Open Access
Research
The challenge of vaccinating adults: attitudes and beliefs of the Canadian public and healthcare providers D M MacDougall,1,2 B A Halperin,1,3,4 D MacKinnon-Cameron,1 Li Li,1 S A McNeil,1,5 J M Langley,1,4,6 S A Halperin1,4,7
To cite: MacDougall DM, Halperin BA, MacKinnonCameron D, et al. The challenge of vaccinating adults: attitudes and beliefs of the Canadian public and healthcare providers. BMJ Open 2015;5:e009062. doi:10.1136/bmjopen-2015009062 ▸ Prepublication history for this paper is available online. To view these files please visit the journal online (http://dx.doi.org/10.1136/ bmjopen-2015-009062). Received 11 June 2015 Revised 25 August 2015 Accepted 3 September 2015
For numbered affiliations see end of article. Correspondence to Dr SA Halperin; scott. [email protected]
ABSTRACT Objectives: Vaccine coverage for recommended vaccines is low among adults. The objective of this study was to assess the knowledge, attitudes, beliefs and behaviours of adults and healthcare providers related to four vaccine-preventable diseases and vaccines (diphtheria-tetanus-pertussis, zoster, pneumococcus and influenza). Design: We undertook a survey and focus groups of Canadian adults and healthcare providers (doctors, nurses, pharmacists). A total of 4023 adults completed the survey and 62 participated in the focus groups; 1167 providers completed the survey and 45 participated in the focus groups. Results: Only 46.3% of adults thought they were up-to-date on their vaccines; 30% did not know. In contrast, 75.6% of providers reported being up-todate. Only 57.5% of adults thought it was important to receive all recommended vaccines (compared to 87.1–91.5% of providers). Positive attitudes towards vaccines paralleled concern about the burden of illness and confidence in the vaccines, with providers being more aware of disease burden and confident in vaccine effectiveness than the public. Between 55.0% and 59.7% of adults reported willingness to be vaccinated if recommended by their healthcare provider. However, such recommendations were variable; while 77.4% of the public reported being offered and 52.8% reported being recommended the influenza vaccine by their provider, only 10.8% were offered and 5.6% recommended pertussis vaccine. Barriers and facilitators to improved vaccine coverage in adults, such as trust-mistrust of health authorities, pharmaceutical companies and national recommendations, autonomy versus the public good and logistical issues (such as insufficient time and lack of vaccination status tracking), were identified by both the public and providers. Conclusions: Despite guidelines for adult vaccination, there are substantial gaps in knowledge and attitudes and beliefs among both the public and healthcare providers that lead to low vaccine coverage. A systematic approach that involves education, elimination of barriers and establishing and improving infrastructure for adult immunisation is required.
Strengths and limitations of this study ▪ Mixed methodology including survey and focus groups. ▪ Large national representative survey. ▪ Healthcare providers and the general public. ▪ Whether Canadian data are generalisable to other countries with different vaccine programmes. ▪ Self-reporting vaccine coverage status.
