Addressing Barriers to Immunization Against Acute Respiratory Infectious: A Qualitative Synthesis

Abstract

RATIONALE: The COVID-19 pandemic highlighted the need for population adherence to recommended prevention and control measures for acute respiratory infections. This study aims to summarize and evaluate the evidence on barriers for populational adherence to vaccine to prevent acute respiratory infections. METHODS: A qualitative evidence synthesis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Protocols statement and the Cochrane Effective Practice and Organization of Care: Qualitative Evidence Synthesis. An electronic search was performed in three databases (MEDLINE [Ovid], Embase [Ovid], and PsycINFO) from their inception to the present. We included studies published in Portuguese, English and Spanish that used both qualitative data collection and analysis methods. We also included studies that used mixed methods, when used qualitative methods of analysis. Risk of bias of the included studies was assessed using the Critical Skills Appraisal Programme (CASP). The certainty of the evidence was assessed by the Grading of Recommendations, Assessment, Development and Evaluations-Confidence in the Evidence from Reviews of Qualitative research (GRADECERQual) approach. The best-fit framework approach was followed as the strategy for data analysis and synthesis. Data were synthesized using adapted dimensions from the 'The Health Belief Model' (HBM) and the 'Behaviour Change Wheel' (BCW). RESULTS: Thirteen studies were included. The studies were related to influenza, H1N1, invasive pneumococcal disease, pertussis, and other acute respiratory infections. Most studies were assessed as having appropriate methological rigour. Regarding the confidence in the evidence of the thirteen findings, identified from the thirteen included studies, four were we graded four as high confidence certainty of evidence, four as moderate, three as low and two as very low certainty of evidence. The findings were presented within the six identified themes of the being two of the HBM model (perceived susceptibility and perceived barriers) and four of the COM-B model (social opportunity, automatic motivation, psychological capability and reflective motivation). CONCLUSIONS: Several factors can be considered barriers to implementing adequate populational adherence to immunization against respiratory infectious diseases: misperceptions on vaccination costs, lack of knowledge about the disease and its severity, lack of personal and environmental susceptibility, general misperceptions about vaccines (including their production, testing, and distribution protocols) and vaccine availability. In addition, other cultural and personal backgrounds can also be considered a leading cause: fear, lack of public awareness, inconvenience to take vaccination, unfortunate experiences in the past, and other misperceptions about efficacy, risks, side effects, among others.