Socio-psychological factors driving adult vaccination: a qualitative study.

Ana Wheelock,Bruno Rigole,Angus Thomson,Charles Vincent,Anam Parand,Nick Sevdalis,Marisa Miraldo,Ilhem Messaoudi

doi:10.1371/journal.pone.0113503

Ana Wheelock, Bruno Rigole + Show 6 more

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https://doi.org/10.1371/journal.pone.0113503

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Abstract

BackgroundWhile immunization is one of the most effective and successful public health interventions, there are still up to 30,000 deaths in major developed economies each year due to vaccine-preventable diseases, almost all in adults. In the UK, despite comparatively high vaccination rates among ≧65 s (73%) and, to a lesser extent, at-risk ≤65 s (52%) in 2013/2014, over 10,000 excess deaths were reported the previous influenza season. Adult tetanus vaccines are not routinely recommended in the UK, but may be overly administered. Social influences and risk-perceptions of diseases and vaccines are known to affect vaccine uptake. We aimed to explore the socio-psychological factors that drive adult vaccination in the UK, specifically influenza and tetanus, and to evaluate whether these factors are comparable between vaccines.Methods20 in-depth, face-to-face interviews were conducted with members of the UK public who represented a range of socio-demographic characteristics associated with vaccination uptake. We employed qualitative interviewing approaches to reach a comprehensive understanding of the factors influencing adult vaccination decisions. Thematic analysis was used to analyze the data.ResultsParticipants were classified according to their vaccination status as regular, intermittent and non-vaccinators for influenza, and preventative, injury-led, mixed (both preventative and injury-led) and as non-vaccinators for tetanus. We present our finding around five overarching themes: 1) perceived health and health behaviors; 2) knowledge; 3) vaccination influences; 4) disease appraisal; and 5) vaccination appraisal.ConclusionThe uptake of influenza and tetanus vaccines was largely driven by participants' risk perception of these diseases. The tetanus vaccine is perceived as safe and sufficiently tested, whereas the changing composition of the influenza vaccine is a cause of uncertainty and distrust. To maximize the public health impact of adult vaccines, policy should be better translated into high vaccination rates through evidence-based implementation approaches.

Highlights

While immunization is one of the most effective and successful public health strategies in reducing or eliminating the health, economic and societal burden of many infectious diseases [1], major developed economies such as the US and Germany still report up to 30,000 deaths each year due to vaccine-preventable diseases, almost all in adults [2, 3]
The tetanus vaccine is perceived as safe and sufficiently tested, whereas the changing composition of the influenza vaccine is a cause of uncertainty and distrust
The US Centers for Disease Control and Prevention (CDC) recommends a 1-time dose of tetanus, diphtheria and pertussis (Tdap), followed by a tetanus and diphtheria (Td) booster every 10 years [9], whereas in France a tetanus, diphtheria and polio booster (Td/IPV) is recommended for under 25 s, a second dose at 45 years old and every 10 years for over 65 s, with one booster being replaced by a Tdap/IPV [10]

Summary

Introduction

While immunization is one of the most effective and successful public health strategies in reducing or eliminating the health, economic and societal burden of many infectious diseases [1], major developed economies such as the US and Germany still report up to 30,000 deaths each year due to vaccine-preventable diseases, almost all in adults [2, 3]. The extraordinary success of childhood routine immunization programs across the world, which show high immunization coverage levels, has not been matched in adult programs [4,5,6] This disparity is of increasing relevance in the context of a rapidly aging population and the attendant societal and economic burden. While immunization is one of the most effective and successful public health interventions, there are still up to 30,000 deaths in major developed economies each year due to vaccine-preventable diseases, almost all in adults.

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