INTRODUCTION While universal immunisation of children is now part of routine global healthcare and has led to substantial reductions in vaccinepreventable diseases, immunisation of adults and control of infectious disease morbidity and mortality substantially lags behind.1–4 Several vaccines routinely given during childhood are recommended as boosters for adults such as tetanus-diphtheria-acellular pertussis vaccine, and other vaccines are specifically targeted to adults (eg, zoster vaccine, influenza vaccine.5–7 Multiple factors have been identified that influence immunisation uptake among adults including social influences, disease-related and vaccine-related factors, general attitudes toward health and vaccines, habit, awareness and knowledge, practical barriers and motivators, and altruism.8 Barriers to improved immunisation coverage in adults include misperceptions among the public and healthcare providers (HCPs) that vaccines are just for children and logistical issues related to vaccine delivery, including lack of vaccine-specific HCP visits, inability to determine immunisation status and lack of funding for adult vaccines and vaccine visits.9 Although strategies have been identified to meet the challenge of low vaccine coverage in adults,1 little progress has been achieved. In Canada, vaccine recommendations are made by the National Advisory Committee
MacDougall DM, et al. BMJ Open 2015;5:e009062. doi:10.1136/bmjopen-2015-009062
1
Open Access on Immunization (NACI); vaccine programmes, however, are implemented independently by each provincial/territorial government. Some vaccines, such as influenza vaccine, are provided free of charge in all provinces/territories; others, such as pertussis and pneumococcal vaccine are provided by some but not all jurisdictions and zoster vaccine is not provided by any jurisdiction. As the concept of an adult immunisation platform becomes increasingly part of public health planning,1 10 we sought to develop a better understanding of the knowledge, attitudes, beliefs and behaviours of HCPs providing care to adults in Canada and the general public. Specifically we explored general issues regarding adult immunisation and specific information related to four diseases and the associated vaccines recommended for routine use in adults (influenza, pertussis, pneumococcus, zoster). A geographically representative national survey and focus groups involving the general public and HCPs who vaccinate was undertaken. METHODS We used a mixed method, sequential, explanatory design consisting of quantitative data collection and analysis (survey) followed by qualitative data collection and analysis (focus groups); 11 12 details of the methodology have previously been published.13 Focus groups were chosen rather than interviews in order to get a concentrated set of observations over a short period of time. As well, interaction among participants increases their sense of cohesiveness and increases their willingness to explore and clarify individual and shared perspectives.14 Quantitative stage (survey) The survey was developed using the Awareness Adherence Model.15 The content validity of individual questions as well as the content validity of the entire questionnaire were evaluated by a panel of experts comprised of infectious diseases physicians. Each item was rated using a standard content validity index with a fourpoint ordinal rating scale, where 1 indicated irrelevance and 4 high relevance. Items that received a score of 3 or 4 were judged to have content validity. Items that did not achieve the required minimum agreement of experts were eliminated or revised. Test–retest reliability was assessed by having five healthcare providers complete the questionnaires at two different points in time. A correlation coefficient was calculated to compare the two sets of responses; a coefficient >0.70 was interpreted that the questionnaire responses were consistent. The survey was then piloted on a convenience sample of 299 of the 1250 attendees at the 2010 Canadian Immunization Conference held in Quebec City. The national public survey reported here was administered by Leger Marketing (Montreal, Quebec, Canada), which maintains email addresses for 350 000 Canadian adults who are representative of the Canadian general population for the purpose of participating in market and 2
