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      Barriers of Influenza Vaccination Intention and Behavior – A Systematic Review of Influenza Vaccine Hesitancy, 2005 – 2016

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          Abstract

          Background

          Influenza vaccine hesitancy is a significant threat to global efforts to reduce the burden of seasonal and pandemic influenza. Potential barriers of influenza vaccination need to be identified to inform interventions to raise awareness, influenza vaccine acceptance and uptake.

          Objective

          This review aims to (1) identify relevant studies and extract individual barriers of seasonal and pandemic influenza vaccination for risk groups and the general public; and (2) map knowledge gaps in understanding influenza vaccine hesitancy to derive directions for further research and inform interventions in this area.

          Methods

          Thirteen databases covering the areas of Medicine, Bioscience, Psychology, Sociology and Public Health were searched for peer-reviewed articles published between the years 2005 and 2016. Following the PRISMA approach, 470 articles were selected and analyzed for significant barriers to influenza vaccine uptake or intention. The barriers for different risk groups and flu types were clustered according to a conceptual framework based on the Theory of Planned Behavior and discussed using the 4C model of reasons for non-vaccination.

          Results

          Most studies were conducted in the American and European region. Health care personnel (HCP) and the general public were the most studied populations, while parental decisions for children at high risk were under-represented. This study also identifies understudied concepts. A lack of confidence, inconvenience, calculation and complacency were identified to different extents as barriers to influenza vaccine uptake in risk groups.

          Conclusion

          Many different psychological, contextual, sociodemographic and physical barriers that are specific to certain risk groups were identified. While most sociodemographic and physical variables may be significantly related to influenza vaccine hesitancy, they cannot be used to explain its emergence or intensity. Psychological determinants were meaningfully related to uptake and should therefore be measured in a valid and comparable way. A compendium of measurements for future use is suggested as supporting information.

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          Most cited references437

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          The theory of planned behavior

          Icek Ajzen (1991)
          Organizational Behavior and Human Decision Processes, 50(2), 179-211
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            Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.

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              Vaccine hesitancy: Definition, scope and determinants.

              The SAGE Working Group on Vaccine Hesitancy concluded that vaccine hesitancy refers to delay in acceptance or refusal of vaccination despite availability of vaccination services. Vaccine hesitancy is complex and context specific, varying across time, place and vaccines. It is influenced by factors such as complacency, convenience and confidence. The Working Group retained the term 'vaccine' rather than 'vaccination' hesitancy, although the latter more correctly implies the broader range of immunization concerns, as vaccine hesitancy is the more commonly used term. While high levels of hesitancy lead to low vaccine demand, low levels of hesitancy do not necessarily mean high vaccine demand. The Vaccine Hesitancy Determinants Matrix displays the factors influencing the behavioral decision to accept, delay or reject some or all vaccines under three categories: contextual, individual and group, and vaccine/vaccination-specific influences.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                26 January 2017
                2017
                : 12
                : 1
                : e0170550
                Affiliations
                [1 ]Center for Empirical Research in Economics and Behavioral Sciences, University of Erfurt, Erfurt, Germany
                [2 ]Department of Media and Communication Sciences, University of Erfurt, Erfurt, Germany
                University of Hong Kong, HONG KONG
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                • Conceptualization: PS CB.

                • Formal analysis: PS DR.

                • Funding acquisition: CB.

                • Investigation: PS DR GL MD.

                • Methodology: PS CB.

                • Project administration: PS CB.

                • Supervision: CB PS.

                • Visualization: PS.

                • Writing – original draft: PS DR CB.

                • Writing – review & editing: PS CB.

                Article
                PONE-D-16-43780
                10.1371/journal.pone.0170550
                5268454
                28125629
                377d60bf-5bd8-4b22-ac22-27820d60aaf8
                © 2017 Schmid et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 3 November 2016
                : 6 January 2017
                Page count
                Figures: 5, Tables: 3, Pages: 46
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100004423, World Health Organization;
                Award ID: TTi-15-APW-13
                Award Recipient :
                This project was financed by the World Health Organization Headquarters, Geneva (WHO Registration Nr. 2015/592427-0; Reg. File TTi-15-APW-13). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Immunology
                Vaccination and Immunization
                Vaccines
                Medicine and Health Sciences
                Immunology
                Vaccination and Immunization
                Vaccines
                Medicine and Health Sciences
                Public and Occupational Health
                Preventive Medicine
                Vaccination and Immunization
                Vaccines
                Medicine and Health Sciences
                Infectious Diseases
                Viral Diseases
                Influenza
                Biology and Life Sciences
                Immunology
                Vaccination and Immunization
                Medicine and Health Sciences
                Immunology
                Vaccination and Immunization
                Medicine and Health Sciences
                Public and Occupational Health
                Preventive Medicine
                Vaccination and Immunization
                People and Places
                Population Groupings
                Age Groups
                Elderly
                Medicine and Health Sciences
                Geriatrics
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Pregnancy
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Pregnancy
                Research and Analysis Methods
                Database and Informatics Methods
                Database Searching
                Biology and Life Sciences
                Behavior
                Custom metadata
                All relevant data are within the paper and its Supporting Information files. Additionally, a full list of analyzed research articles and determinants as well as a full list with excluded papers and reasons for exclusion are available for download from the OSF database (URL osf.io/y83z7).

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                Uncategorized

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