 2022 and March 2023 were 25·8 % (95 % CI: 23·8 % to 28·0 %). All factors were associated with uptake, which was lowest in: more deprived General Practices (family doctor; primary care physician), males, children aged 0-1, and in people identifying as Any Other ethnicity. Individuals identifying as White or Mixed/Multiple ethnic groups were most likely to be vaccinated, while those identifying as Black, Black British, Caribbean or African, and Asian or Asian British had lower uptake. Similarly, rates were higher in individuals aged 2-3, 4-10, and 65+ than 16-64, while no difference was found between the latter group and ages 11-15. Deprivation did not interact with age, sex, or ethnicity.

CONCLUSION

These findings support that deprivation, age, sex, and ethnicity influence influenza vaccine uptake, and that they do so uniquely in Liverpool. While deprivation did not interact with other characteristics, this may be due to the impact of inequality (large deprivation gap between richer and poorer areas) on the whole city, as this is as a social stressor that can impair health outcomes for all, not just those in more deprived areas. Future work should investigate experiences of people in areas with lower uptake in Liverpool, to understand potential barriers and enable targeted intervention.

Influenza Vaccination Trends and Associated Factors Among Middle-aged Working Adults With an Elevated Cardiovascular Risk in Korea

BACKGROUND AND OBJECTIVES

The development of atherosclerotic cardiovascular disease (ASCVD) in middle-aged working groups can be a major contributor to disability-adjusted life years. However, information regarding the current trends in influenza vaccination within this demographic group remains scarce. Thus, we aimed to investigate the recent 11-year trends in influenza vaccination and related factors among these populations in Korea.

METHODS

Of 42,879 individuals aged 40-64 years enrolled in the Korea National Health and Nutrition Examination Survey between 2010 and 2021, 35,323 were included. We investigated the yearly trend of influenza vaccination rate according to ASCVD risk and factors associated with being unvaccinated in the elevated ASCVD risk group (ASCVD risk score: ≥7.5%).

RESULTS

Among the 35,323 participants, 20,392 (57.7%) were classified into the elevated ASCVD risk group. Over the 11 years, the vaccination rate was significantly higher in the elevated ASCVD risk group than in the low ASCVD risk group (33.8% vs. 25.3%, p<0.001). Factors associated with the unvaccinated status in the elevated ASCVD risk group included younger age (<50 years; adjusted odds ratio, 1.61; 95% confidence interval, 1.31-1.98), male sex (1.43; 1.16-1.76), current smoker status (1.41; 1.13-1.76), residence in an urban area (1.19; 1.01-1.41), and having higher education (1.3; 1.04-1.64).

CONCLUSIONS

One in 3 middle-aged working adults with an elevated risk of ASCVD received the influenza vaccination. Although the influenza vaccination rate was higher in participants with an elevated ASCVD risk than in those with low ASCVD risk, the vaccination rate was relatively unsatisfactory.

"It's My Moral Responsibility to Protect Others!" Examining the Effects of Moral Framing and Message Format on Influenza Vaccination Attitude and Intention

Vaccinations serve a dual purpose: safeguarding the vaccinated individuals while also preventing potential transmission to others. However, the pro-vaccine message has primarily emphasized the personal health risks and harms of not getting vaccinated, while rarely highlighting the moral responsibility of getting vaccinated to protect others. Guided by the Model of Intuitive Morality and Exemplars (MIME) along with the narrative persuasion framework, the current study conducted a 2 (moral framing: vaccination to protect oneself vs. protect others) X 2 (message format: statistical vs. narrative) between-subject online experiment to examine the effects of moral framing and message format on vaccination decision-making. The results revealed that individuals exposed to a pro-vaccine message framing vaccination as a moral responsibility to protect others from harm reported significantly higher levels of perceived moral responsibility and elevation, more positive attitudes toward the flu vaccine, and an increased intention to get vaccinated compared to a pro-vaccine message emphasizing vaccination for self-protection. Counterintuitively, presenting the moral responsibility of receiving the flu vaccine to safeguard others in a statistical format was discovered to be more effective in fostering favorable attitudes toward vaccination and increasing the intention to get vaccinated. This study offers a valuable insight: promoting vaccination as a moral duty could be a promising strategy for motivating individuals to get vaccinated.

Effectiveness of Text Messaging Nudging to Increase Coverage of Influenza Vaccination Among Older Adults in Norway (InfluSMS Study): Protocol for a Randomized Controlled Trial

BACKGROUND

The coverage of influenza vaccination among older adults in Norway is insufficient, especially in some immigrant groups. To improve public health, there is a need for an intervention that can increase influenza vaccination coverage. Further, interventions tailored to reduce potential barriers among immigrants can reduce health inequities.