other research. Sampling was based on regional representation across the country, age, gender and urban and rural residence. A subset of HCPs within this database was invited to participate in the HCP survey. Sampling was based on regional representation, age, gender, urban and rural practice, and specialty (general practice physicians, internal medicine specialists, nurses and pharmacists). Inclusion criteria were being in practice for a minimum of 3 years and responsibility for immunisation delivery to adults and/or patient consultation concerning vaccines in their province or territory. Participants received an email invitation to the survey outlining the purpose of the study, its voluntary nature and the time commitment involved. Consent to participate was implied by completion of the web-based survey. For the public survey, a sample size of 4000 adults was calculated to provide an acceptable precision by region (95% CI around the point estimate) of ±5%. For the HCP survey, a sample size of 500 family physicians and 400 pharmacists was calculated to provide a precision (95% CI around the point estimate) of ±5%; a sample size of 100 internal medicine specialists and 200 nurses was calculated to provide a precision of ±5–10% for each practitioner type. The first level of analysis comprised a review of the descriptive, summative statistics for trends in the data. The second level of analysis involved tests of association. Data were divided by public and by HCP profession ( physician, nurse and pharmacist) and locale ( province/territory). Continuous variables were presented by summary statistics (ie, mean and SE) and the categorical variables by frequency distributions (ie, frequency counts, percentages and their two-sided 95% exact binomial CIs). Differences in survey responses between groups were assessed using Fisher’s exact tests. For continuous variables, logistic regression was used. Associations between attitude questions, behavioural responses and demographics were estimated using ordinal logistic regression or Fisher’s exact tests. p Values 75% 109 (54.0) 469 (93.8) Number of years providing vaccines; 9.7 (7.3) 19.5 (8.9) mean (SD) Vaccines administered to adults/month None 13 (7.1) 5 (1.0) 1–5 61 (33.5) 46 (9.3) 6–10 38 (20.9) 101 (20.4) 11–20 32 (17.6) 165 (33.3) 21–50 26 (14.3) 131 (26.5) >50 12 (6.6) 47 (9.5) Highest level of education Not obtained Not obtained Elementary High school College University diploma University baccalaureate University masters University doctorate Prefer not to answer Do you think you are up to date on all your adult vaccinations? (%) Yes 83.7 78.0 No 11.9 16.6 Do not know 4.5 5.4
Internists
Pharmacists (n (%))
Canadian Public (n (%))
65 (5.6)
400 (34.3)
Not applicable
16 (24.6) 49 (75.4)
199 (49.8) 201 (50.3)
1771 (44.0) 2252 (56.0)
– 2 (3.1) 24 (36.9) 25 (38.5) 14 (21.5) – –
1 (0.3) 104 (26.0) 164 (41.0) 99 (24.8) 32 (8.0) – –
354 (8.8) 509 (12.7) 676 (16.8) 933 (23.2) 790 (19.6) 623 (15.5) 138 (3.4)
5 (7.7) 7 (10.8) 1 (1.5) 5 (7.7) 25 (38.5) 17 (26.2) 1 (1.5) 3 (4.6) – 1 (1.5)
53 (13.1) 45 (11.3) 19 (4.8) 17 (4.3) 125 (31.3) 82 (20.5) 23 (5.8) 22 (5.5) 2 (0.5) 12 (3.0)
504 (12.5) 403 (10.0) 251 (6.2) 253 (6.3) 1206 (30.0) 804 (20.0) 227 (5.6) 220 (5.5) 46 (1.1) 109 (2.7)
38 (58.5) 18 (27.7) 9 (13.8) – 56 (86.2) 15.9 (4.5)
219 (54.8) 125 (31.3) 53 (13.3) – 164 (41.0) 6.1 (7.5)
1691 (42.0) 1471 (36.6) 830 (20.6) 31 (0.8) Not applicable Not applicable Not applicable
3 (4.7) 19 (29.7) 17 (26.6) 14 (21.9) 6 (9.4) 5 (7.8) Not obtained
14 (4.2) 106 (32.1) 95 (28.8) 82 (24.8) 25 (7.6) 8 (2.4) Not obtained 18 (0.4) 964 (24.0) 1221 (30.4) 314 (7.8) 1038 (25.8) 355 (8.8) 83 (2.1) 30 (0.7)
69.2 20.0 10.8
69.5 18.8 11.8
1861 (46.3) 954 (23.7) 1208 (30.0)
HCP, healthcare provider.
