Navigating vaccine confidence: A mixed methods study investigating healthcare providers' perspectives across four non-EU European regions.

Background: Vaccine confidence remains a global public health challenge, especially highlighted during the COVID-19 pandemic. Public trust in vaccines is crucial, with healthcare providers (HCPs) playing a pivotal role in navigating this sensitive topic. This requires an understanding of HCPs' perceptions of vaccines. Most European studies focus solely on the 27 EU countries, with sparse evidence available among other European countries. This study aims to expand the scope of HCPs' vaccine confidence oversight into European regions where limited research has been conducted thus far.

Methods: The study employed a mixed-methods approach to examine vaccine confidence among HCPs (general practitioners and nurses) in six European countries outside of the EU: North Macedonia, Bosnia & Herzegovina (Balkans), Belarus (Eastern Europe), Armenia, Georgia (Caucasus), and Kazakhstan (Central Asia). Quantitative surveys (N = 600) assessed vaccine confidence levels and recommendation practices, which were analyzed using SPSS. Qualitative interviews (N = 30) provided deeper insights into HCPs' perceptions of vaccination, role, and training needs, and were processed using NVivo.

Results: Findings revealed varying levels of vaccine confidence among HCPs across the six countries. The quantitative survey indicated disparities in confidence levels, with Belarus and Kazakhstan exhibiting notably lower confidence in vaccines. North Macedonia stands out as the country where HCPs are most confident about their role in encouraging vaccination, while the remaining five countries share similar lower levels. Qualitative interviews provided deeper insights into HCP perspectives, highlighting the complexities of tailoring recommendations and the collaborative decision-making process. HCPs expressed a clear need for training on vaccination, particularly in understanding effective doctor-patient communication.

Conclusions: These findings underscore the value of implementing targeted interventions to support HCPs, for example by providing training in vaccination knowledge and communication to improve their confidence in addressing patient concerns about vaccination. Ultimately, responding to skills and knowledge needs, this can contribute to improved vaccine acceptance.