OBJECTIVE

InfluSMS aims to determine if SMS nudging increases vaccination coverage among those aged 65 years or older (1) in Norway's general population; (2) among immigrants born in Poland; and (3) among immigrants born in Ukraine; and evaluate the impact of SMS nudging in Norwegian versus in the official language of the native country of immigrants born in Poland or Ukraine.

METHODS

InfluSMS is a pragmatic randomized controlled trial conducted among people aged 65 years or older residing in Norway. Influenza vaccination coverage is the main outcome, measured in control and intervention arms for each of the 3 populations listed earlier. In all 3 populations, the control arm is standard care, that is, no individual reminder for influenza vaccination. All populations have an intervention arm that will receive an SMS nudge in the Norwegian language. In addition, the Polish and Ukrainian immigrant populations include a second intervention arm that will receive an SMS nudge in Polish or Ukrainian, respectively. In the general population, at least 23,485 individuals will be randomized to the SMS intervention arm while the rest of the population constitutes the control arm. In each of the 2 immigrant populations, we will randomize all eligible individuals 1:1:1 into the 3 arms. The intervention will take place at the start of the 2025-2026 influenza season. All eligible individuals will be passively followed up through the National Immunisation Registry, SYSVAK, from which individual influenza vaccination status 3 months after the SMS nudge will be collected. Coverage rates between arms within each population and effect sizes between the populations will be compared. The cost-effectiveness of SMS nudging will also be assessed.

RESULTS

The inclusion of participants will start in the third quarter of 2025, and the registry data will be available in the first quarter of 2026. Coverage rates of each strategy and coverage differences between strategies will be presented.

CONCLUSIONS

SMS nudging is a scalable, inexpensive, and nonintrusive intervention that could be integrated into the national influenza vaccination program if the trial shows it effectively increases influenza vaccination coverage among older adults. Further, the trial will establish whether language is a barrier to influenza vaccination uptake among recent immigrant groups that have low influenza vaccination coverage, and to what extent this potential barrier can be diminished by SMS nudging in the official language of their native country.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06486766; https://clinicaltrials.gov/study/NCT06486766.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/63938.

Trust in official information as a key predictor of COVID-19 vaccine acceptance: evidence from a Czech longitudinal survey study

BACKGROUND

COVID-19 vaccine hesitancy (CVH) has become a critical public health issue, with attitudes toward vaccines emerging as a broader social issue. Public debates surrounding vaccines have expanded beyond health considerations to include issues of trust, misinformation, and societal values, making CVH a complex challenge that requires multifaceted solutions. Analyzing the various determinants of CVH is crucial for developing targeted strategies to improve vaccine acceptance in specific countries and to better prepare for future public health crises. However, no study to date has evaluated the determinants of CVH in a representative sample of the Czech population.

METHODS

A multiple hierarchical logistic regression was used to analyze the associations between various sociodemographic, trust and attitudinal factors with COVID-19 vaccine acceptance (CVA). The analysis utilized survey data from a representative longitudinal sample of the Czech population (N = 1,407).

RESULTS

After controlling for all other factors, trust in official statements from the Ministry of Health was the strongest predictor of CVA, followed by prior positive attitudes toward COVID-19 vaccination (prior to vaccine availability) and older age. Lower trust in COVID-19 misinformation also predicted CVA, while lower interest in COVID-19 media content was associated with CVA. Higher income initially predicted CVA but lost statistical significance after controlling for other variables. Interestingly, education did not play a role in CVA.

CONCLUSION

CVH was primarily driven by distrust in government-provided information. Notably, vaccine refusers demonstrated a higher motivation to seek information on the topic, offering a promising opportunity for health policy interventions. Our findings suggest that strategies to reduce CVH should prioritize building trust in state institutions and effectively combating misinformation.

Barriers and facilitators of adherence to treatment interventions for COPD amongst individuals from minority ethnic communities: Meta-ethnography

OBJECTIVE

Numerous studies have documented the low adherence rate to treatment interventions for Chronic Obstructive Pulmonary Disease (COPD) amongst minority ethnic communities. This systematic meta-ethnographic review was performed to identify barriers and facilitators of adherence to treatment interventions (e.g., smoking cessation and pulmonary rehabilitation) of COPD in minority ethnic communities.

