Universal tetanus, diphtheria, acellular pertussis (Tdap) vaccination of adults: What Canadian health care providers know and need to know

Abstract

The tetanus, diphtheria, and acellular pertussis vaccine (Tdap) is recommended for all adults in both Canada and the United States. There are few data on the proportion of Canadian adults vaccinated with Tdap; however, anecdotal reports indicate that uptake is low. This study aimed to explore the knowledge, attitudes, beliefs, and behaviors of Canadian health care providers (HCPs) in an attempt to identify potential barriers and facilitators to Tdap uptake. HCPs were surveyed and a geographic and practice representative sample was obtained (N =1,167). In addition, 8 focus groups and 4 interviews were conducted nationwide. Results from the survey indicate that less than half (47.5%) of all respondents reported being immunized with Tdap themselves, while 58.5% routinely offer Tdap to their adult patients. Knowledge scores were relatively low (63.2% correct answers). The best predictor of following the adult Tdap immunization guidelines was awareness of and agreement with those recommendations. Respondents who were aware of the recommendations were more likely to think that Tdap is safe and effective, that their patients are at significant risk of getting pertussis, and to feel that they have sufficient information (p < 0.0001 for each statement). Focus group data supported the survey results and indicated that there are substantial gaps in knowledge of pertussis and Tdap among Canadian HCPs. Lack of public knowledge about adult immunization, lack of immunization registries, a costing differential between Td and Tdap, workload required to deliver the vaccine, and vaccine hesitancy were identified as barriers to compliance with the national recommendations for universal adult immunization, and suggestions were provided to better translate recommendations to front-line practitioners.

Keywords: Tdap; adult immunization; attitudes; beliefs; knowledge; pertussis; pertussis vaccine; vaccine coverage.

Figure 1.

Mean knowledge scores (% correct response) of 9 questions by practice type and by practice location. In practice type, the black bar depicts all health care providers, the dark gray bar depicts nurses, the light gray bar physicians (general practitioners and internists), and the white bar pharmacists. For practice location the black bar depicts urban/suburban practitioners, the dark gray bar urban/suburban nurses, the light gray bar urban/suburban physicians, the white bar urban/suburban pharmacists, the bar cross-hatched down to the right depicts rural practitioners, the bar cross-hatched horizontaly rural nurses, cross-hatched up to the right rural physicians, and cross-hatched vertically rural pharmacists.

Figure 2.

Health care provider awareness of provincially funded programs for vaccination of adults with Tdap. Black bars depict correct responses, gray bars incorrect responses, and white bars those who responded that they did not know the answer to the question “In my province, the Tdap vaccine is publicly funded (free of charge) for adults.”