4
MacDougall DM, et al. BMJ Open 2015;5:e009062. doi:10.1136/bmjopen-2015-009062
Open Access Table 2 Healthcare provider attitudes about adult immunisation Synopsis of statements
Agreement
It is important for adults to receive all recommended vaccines according to provincial guidelines
Strongly agree/agree Neither agree nor disagree Disagree/strongly disagree Strongly agree/agree Neither agree nor disagree Disagree/strongly disagree Strongly agree/agree Neither agree nor disagree Disagree/strongly disagree Strongly agree/agree Neither agree nor disagree Disagree/strongly disagree Strongly agree/agree Neither agree nor disagree Disagree/strongly disagree Strongly agree/agree Neither agree nor disagree Disagree/strongly disagree Strongly agree/agree Neither agree nor disagree Disagree/strongly disagree Strongly agree/agree Neither agree nor disagree Disagree/strongly disagree Strongly agree/agree Neither agree nor disagree Disagree/strongly disagree Strongly agree/agree Neither agree nor disagree Disagree/strongly disagree Strongly agree/agree Neither agree nor disagree Disagree/strongly disagree
Vaccines are more important for children than adults
Vaccines that are recommended for adults should be available free of charge
I do not have enough time to administer vaccines to adult patients
It is difficult to keep track of adult patients’ vaccine status
I think there should be a national electronic vaccine registry that keeps track of all the vaccines that I administer to my patients
It is important to inform adult patients about the benefits and risks of adult vaccinations
It is difficult to keep up with vaccination recommendations for adults
It is important to use patient encounters as an opportunity to ask about their vaccine status
I do not have adequate storage facilities to provide adult vaccines
I am not sufficiently reimbursed to make offering adult immunisation worthwhile
Nurses (%)
Physicians (%)
Pharmacists (%)
87.1 9.4
90.6 9.0
91.5 6.5
3.5
0.4
2.0
40.6 16.8
46.9 19.5
41.3 21.0
42.6
33.6
37.8
91.6 5.9
86.0 11.5
81.8 9.3
2.5
2.5
9.0
15.8 31.2
25.1 19.8
33.5 35.8
53.0
55.0
30.8
70.3 14.4
68.1 16.3
83.0 11.0
15.3
15.6
6.0
83.7 11.4
75.4 18.1
84.8 10.5
5.0
6.5
4.8
96.0 3.0
91.5 6.7
93.8 5.3
1.0
1.8
1.0
54.5 16.3
54.7 19.8
64.3 22.0
29.2
25.5
13.8
93.6 5.4
85.7 11.9
82.3 14.5
1.0
2.5
3.3
19.3 29.7
24.6 16.8
30.0 19.8
51.0
58.6
50.3
12.4 42.6
43.7 23.7
52.3 33.0
45.0
32.6
14.8
p Value 0.0085
0.1370
Research
The challenge of vaccinating adults: attitudes and beliefs of the Canadian public and healthcare providers D M MacDougall,1,2 B A Halperin,1,3,4 D MacKinnon-Cameron,1 Li Li,1 S A McNeil,1,5 J M Langley,1,4,6 S A Halperin1,4,7
To cite: MacDougall DM, Halperin BA, MacKinnonCameron D, et al. The challenge of vaccinating adults: attitudes and beliefs of the Canadian public and healthcare providers. BMJ Open 2015;5:e009062. doi:10.1136/bmjopen-2015009062 ▸ Prepublication history for this paper is available online. To view these files please visit the journal online (http://dx.doi.org/10.1136/ bmjopen-2015-009062). Received 11 June 2015 Revised 25 August 2015 Accepted 3 September 2015
For numbered affiliations see end of article. Correspondence to Dr SA Halperin; scott. [email protected]
ABSTRACT Objectives: Vaccine coverage for recommended vaccines is low among adults. The objective of this study was to assess the knowledge, attitudes, beliefs and behaviours of adults and healthcare providers related to four vaccine-preventable diseases and vaccines (diphtheria-tetanus-pertussis, zoster, pneumococcus and influenza). Design: We undertook a survey and focus groups of Canadian adults and healthcare providers (doctors, nurses, pharmacists). A total of 4023 adults completed the survey and 62 participated in the focus groups; 1167 providers completed the survey and 45 participated in the focus groups. Results: Only 46.3% of adults thought they were up-to-date on their vaccines; 30% did not know. In contrast, 75.6% of providers reported being up-todate. Only 57.5% of adults thought it was important to receive all recommended vaccines (compared to 87.1–91.5% of providers). Positive attitudes towards vaccines paralleled concern about the burden of illness and confidence in the vaccines, with providers being more aware of disease burden and confident in vaccine effectiveness than the public. Between 55.0% and 59.7% of adults reported willingness to be vaccinated if recommended by their healthcare provider. However, such recommendations were variable; while 77.4% of the public reported being offered and 52.8% reported being recommended the influenza vaccine by their provider, only 10.8% were offered and 5.6% recommended pertussis vaccine. Barriers and facilitators to improved vaccine coverage in adults, such as trust-mistrust of health authorities, pharmaceutical companies and national recommendations, autonomy versus the public good and logistical issues (such as insufficient time and lack of vaccination status tracking), were identified by both the public and providers. Conclusions: Despite guidelines for adult vaccination, there are substantial gaps in knowledge and attitudes and beliefs among both the public and healthcare providers that lead to low vaccine coverage. A systematic approach that involves education, elimination of barriers and establishing and improving infrastructure for adult immunisation is required.
