Healthcare workers’ perceptions and experiences of communicating with people over 50 years of age about vaccination: a qualitative evidence synthesis
Information
- DOI:
- https://doi.org/10.1002/14651858.CD013706.pub2Copy DOI
- Database:
-
- Cochrane Database of Systematic Reviews
- Version published:
-
- 20 July 2021see what's new
- Type:
-
- Qualitative
- Stage:
-
- Review
- Cochrane Editorial Group:
-
Cochrane Effective Practice and Organisation of Care Group
- Copyright:
-
- Copyright © 2021 The Authors. Cochrane Database of Systematic Reviews published by John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration.
- This is an open access article under the terms of the Creative Commons Attribution-Non-Commercial Licence , which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Article metrics
Altmetric:
Cited by:
Authors
Contributions of authors
SL, CG and BAW conceptualised the review.
CG, BC, SL, MW, BAW and RE screened potential studies for inclusion.
CG, BC, SL, MW and RE extracted the study data and carried out the assessment of the methodological limitations of the included studies.
CG and SL carried out the TRANSFER process.
CG and BC coded the data and drafted the findings, and thereafter shared these with the remaining co‐authors for review.
CG and BC carried out the GRADE‐CERQual assessments of the findings and MW, RE and SL checked these assessments.
CG, RE and SL assessed study author motivation.
CG, SL and BAW developed the implementations for practice and research.
All authors reviewed and commented on all drafts of this review.
CG is the guarantor of the review.
Sources of support
Internal sources
-
South African Medical Research Council, South Africa
Simon Lewin receives additional funding from the South African Medical Research Council.
External sources
-
This review was undertaken within the Vaccines and Infectious Diseases in the Ageing Population (VITAL) consortium. The VITAL project has received funding from the Innovative Medicines Initiative 2 Joint Undertaking (JU) under grant agreement No 806776. The JU receives support from the European Union's Horizon 2020 research and innovation programme and EFPIA. Cochrane's Conflict of Interest Arbiters have considered this case and determined that the Innovative Medicines Initiative funding for the review does not breach the Cochrane Commercial Sponsorship Policy. Their decision is based on the fact that there is no direct funding by the pharmaceutical industry. IMI's funding is part of a partnership, with controls and legislation around how the money is spent, and there seems to be extensive canvassing to set the research agenda, which must also align with EU and WHO goals, Other
Declarations of interest
CG: no financial conflicts of interest. CG is an EPOC editor but was not involved in the editorial process for this review.
BC: no financial conflicts of interest.
SL: no financial conflicts of interest. SL is the Joint Co‐ordinating Editor for EPOC but was not involved in the editorial process for this review.
MW: no financial conflicts of interest.
BAW: no financial conflicts of interest.
RE: no financial conflicts of interest. RE was a co‐author on one of the included papers and was, therefore, excluded from the screening, data extraction and assessment of this paper.
Several non‐financial issues, including personal, political and academic factors, could have influenced the review authors' input when conducting this review. The review authors have discussed this further in the sections on reflexivity in the 'Methods' and 'Result's sections.
Acknowledgements
We would like to thank the following healthcare workers, researchers, communication advisers and older adults for giving us feedback to different sections of the review: Heather Ames (Norway), Hege Estestad Haugen (Norway), Sophie Hill (Australia), Kerstin Holmberg (Sweden), Jessica Kaufman (Australia), Sue Marcus (UK), Luis Ortiz (Chile), Dympna Tuohy (Ireland), Betty and Michael from the Ageing Research Centre Older Adult and Family Carer Stakeholder panel at the University of Limerick (Ireland), Ulysses Panisset (Brazil), Ted van Essen (the Netherlands), Kjetil Berg Veire (Norway), and Božidar Voljc (Slovenia).
We thank the following peer‐reviewers for their constructive feedback on the review: Jane Noyes, Eric Wong, and Mohammad Razi.
Thanks also to Effective Practice and Organisation of Care (EPOC) group's managing editor Elizabeth Paulsen and information specialist Marit Johansen for their support in preparing this review, and to Heather Munthe‐Kaas for her support when using the TRANSFER process.
The research leading to these results was conducted as part of the VITAL consortium. For further information refer to www.vital-imi.eu.
The Norwegian Satellite of the EPOC Group receives funding from the Norwegian Agency for Development Co‐operation (Norad), via the Norwegian Institute of Public Health to support review authors in the production of their reviews.