METHOD

This systematic meta-ethnographic review followed the approach by Noblit and Hare. Systematic searches were performed across six databases MEDLINE (OVID), EMBASE (OVID), CINAHL (EBSCO), PsycINFO (OVID), Web of Science, and Scopus from their inception until November 2023. Quality appraisal of included studies was conducted using Critical Appraisal Skills Programme (CASP) tools.

RESULTS

Out of 1,329 identified citations, seven qualitative studies were included in this meta-ethnography. Using reciprocal translation, four overarching themes were developed to represent the barriers and facilitators of adherence to treatment interventions of COPD amongst minority ethnic communities: 1) positive and negative experiences affecting a person's motivation for their care, 2) patient attitude and beliefs, 3) being able to access and attend care, and 4) the influence of communication and culture on a person's care.

CONCLUSION

This review highlighted the barriers and facilitators of adherence to treatment interventions for COPD amongst individuals from minority ethnic communities. The key barriers include language difficulties and the inability to comprehend and communicate effectively with healthcare professionals. This demonstrates the need for further research on the impact of linguistic and cultural characteristics on adherence to treatment interventions for COPD. Addressing ethnicity-specific barriers could inform the development of tailored protocols and strategies for optimising adherence among minority ethnic communities. (PROSPERO CRD42023476187).

An Exploratory Investigation of Representations of Herpes Zoster and Adjuvanted Recombinant Herpes Zoster Vaccination in a Sample of Fragile Adults in Italy

In the context of the Italian National Herpes Zoster Vaccine program, an exploratory survey was conducted on a sample of fragile adult patients to investigate the representations of the disease and its prevention to build future local vaccination campaigns. An ad hoc questionnaire was administered to 271 fragile adult patients who had adjuvanted recombinant Herpes Zoster vaccination to detect the following: knowledge and perception of the disease and its risks; information sources and confidence in the information sources used; and perception of the Herpes Zoster vaccination. Fragile adult patients have the representation of Herpes Zoster as a serious disease (86.5%), and they consider themselves informed concerning symptoms and health effects. Women are more fearful of the impact of the disease (Chi-square = 10.03; DF = 3; p-value = 0.018), while those with a higher average age consider themselves less informed (R = -158; p-value = 0.039). The sources of information that contributed to the construction of illness representation are health personnel (73.5%), followed by the web and social web (14.7%), and media such as radio and TV (10.0%). Regarding the vaccine representation, fragile patients are confident about the vaccine and the science behind it and believe everyone should receive it. However, a high percentage (62.9%) fear side effects. Our analysis highlights that vaccination campaigns must be planned based on the target audience, individual and contextual needs, and representations of the disease, particularly when dealing with frail patients, to implement effective preventive interventions.

Explaining seasonality increases perceived effectiveness of influenza vaccination: An experimental study

BACKGROUND

Doubts regarding vaccine effectiveness may prompt people to decide against a seasonal influenza vaccination. While fact boxes show the effectiveness in terms of cases prevented, people often lack knowledge about important contextual factors, for example, why the vaccine formulation needs to be updated annually, the vaccine mechanism and relevance of the antigen-virus match. Adding such contextual information could improve effectiveness perceptions.

OBJECTIVE

In a preregistered online experiment, we tested whether explaining the seasonality's relevance and mechanisms behind influenza vaccine effectiveness affects people's perceptions of influenza vaccination. We compared two means of explanation (an additional expository text vs. a narrative offering an analogy to improve understanding of vaccine effectiveness) with a control condition simply providing effectiveness information.

DESIGN

Unvaccinated participants (N = 1554) were assigned to one of three conditions: (1) fact box only (providing the influenza vaccine's benefit-risk profile; control group), (2) fact box plus informational expository text or (3) fact box plus narrative analogy.

METHODS

After the experimental manipulations, participants rated the vaccine's effectiveness in preventing influenza disease and answered knowledge questions. Effects on perceived risk of vaccination and intention to get vaccinated were also explored.

RESULTS

Reading the expository text increased the perceived vaccine effectiveness and overall knowledge, while reading the narrative analogy only increased the perceived vaccine effectiveness compared with the control condition. All other dependent variables were similar in both text conditions.

CONCLUSIONS

Extended explanations of vaccine effectiveness can increase perceived vaccine effectiveness. The text format chosen can affect outcomes, such as vaccine-related perceptions or knowledge.

A Bundled, Practice-Based Intervention to Increase HPV Vaccination

BACKGROUND AND OBJECTIVES

Human papillomavirus (HPV) vaccination rates are suboptimal, and missed vaccination opportunities are common. We hypothesized that a bundled intervention improves missed HPV vaccination opportunities.