Strengths and limitations of this study ▪ Mixed methodology including survey and focus groups. ▪ Large national representative survey. ▪ Healthcare providers and the general public. ▪ Whether Canadian data are generalisable to other countries with different vaccine programmes. ▪ Self-reporting vaccine coverage status.
INTRODUCTION While universal immunisation of children is now part of routine global healthcare and has led to substantial reductions in vaccinepreventable diseases, immunisation of adults and control of infectious disease morbidity and mortality substantially lags behind.1–4 Several vaccines routinely given during childhood are recommended as boosters for adults such as tetanus-diphtheria-acellular pertussis vaccine, and other vaccines are specifically targeted to adults (eg, zoster vaccine, influenza vaccine.5–7 Multiple factors have been identified that influence immunisation uptake among adults including social influences, disease-related and vaccine-related factors, general attitudes toward health and vaccines, habit, awareness and knowledge, practical barriers and motivators, and altruism.8 Barriers to improved immunisation coverage in adults include misperceptions among the public and healthcare providers (HCPs) that vaccines are just for children and logistical issues related to vaccine delivery, including lack of vaccine-specific HCP visits, inability to determine immunisation status and lack of funding for adult vaccines and vaccine visits.9 Although strategies have been identified to meet the challenge of low vaccine coverage in adults,1 little progress has been achieved. In Canada, vaccine recommendations are made by the National Advisory Committee
MacDougall DM, et al. BMJ Open 2015;5:e009062. doi:10.1136/bmjopen-2015-009062
1
Open Access on Immunization (NACI); vaccine programmes, however, are implemented independently by each provincial/territorial government. Some vaccines, such as influenza vaccine, are provided free of charge in all provinces/territories; others, such as pertussis and pneumococcal vaccine are provided by some but not all jurisdictions and zoster vaccine is not provided by any jurisdiction. As the concept of an adult immunisation platform becomes increasingly part of public health planning,1 10 we sought to develop a better understanding of the knowledge, attitudes, beliefs and behaviours of HCPs providing care to adults in Canada and the general public. Specifically we explored general issues regarding adult immunisation and specific information related to four diseases and the associated vaccines recommended for routine use in adults (influenza, pertussis, pneumococcus, zoster). A geographically representative national survey and focus groups involving the general public and HCPs who vaccinate was undertaken. METHODS We used a mixed method, sequential, explanatory design consisting of quantitative data collection and analysis (survey) followed by qualitative data collection and analysis (focus groups); 11 12 details of the methodology have previously been published.13 Focus groups were chosen rather than interviews in order to get a concentrated set of observations over a short period of time. As well, interaction among participants increases their sense of cohesiveness and increases their willingness to explore and clarify individual and shared perspectives.14 Quantitative stage (survey) The survey was developed using the Awareness Adherence Model.15 The content validity of individual questions as well as the content validity of the entire questionnaire were evaluated by a panel of experts comprised of infectious diseases physicians. Each item was rated using a standard content validity index with a fourpoint ordinal rating scale, where 1 indicated irrelevance and 4 high relevance. Items that received a score of 3 or 4 were judged to have content validity. Items that did not achieve the required minimum agreement of experts were