Version history
| Published | Title | Stage | Authors | Version |
| 2021 Jul 20 | Healthcare workers’ perceptions and experiences of communicating with people over 50 years of age about vaccination: a qualitative evidence synthesis | Review | Claire Glenton, Benedicte Carlsen, Simon Lewin, Manuela Dominique Wennekes, Brita Askeland Winje, Renske Eilers, on behalf of the VITAL consortium | |
| 2020 Aug 13 | Healthcare workers’ perceptions and experiences of communicating with people over 50 about vaccination: a qualitative evidence synthesis | Protocol | Claire Glenton, Brita Askeland Winje, Benedicte Carlsen, Renske Eilers, Manuela Dominique Wennekes, Simon Lewin | |
Differences between protocol and review
We made the following changes from our protocol (Glenton 2020b).
Our assessment of the included studies' methodological limitations indicated a general lack of reflexivity from study authors. Therefore, we decided to extract and assess data on study author motivation as part of the review (see description in 'Methods' section).
We made a slight change to the wording of the objective. In the protocol version, the objective was presented as follows: "The aim of this systematic review was to explore healthcare workers' perceptions and experiences of communication between themselves and older adults about vaccination." The current objective is now presented as follows: "The aim of this systematic review was to explore healthcare workers' perceptions and experiences of communicating with older adults about vaccination."
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
- Age Factors;
- Caregivers;
- *Communication;
- Decision Making;
- *Health Knowledge, Attitudes, Practice;
- Health Personnel [*psychology];
- Herpes Zoster Vaccine [administration & dosage];
- Influenza Vaccines [administration & dosage];
- Persuasive Communication;
- Pneumococcal Vaccines [administration & dosage];
- Professional-Family Relations;
- Qualitative Research;
- Vaccination [*psychology, statistics & numerical data];
- Vaccines [*administration & dosage];
Medical Subject Headings Check Words
Aged; Humans; Middle Aged;
| Summary of review finding | GRADE‐CERQual assessment of confidence in the evidence | Explanation of GRADE‐CERQual assessment | Studies contributing to the review finding1 |
|---|---|---|---|
| Finding 1. Healthcare workers reported that older adults asked about vaccination to different extents, ranging from not asking about vaccines at all in some settings to great demand in other settings. | High confidence | No/very minor concerns regarding methodological limitations, no/very minor concerns regarding coherence, no/very minor concerns regarding adequacy and no/very minor concerns regarding relevance. | |
| Finding 2. When the topic of vaccination was discussed, healthcare workers described a lack of information, and presence of misinformation, fears and concerns about vaccines among older adults. | Moderate confidence | No/very minor concerns regarding methodological limitations, no/very minor concerns regarding coherence, minor concerns regarding adequacy and minor concerns regarding relevance | Badertscher 2012; Ellen 2018; Huston 2019; Raftopoulos 2008; Wray 2007 |
| Finding 3. The manner in which healthcare workers discussed vaccines with older adults appeared to be linked to what they saw as the aim of vaccination communication. Healthcare workers differed among themselves in their perceptions of this aim and about their own roles and the roles of older adults in vaccine decisions. Some healthcare workers thought it was important to provide information but emphasised the right and responsibility of older adults to decide for themselves. Other healthcare workers used information to persuade and convince older adults to vaccinate in order to increase 'compliance' and 'improve' vaccination rates, and in some cases to gain financial benefits. A third group of healthcare workers tailored their approach to what they believed the older adult needed or wanted. | Moderate confidence | Minor concerns regarding methodological limitations, no/very minor concerns regarding coherence, no/very minor concerns regarding adequacy and moderate concerns regarding relevance | Badertscher 2012; Eilers 2015; Ellen 2018; Hinshaw 2011; Huston 2019; Hutt 2010; Lasser 2008; Lehmann 2014; Raftopoulos 2008; Wray 2007; Zaouk 2019 |
| Finding 4. Healthcare workers in community‐based and primary care settings described how older adults often followed their vaccine recommendations. Healthcare workers believed that this influence was linked to trust, which in turn was linked to long‐lasting relationships and sometimes also to shared cultural or language backgrounds. | Low confidence | Minor concerns regarding methodological limitations, no/very minor concerns regarding coherence, moderate concerns regarding adequacy and moderate concerns regarding relevance | Eilers 2015; Ellen 2018; Huston 2019; Lasser 2008; Wray 2007 |