METHODS

We used a pre-post design to assess differences in HPV vaccine missed opportunities (visits when vaccine-eligible adolescents are not vaccinated). We compared rates for a 12-month period before vs those for a 6-month period (February 23, 2022, to August 9, 2022) during a bundled intervention. We implemented the bundled intervention in 24 primary care pediatric practices that had been usual care controls for a prior randomized trial. The bundled intervention involved 3 components: online clinician training on HPV vaccine communication, performance feedback on missed HPV vaccination opportunities, and clinician prompts for HPV vaccination. As a secondary analysis, we compared missed opportunities for these 24 practices vs 48 contemporaneous comparison group practices identified retrospectively.

RESULTS

For well-child care (WCC) visits, missed HPV vaccination opportunities were improved during vs before the intervention by 4.8 percentage points (95% CI, -7.2% to -2.4%) for initial HPV vaccine doses and a modest 2.2 percentage points (95% CI, -4.4% to -0.0%) for subsequent doses. For other visit types, findings ruled out changes beyond minimal improvements. Missed vaccination opportunity rates for initial HPV vaccination at WCC visits were similar for the 24 intervention practices vs the 48 comparison practices for a 4.5-year period before the intervention, but they improved for intervention practices and worsened for comparison practices during the intervention period (difference, -6.6%; 95% CI, -9.3% to -3.8%).

CONCLUSIONS

This bundled intervention appeared to improve HPV vaccination during WCC visits.

Strategies and resources used by public health units to encourage COVID-19 vaccination among priority groups: a behavioural science-informed review of three urban centres in Canada

BACKGROUND

Ensuring widespread COVID-19 vaccine uptake is a public health priority in Canada and globally, particularly within communities that exhibit lower uptake rates and are at a higher risk of infection. Public health units (PHUs) have leveraged many resources to promote the uptake of recommended COVID-19 vaccine doses. Understanding barriers and facilitators to vaccine uptake, and which strategies/resources have been used to address them to date, may help identify areas where further support could be provided. We sought to identify the strategies/resources used by PHUs to promote the uptake of the first and third doses of the COVID-19 vaccine among priority groups in their jurisdictions. We examined the alignment of these existing strategies/resources with behavioral science principles, to inform potential complementary strategies/resources.

METHODS

We reviewed the online and in-person strategies/resources used by three PHUs in Ontario, Canada to promote COVID-19 vaccine uptake among priority groups (Black and Eastern European populations, and/or neighbourhoods with low vaccine uptake or socioeconomic status). Strategies/resources were identified from PHU websites, social media, and PHU liaison. We used the Behaviour Change Techniques (BCT) Taxonomy - which describes 93 different ways of supporting behaviour change - to categorise the types of strategies/resources used, and the Theoretical Domains Framework - which synthesises 14 factors that can be barriers or facilitators to decisions and actions - to categorise the barriers and facilitators addressed by strategies/resources.

RESULTS

PHUs operationalised 21 out of 93 BCTs, ranging from 15 to 20 BCTs per PHU. The most frequently operationalised BCTs were found in strategies/resources that provided information about COVID-19 infection and vaccines, increased access to COVID-19 vaccination, and integrated social supports such as community ambassadors and engagement sessions with healthcare professionals. Identified BCTs aligned most frequently with addressing barriers and facilitators related to Knowledge, Environmental context and resources, and Beliefs about consequences domains.

CONCLUSION

PHUs have used several BCTs to address different barriers and facilitators to COVID-19 vaccine uptake for priority groups. Opportunities should be pursued to broaden the scope of BCTs used (e.g., operationalizing the pros and cons BCT) and barriers/facilitators addressed in strategies/resources for ongoing and future COVID-19 vaccine uptake efforts among general and prioritised populations.

Relationship between influenza-related experience and current vaccination outcome

BACKGROUND

This study investigated how a person's influenza-related experience, together with demographic, socioeconomic, and health-related factors, was associated with their current vaccination decisions.

METHODS

The analysis used ten panels of the Medical Expenditure Panel Survey (MEPS) from 2006 to 2016. Linear and logistic probability models were estimated to predict influenza vaccination using a person's vaccination status in the previous year and history of influenza infection, adjusting for demographics, socioeconomic variables, general health status, and healthcare access. The models used two-way and three-way interactions with race/ethnicity, income, education, health status, and elderly status to examine changing relationships of flu-related experience across these variables.

