Background: 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. 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.
Methods: 20 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.
Results: Participants 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.
Conclusion: The 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.