| Finding 5. Nurses, pharmacists and doctors suggested that some older adults preferred or were more likely to be influenced by some types of healthcare workers, particularly doctors. Some healthcare workers suggested that this was linked to doctors' perceived status and prestige. | Low confidence | No/very minor concerns regarding methodological limitations, no/very minor concerns regarding coherence, moderate concerns regarding adequacy and moderate concerns regarding relevance | |
| Finding 6. Some healthcare workers who had chosen not to have the influenza vaccine themselves noted that they would still promote this vaccine to older people. However, other healthcare workers suggested that it was easier to convince older adults to accept vaccines if the healthcare workers themselves believed in the advantages of vaccination and if they led by example in accepting vaccination. | Low confidence | Minor concerns regarding methodological limitations, no/very minor concerns regarding coherence, moderate concerns regarding adequacy and moderate concerns regarding relevance | |
| Finding 7. Across different healthcare settings, healthcare workers generally regarded infections such as influenza, pneumococcal disease and herpes zoster as having serious enough consequences for older adults to justify a vaccine. | Moderate confidence | Minor concerns regarding methodological limitations, no/very minor concerns regarding coherence, no/very minor concerns regarding adequacy and moderate concerns regarding relevance | Eilers 2015; Ellen 2018; Lehmann 2014; Raftopoulos 2008; Wray 2007; Zaouk 2019 |
| Finding 8. Healthcare workers' exposure to certain infectious diseases in their clinical practice could influence their views of disease severity or the priority they gave its prevention. | Moderate confidence | No/very minor concerns regarding methodological limitations, no/very minor concerns regarding coherence, moderate concerns regarding adequacy and no/very minor concerns regarding relevance | |
| Finding 9. Not all healthcare workers were convinced of the effectiveness of vaccines for older adults, and emphasised the importance of evidence about benefits and harms. | Moderate confidence | No/very minor concerns regarding methodological limitations, no/very minor concerns regarding coherence, moderate concerns regarding adequacy and minor concerns regarding relevance | |
| Finding 10. A few healthcare workers were not convinced of the usefulness of vaccines for older adults with serious underlying illnesses and poor quality of life, and a small number of GPs suggested that in some cases it might be more merciful to let weaker older adults die of diseases such as influenza or pneumonia. | Very low confidence | No/very minor concerns regarding methodological limitations, no/very minor concerns regarding coherence, serious concerns regarding adequacy and serious concerns regarding relevance | |
| Finding 11. Some healthcare workers did not think age in itself should be the only indicator for vaccination, but also pointed to other factors such as their medical history and living arrangements. | Moderate confidence | No/very minor concerns regarding methodological limitations, no/very minor concerns regarding coherence, moderate concerns regarding adequacy and no/very minor concerns regarding relevance | |
| Finding 12. Healthcare workers did not always prioritise vaccination services for older adults when faced with limited time and other, more acute health issues. | Moderate confidence | Minor concerns regarding methodological limitations, minor concerns regarding coherence, no/very minor concerns regarding adequacy and no/very minor concerns regarding relevance | Badertscher 2012; Huston 2019; Lasser 2008; Lehmann 2014; Zaouk 2019 |
| Finding 13. Across settings, providers sometimes offered vaccine services opportunistically (for instance, when attending appointments about other healthcare issues) or at designated timepoints (for instance, during vaccination days), and had different opinions about the practicalities of the different approaches. | High confidence | No/very minor concerns regarding methodological limitations, no/very minor concerns regarding coherence, minor concerns regarding adequacy, and no/very minor concerns regarding relevance | Eilers 2015; Ellen 2018; Huston 2019; Hutt 2010; Lasser 2008 |
| Finding 14. Some healthcare workers complained of having limited knowledge about vaccination for older adults and wanted more training. Ongoing training was seen as important because of staff turnover. However, some healthcare workers complained about a lack of time for training. | Low confidence | Minor concerns regarding methodological limitations, no/very minor concerns regarding coherence, moderate concerns regarding adequacy and moderate concerns regarding relevance | |