RESULTS

Previous vaccination was the most important predictor, with an increase of 63.0-71.8% probability of vaccination in the next year. Infection history could either increase or decrease the impact of past vaccination depending on race/ethnicity, income, education level, health status, and age. There were significant disparities across demographic, socioeconomic, and health-related variables.

CONCLUSION

Vaccination promotion efforts could focus on those who have not been vaccinated in the past and on specific sub-populations, such as people who are Hispanic, people with lower education levels, the population aged 65 and above, and families with low-income levels. Although past infection is a predictor for some population groups, its magnitude is small and is often not a significant determinant.

The influence of factors related to public health campaigns on vaccination behavior among population of Wuxi region, China

Background

Public health campaigns are essential for promoting vaccination behavior, but factors such as socioeconomic status, geographical location, campaign quality, and service accessibility influence vaccine uptake. In the Wuxi region of China, disparities in vaccination behavior are seen between urban and rural populations and among different socioeconomic groups. This study aims to explore the factors related to public health campaigns that affect vaccination behavior in Wuxi, contributing to better public health strategies.

Methods

A cross-sectional survey was conducted among 750 participants in Wuxi, focusing on their perceptions of socioeconomic status, geographical location, health campaign quality, and vaccination convenience. The questionnaire was developed based on a literature review and expert input using the Delphi method. Data were analyzed using descriptive statistics, reliability and validity tests, correlation analysis, and regression analysis, employing both SPSS and R software.

Results

Socioeconomic status, geographic location, campaign quality, and accessibility all significantly influence vaccination behavior. Higher socioeconomic backgrounds, urban residency, better campaign quality, and greater accessibility to vaccination services are positively correlated with higher vaccination uptake. Regression analysis revealed that public health campaigns and accessibility are particularly influential in promoting vaccination behavior.

Conclusion

To improve vaccination rates, targeted strategies focusing on low socioeconomic groups, rural areas, and improving campaign quality and service accessibility are necessary. Public health campaigns should be clear, culturally relevant, and utilize multiple communication channels. Future research should address misinformation, explore behavioral economics, and integrate emerging technologies like AI to optimize vaccination efforts.

Socioeconomic disparities in influenza vaccination uptake: impact of the COVID-19 pandemic in South Korea

BACKGROUND

This study aimed to investigate the sociodemographic and behavioral factors related to increased influenza vaccination uptake during the COVID-19 pandemic in South Korea, particularly among adults not eligible for free vaccination.

METHODS

Analyzing data from 78,815 participants in the Korea National Health and Nutrition Examination Survey (2010-2021), we assessed trends in influenza vaccination coverage. Various sociodemographic factors, behavioral aspects, and psychological stress levels were assessed using multivariable logistic regression to evaluate the difference in vaccination response during pre-/post-COVID-19 periods.

RESULTS

Lowest income quartile households exhibited decreased influenza vaccination uptake during the pandemic (adjusted odds ratio 0.67, p = 0.011), whereas higher income quartiles exhibited increased uptake. In the lowest income households, unemployed status of household was additionally associated with decreased influenza vaccine uptake (adjusted odds ratio 0.50, p = 0.003).

CONCLUSIONS

This study identified income-based disparities in the responsive increase of influenza vaccination during the COVID-19 pandemic. Lower-income households exhibited a disproportionate reduction in influenza vaccine uptake, emphasizing the need for targeted support systems and expanded free vaccination for prioritized groups to address these disparities.

Understanding Influenza Vaccine Clinical Performance: A Podcast

Despite well-established vaccination programs, seasonal influenza is still causing substantial clinical, economic and societal burdens. As part of strategies to continually improve influenza vaccine clinical performance, several new approaches are being examined, including high-dose vaccines, adjuvanted vaccines, egg-free vaccines, nasal spray vaccines and mRNA vaccines. Given this range of influenza vaccines, coupled with various vaccine hesitancy concerns, healthcare professionals' understanding and confidence in the clinical performance of influenza vaccines remain key. In this podcast, we discuss the challenges for healthcare professionals in understanding the clinical performance of influenza vaccines and the importance of education in this area, particularly to address perceptions of influenza vaccine failure. We also explore several elements that should be considered in the assessment of influenza vaccine clinical performance: (1) assessing relevant clinical outcomes, such as hospitalization data, (2) utilizing robust methodology in influenza vaccine trials to ensure high quality evidence and (3) approaches used when considering the full body of evidence.

