Barriers and enablers to influenza vaccination uptake in adults with chronic respiratory conditions: applying the behaviour change wheel to specify multi-levelled tailored intervention content

Objective To specify intervention content to enhance influenza vaccination uptake among adults with chronic respiratory conditions using the Behaviour Change Wheel (BCW). Design Cross-sectional, multi-modal data collection and theory-informed analysis and expert stakeholder engagement. Methods Content analysis was used to identify barriers and enablers to influenza vaccination from nine focus groups (n = 38), individual interviews (n = 21) and open-ended survey responses (n = 101). The Theoretical Domains Framework (TDF) and the BCW were used to specify evidence-based and theoretically-informed recommendations. Expert stakeholders refined recommendations using the Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Equity (APEASE) criteria to yield a range of potentially actionable ideas. Results TDF analysis identified perceptions of vaccine side effects (beliefs about consequences [BACons]) was the most common barrier to vaccination, followed by time constraints (environmental context and resources [ECR]) and fear of needles (Emotion). Enablers included protection from influenza (BACons), receiving reminders (ECR) and support from others (Social Influences). These factors mapped to seven BCW intervention functions and 22 behaviour change techniques. Conclusions Factors affecting vaccine uptake are multifaceted and multileveled. The study suggested a suite of complementary multi-level intervention components to enhance vaccination uptake involving a range of diverse actors, intervention recipients and settings.

Automated summary

This study aimed to enhance influenza vaccination uptake among adults with chronic respiratory conditions by using the Behaviour Change Wheel (BCW) to specify intervention content. The study identified barriers and enablers to vaccination through focus groups, interviews, and surveys. Factors such as perceptions of vaccine side effects, time constraints, and fear of needles were found to be common barriers, while enablers included protection from influenza, reminders, and support from others. Based on the findings, the study proposed a suite of multi-level intervention components involving diverse actors, recipients, and settings to enhance vaccination uptake.