| Finding 15. The extent to which healthcare workers regarded vaccine services as part of their role and responsibilities varied. Some providers saw it as part of their role, others were concerned about encroaching on the roles of other providers, and others were unclear about who was responsible. | Moderate confidence | No/very minor concerns regarding methodological limitations, no/very minor concerns regarding coherence, moderate concerns regarding adequacy, and no/very minor concerns regarding relevance | |
| Finding 16. Providers' access to patient data, including patients' vaccination history or information about their comorbidities, sometimes influenced their ability to offer vaccination services. | Moderate confidence | Minor concerns regarding methodological limitations, no/very minor concerns regarding coherence, minor concerns regarding adequacy, and no/very minor concerns regarding relevance | |
| 1The GRADE‐CERQual evidence profile for each finding is available in Appendix 1 | |||
| Author/ date | Title | Review objective | Included studies |
|---|---|---|---|
| Addressing common barriers in adult immunizations: a review of interventions | To assess the effectiveness of interventions in adults that aimed to address barriers to vaccine uptake. | Controlled studies or before‐after studies English‐language studies of adults aged ≥ 18 years. Studies relevant to US context | |
| Factors affecting the uptake of vaccination by the elderly in Western society | To explore factors related to vaccine uptake by elderly people. | Qualitative and quantitative studies English‐language studies of adults aged ≥ 50 years from Western countries | |
| Factors influencing seasonal influenza vaccination behaviour among elderly people: a systematic review | To explore behaviour‐related factors influencing influenza vaccination among elderly people. | Cross‐sectional, longitudinal and qualitative studies English‐language studies of adults aged ≥ 60 years. No restriction on country | |
| Seasonal influenza vaccination of healthcare workers: systematic review of qualitative evidence
| To explore healthcare workers' perceptions and experiences of vaccination for seasonal influenza. | Qualitative studies English‐language studies of healthcare workers No restriction on country | |
| Social determinants of health and seasonal influenza vaccination in adults ≥65 years: a systematic review of qualitative and quantitative data | To assess the social determinants of health preventing adults aged ≥ 65 years from accessing and accepting seasonal influenza vaccination. | Qualitative and quantitative studies English‐language studies of adults aged ≥ 65 years No restriction on country | |
| Maximising influenza vaccination awareness and uptake among older adults in Singapore | To identify the need and priorities for influenza vaccination and strategies to increase uptake among adults aged < 65 years. | Papers from peer‐reviewed journals English‐language studies published between 2001 and 2016 No restriction on country | |
| Interventions to increase influenza vaccination rates of those 60 years and older in the community | To assess the effectiveness of access, provider, system and societal interventions to increase the uptake of influenza vaccination. | Randomised trials or cluster‐randomised trials Adults aged ≥ 60 years No restriction on study language or country | |
| A review of the factors involved in older people's decision‐making with regard to influenza vaccination: a literature review | To explore factors involved in older people's decision‐making with regard to influenza vaccination. | Papers from peer‐reviewed journals English‐language studies of adults aged ≥ 65 years Studies relevant to UK context |
| Study ID | Are the setting/s and context described adequately? | Is the sampling strategy described, and is this appropriate? | Is the data collection strategy described and is it appropriate?a | Is the data analysis described, and is this appropriate? | Are the claims made/findings supported by sufficient evidence? | Is there evidence of reflexivity? | Does the study demonstrate sensitivity to ethical concerns? | Overall assessment of methodological limitations |
|---|---|---|---|---|---|---|---|---|
| Yes | Partial | Yes | Yes | Yes | No | Yes | Minor concerns | |
| Yes | Yes | Yes | Yes | Yes | No | Yes | Minor concerns | |
| Yes | Yes | Yes | Yes | Yes | No | Yes | Minor concerns | |
| Partial | No | No | No | Unclear | No | Yes | Moderate concerns | |
| Yes | Yes | Yes | Yes | Yes | Partial | Yes | Minor concerns | |
| Yes | Yes | Partial | Yes | Yes | No | No | Minor concerns | |
| Yes | Yes | Yes | Yes | Yes | Partial | Yes | No or very minor concerns | |
| Partial | Yes | Yes | Yes | Yes | Partial | Yes | No or very minor concerns | |
| Yes | Yes | Yes | Yes | No | No | Yes | Serious concerns | |
| Yes | No | Partial | Partial | Yes | No | Yes | Moderate concerns | |
| Yes | Yes | No | Yes | Yes | No | Yes | Minor concerns | |
| aWe assessed the data collection strategies as appropriate for most of these studies. However, for some review findings, we noted that a concern was that none of the contributing studies had collected data using observation of practice. | ||||||||