Influenza vaccine hesitancy and its determinants among Lebanese public transportation drivers

Introduction

According to the National Institute for Occupational Safety and Health, ensuring influenza vaccination for public transportation drivers is considered a public health objective, given that these drivers are at high risk of contracting influenza. The main purpose of this cross-sectional study is, thus, to evaluate influenza vaccine hesitancy (VH) and its determinants among a representative sample of Lebanese public transportation drivers.

Methods

A survey questionnaire is conducted between January and March 2023, with the participation of a proportionate purposeful sample of 509 drivers from various regions in Lebanon. Study exposures include socio-demographics, health/work related variables, past experiences, knowledge and fatalistic views. VH and Vaccination Attitudes Examination (VAX) scales (score range 1 to 5 each) are used to measure study outcomes. Descriptive and bivariate statistical analyses, followed by ordinal and linear regression analyses are performed. Statistical significance is set at P < 0.025 (two sided).

Results

The vast majority of study participants (n = 499, 98 %) are males. Their age mean is 44.7 ± 12.6 years, while the mean duration of their work in public transportation is 11.5 ± 10.1 years. Results show vaccine hesitancy in terms of influenza risk calculation (3.27 ± 1.28), preference to natural immunity over influenza vaccines (3.23 ± 1.14) and vaccine constraints (2.83 ± 1.38). As for concerns regarding commercial profiteering behind influenza vaccines, the mean score of agreement with vaccines is 2.77 ± 1.10, while the mean score of lack of trust in vaccine safety is 2.70 ± 1.32.

Conclusions

Influenza VH among public transportation drivers in Lebanon is evident. Although a significant number of drivers are willing to be vaccinated, hesitancy often delays their decision. Study findings can inform influenza vaccination campaigns and syndicates regarding the need to raise awareness about influenza vaccine benefits among drivers and alleviate their hesitancies prior the upcoming flu season.

Vaccination status of elite athletes in the German Armed Forces: a retrospective descriptive overview

Purpose

Vaccination of athletes is an effective preventive intervention to maintain athletic performance. Data reporting the vaccination status of elite athletes are limited. Aim of this study was to provide an overview about the vaccination status in elite athletes who were affiliated to the German Armed Forces.

Materials and Methods

Six hundred seventy athletes were included in this retrospective cross-sectional study. Statistical analysis was performed using McNemar's test, φ coefficient and logistic regression.

Results

The 0.3% of all included athletes had a complete vaccination status as recommended by the German Standing Commission on Vaccination when they started their career. Regarding the different kinds of vaccination, there was a range from 3.0% (influenza) to 69.6% (mumps, measles, rubella). Although a valid vaccination status is mandatory for soldiers, only 6.3% of the athletes had a valid one at the time of data collection. During the observation period, only few athletes worsened their vaccination status. Specific differences could be seen for different kinds of sports. Swimmers and sleigh drivers were almost completely below average. The vaccination status among Taekwondo Fighters and Fencers were almost entirely above average. Worse vaccination status was found for vaccinations that required more frequent repetition. The vaccination status was comparable for vaccinations that are available as combination vaccines.

Conclusion

Although a complete vaccination status was mandatory, there were vaccination gaps. It seems necessary to be more stringent in the prevention of vaccination gaps. Athletes, physicians, and sports associations should cooperate to find an effective way to get optimum prevention.

[Understanding vaccination behavior of healthcare workers in German hospitals-results from the OKaPII study]

BACKGROUND

Influenza vaccination coverage in Germany is generally low. Even in hospitals, the demand for influenza vaccination is lacking although it has the potential to prevent the spread of the influenza virus and diseases. To take effective actions, a deeper understanding of vaccination behavior of healthcare workers is crucial.

METHODS

OKaPII is an annual German-wide online survey of clinical staff on influenza vaccination. Differences in vaccination behavior were tested for occupation, sex, and age, and differences in knowledge were tested between physicians and nurses. We used logistic regressions to analyze associations between psychological determinants and vaccination behavior among physicians and nursing staff.

RESULTS

From 115 clinics, 15,312 employees participated in the survey (17 April to 15 May 2023). In the 2022/23 season, 58.7% of the participants were vaccinated against influenza. The vaccination coverage was 80.7% for physicians and 51.1% for nursing staff . The vaccination behavior of physicians and nursing staff was significantly associated with collective responsibility and confidence in vaccination safety. Of the knowledge items, 87.2% were answered correctly by physicians and 62% by nursing staff.

DISCUSSION

We identified significant differences in vaccine uptake between occupational groups in German hospitals. Low vaccination coverage has existed for years, especially among nursing staff. Tailored interventions should promote the idea of protecting vulnerable people and confidence in the safety of vaccination. Increased education, especially on vaccination safety issues, can have a positive impact on the decision to vaccinate. Possibilities to get vaccinated despite time constraints in the workplace should be provided.

