Determinants of Vaccination Uptake in Risk Populations: A Comprehensive Literature Review

Abstract

Vaccination uptake has decreased globally in recent years, with a subsequent rise of vaccine-preventable diseases. Travellers, immunocompromised patients (ICP), and healthcare workers (HCW) are groups at increased risk for (severe) infectious diseases due to their behaviour, health, or occupation, respectively. While targeted vaccination guidelines are available, vaccination uptake seems low. In this review, we give a comprehensive overview of determinants-based on the integrated change model-predicting vaccination uptake in these groups. In travellers, low perceived risk of infection and low awareness of vaccination recommendations contributed to low uptake. Additionally, ICP were often unaware of the recommended vaccinations. A physician's recommendation is strongly correlated with higher uptake. Furthermore, ICP appeared to be mainly concerned about the risks of vaccination and fear of deterioration of their underlying disease. For HCW, perceived risk of (the severity of) infection for themselves and for their patients together with perceived benefits of vaccination contribute most to their vaccination behaviour. As the determinants that affect uptake are numerous and diverse, we argue that future studies and interventions should be based on multifactorial health behaviour models, especially for travellers and ICP as only a limited number of such studies is available yet.

Keywords: determinants; health behaviour model; healthcare workers; immunocompromised; risk groups; travellers; vaccination uptake; vaccine hesitancy; vaccine refusal.

Figure 1

Simplified I-Change model summarizing the studied determinants that could predict vaccination uptake. We used a simplified version of the I-Change model applied to vaccination uptake. Uptake is shaped by the intention to get vaccinated which is subject to barriers and facilitators. Intention is established by motivation (attitude, social influence, and self-efficacy), awareness (awareness, knowledge, and perceived risk) and information and predisposing determinants. Predisposing factors include baseline characteristics of studied populations and influence awareness, motivation and uptake. Information factors include information retrieved via media, social contacts and healthcare workers.

Figure 2

Flow diagram of study selection procedure. * n = 2 articles were included in both ICP and HCW.