A cross-sectional study on the understanding and attitudes toward influenza and influenza vaccines among different occupational groups in China

This study aimed to assess the level of knowledge regarding influenza viruses and vaccines among different professional groups to investigate the reasons for vaccine hesitancy. We collected 2190 questionnaires regarding influenza vaccines in China in 2022. The respondents were categorized into the general population (GP), foreign affairs workforce population (FAWP), and veterinary workforce population (VWP) according to their job positions. Linear regression was used to assess the association between multiple factors and influenza vaccination rates. The association between work and influenza vaccination rates was also assessed by grouping different workforce populations. The vaccination rate of the GP was higher than that of the VWP (odds ratio: 1.342, 95% confidence interval: 1.025-1.853), surpassing the rates reported in previous studies. This may be attributed to heightened concerns about infectious diseases influenced by the ongoing coronavirus disease 2019 pandemic. Despite the VWP's more in-depth knowledge of the VWP on zoonotic diseases and their recognition of their importance, there was no significant difference in influenza knowledge among the three populations. This discrepancy contrasts with the observed differences in vaccination rates. Further investigation revealed that, compared with FAWP, the price of vaccines emerged as a primary influencing factor for vaccination rates (odds ratio:0.398, 95%CI; 0.280-0.564). General concerns regarding the protective effects and side effects of vaccines were also noted.

Parent and family characteristics associated with reported pediatric influenza vaccination in a sample of Canadian digital vaccination platform users. An exploratory, cross-sectional study in the 2018-2019 influenza season

Seasonal vaccination remains one of the best interventions to prevent morbidity and mortality from influenza in children. Understanding the characteristics of parents who vaccinate their children can inform communication strategies to encourage immunization. Using a cross-sectional study, we described parental characteristics of people who reported vaccinating their children against influenza during 2018/2019 in a cohort of Canadian digital immunization record users. Data was collected from a free, Pan-Canadian digital vaccination tool, CANImmunize. Eligible accounts contained at least one parental and one "child/dependent" record. Each parental characteristic (gender, age, family size, etc) was tested for association with pediatric influenza vaccination, and a multivariate logistic regression model was fit. A total of 6,801 CANImmunize accounts met inclusion criteria. After collapsing the dataset, the final sample contained 11,381 unique dyads. Influenza vaccination was reported for 32.3% of the children and 42.0% of the parents. In the multivariate logistic regression analysis, parents receiving the seasonal influenza vaccine were most strongly associated with reporting pediatric influenza vaccination (OR 17.05, 95% CI 15.08, 19.28). Having a larger family size and fewer transactions during the study period was associated with not reporting pediatric influenza vaccination. While there are several limitations to this large-scale study, these results can help inform future research in the area. Digital technologies may provide a unique and valuable source of vaccine coverage data and to explore associations between individual characteristics and immunization behavior. Policy makers considering digital messaging may want to tailor their efforts based on parental characteristics to further improve pediatric seasonal influenza vaccine uptake.

Exploring vaccine hesitancy and acceptance in the general population of Pakistan: Insights into COVID-19-related distress, risk perception, and stigma

The coronavirus disease 2019 (COVID-19) caused several impacts. Focusing on 360 participants (178 males, 182 females), this study explored the association between COVID-19 related distress, risk perception, stigma, and vaccine hesitancy and acceptance in the general population. Measures used included the Hospital Anxiety and Depression Scale (HADS) and COVID Stress Scale (CSS) to evaluate anxiety, depression, and COVID-19 related distress, the COVID-19 Risk Perception Scale and COVID-19 Stigma Discrimination Scale to assess risk perception and stigma, and the Oxford COVID-19 Vaccine Hesitancy Scale and Vaccine Acceptance Instrument to measure vaccine hesitancy and acceptance. The findings revealed that 66.9% of participants exhibited vaccine hesitancy, and stress and risk perception were significant predictors of both vaccine hesitancy and acceptance, even after controlling for demographic factors. This study highlights the importance of understanding the factors mentioned above that will contribute to vaccine hesitancy and acceptance, which will contribute to promoting vaccine acceptance.

Association between friends' hesitancy and personal COVID-19 vaccine hesitancy among Chinese medical staff

COVID-19 vaccine hesitancy remains problematic among healthcare workers. Social network influences may shape vaccine decision-making, but few studies have examined this in this critical workforce. We assessed the relationship between friends' COVID-19 vaccination attitudes and personal hesitancy among Chinese healthcare personnel. In December 2022-January 2023, a cross-sectional online survey was conducted at a tertiary hospital in China using WeChat. Of the 1832 healthcare personnel who were invited to answer the structured questionnaire, 613 (33.5%) samples had valid data for data analysis. Logistic regression examined the association between friends' hesitancy and participants' own hesitancy, adjusting for confounders. Of 613 healthcare workers included, 266 (43.4%) were hesitant. Those with hesitant friends had 6.34 times higher adjusted odds of hesitating themselves versus those without hesitant friends (95% CI 2.97-13.52). Strong associations persisted across subgroups. Chinese healthcare workers' COVID-19 vaccination hesitancy was highly influenced by perceived friends' attitudes. Fostering pro-vaccine social norms through trusted peer networks could help promote vaccine acceptance in this critical workforce.

Vaccine hesitancy educational interventions for medical students: A systematic narrative review in western countries

Physician recommendations can reduce vaccine hesitancy (VH) and improve uptake yet are often done poorly and can be improved by early-career training. We examined educational interventions for medical students in Western countries to explore what is being taught, identify effective elements, and review the quality of evidence. A mixed methods systematic narrative review, guided by the JBI framework, assessed the study quality using MERSQI and Cote & Turgeon frameworks. Data were extracted to analyze content and framing, with effectiveness graded using value-based judgment. Among the 33 studies with 30 unique interventions, effective studies used multiple methods grounded in educational theory to teach knowledge, skills, and attitudes. Most interventions reinforced a deficit-based approach (assuming VH stems from misinformation) which can be counterproductive. Effective interventions used hands-on, interactive methods emulating real practice, with short- and long-term follow-ups. Evidence-based approaches like motivational interviewing should frame interventions instead of the deficit model.

Exploring barriers to influenza vaccine uptake and recommendation among healthcare providers in the community in China: A qualitative study

Healthcare providers (HCPs) are recommended for priority influenza vaccination due to their high risk of contracting influenza. HCPs greatly aid in targeted population immunization campaigns. Therefore, understanding the factors that influence HCPs' decisions to get vaccinated and to recommend influenza vaccination is essential. However, there currently needs to be more evidence on this topic in China. Qualitative interviews using a semi-structured interview method were conducted with 180 HCPs from urban community hospitals and town hospitals in four cities in Shandong Province during August 2023. The interview content was analyzed using thematic analysis to identify the variables impacting the vaccination and recommendation practices of HCPs, as well as their suggestions for improving vaccination services. The results will help support the future development of precise intervention measures as well as focused education and training.

Coverage of influenza vaccination and influencing factors among healthcare workers in Shandong Province, China, 2021-2022

Healthcare workers (HCWs) are at increased risk of exposure to the influenza virus in their daily clinical and disease prevention activities, making them a high-risk group for influenza infection. However, the vaccination rate among HCWs has always been low. This study investigated influenza vaccination uptake and willingness among HCWs in the context of the COVID-19 pandemic. The analysis revealed that the influenza vaccination uptake among HCWs was 67.5%, with 79.6% willing to receive the influenza vaccine in 2022/2023 A significant majority (92.7%) agreed that the COVID-19 pandemic increased their willingness to receive the influenza vaccine, and 94.8% agreed with the necessity of receiving the influenza vaccine even after COVID-19 vaccination. Binary logistic regression model identified key factors that influence vaccination intentions. HCWs who perceived a high risk of influenza and its threat to health, found vaccination convenient, and believed in the safety of the influenza vaccine were more likely to be vaccinated. Conversely, the high price of the influenza vaccine was a barrier, whereas those who considered the vaccine affordable were more likely to be vaccinated. Although Changchun Changsheng vaccine incident (The Changchun Changsheng Biotechnology Company was found to have violated good manufacturing practices in 2018, leading to widespread distribution of subpotent vaccines in China.) may not significantly impact the vaccination uptake among healthcare workers, some HCWs still harbor doubts about vaccine safety, which remains a key reason for vaccine hesitancy. This study emphasizes the importance of the strict monitoring and management of vaccines, conducting clinical studies to support vaccine safety, and implementing free influenza vaccine policies, workplace vaccination requirements, and organized mass vaccinations. Educational efforts to increase HCWs' understanding of influenza and influenza vaccines are crucial to increasing vaccination uptake. Furthermore, implementing comprehensive intervention measures is essential to effectively improve the influenza vaccination uptake.