eliminated or revised. Test–retest reliability was assessed by having five healthcare providers complete the questionnaires at two different points in time. A correlation coefficient was calculated to compare the two sets of responses; a coefficient >0.70 was interpreted that the questionnaire responses were consistent. The survey was then piloted on a convenience sample of 299 of the 1250 attendees at the 2010 Canadian Immunization Conference held in Quebec City. The national public survey reported here was administered by Leger Marketing (Montreal, Quebec, Canada), which maintains email addresses for 350 000 Canadian adults who are representative of the Canadian general population for the purpose of participating in market and 2
other research. Sampling was based on regional representation across the country, age, gender and urban and rural residence. A subset of HCPs within this database was invited to participate in the HCP survey. Sampling was based on regional representation, age, gender, urban and rural practice, and specialty (general practice physicians, internal medicine specialists, nurses and pharmacists). Inclusion criteria were being in practice for a minimum of 3 years and responsibility for immunisation delivery to adults and/or patient consultation concerning vaccines in their province or territory. Participants received an email invitation to the survey outlining the purpose of the study, its voluntary nature and the time commitment involved. Consent to participate was implied by completion of the web-based survey. For the public survey, a sample size of 4000 adults was calculated to provide an acceptable precision by region (95% CI around the point estimate) of ±5%. For the HCP survey, a sample size of 500 family physicians and 400 pharmacists was calculated to provide a precision (95% CI around the point estimate) of ±5%; a sample size of 100 internal medicine specialists and 200 nurses was calculated to provide a precision of ±5–10% for each practitioner type. The first level of analysis comprised a review of the descriptive, summative statistics for trends in the data. The second level of analysis involved tests of association. Data were divided by public and by HCP profession ( physician, nurse and pharmacist) and locale ( province/territory). Continuous variables were presented by summary statistics (ie, mean and SE) and the categorical variables by frequency distributions (ie, frequency counts, percentages and their two-sided 95% exact binomial CIs). Differences in survey responses between groups were assessed using Fisher’s exact tests. For continuous variables, logistic regression was used. Associations between attitude questions, behavioural responses and demographics were estimated using ordinal logistic regression or Fisher’s exact tests. p Values 75% 109 (54.0) 469 (93.8) Number of years providing vaccines; 9.7 (7.3) 19.5 (8.9) mean (SD) Vaccines administered to adults/month None 13 (7.1) 5 (1.0) 1–5 61 (33.5) 46 (9.3) 6–10 38 (20.9) 101 (20.4) 11–20 32 (17.6) 165 (33.3) 21–50 26 (14.3) 131 (26.5) >50 12 (6.6) 47 (9.5) Highest level of education Not obtained Not obtained Elementary High school College University diploma University baccalaureate University masters University doctorate Prefer not to answer Do you think you are up to date on all your adult vaccinations? (%) Yes 83.7 78.0 No 11.9 16.6 Do not know 4.5 5.4
Internists
Pharmacists (n (%))
Canadian Public (n (%))
65 (5.6)
400 (34.3)
Not applicable
16 (24.6) 49 (75.4)
199 (49.8) 201 (50.3)
1771 (44.0) 2252 (56.0)
– 2 (3.1) 24 (36.9) 25 (38.5) 14 (21.5) – –
1 (0.3) 104 (26.0) 164 (41.0) 99 (24.8) 32 (8.0) – –
354 (8.8) 509 (12.7) 676 (16.8) 933 (23.2) 790 (19.6) 623 (15.5) 138 (3.4)
5 (7.7) 7 (10.8) 1 (1.5) 5 (7.7) 25 (38.5) 17 (26.2) 1 (1.5) 3 (4.6) – 1 (1.5)
53 (13.1) 45 (11.3) 19 (4.8) 17 (4.3) 125 (31.3) 82 (20.5) 23 (5.8) 22 (5.5) 2 (0.5) 12 (3.0)
504 (12.5) 403 (10.0) 251 (6.2) 253 (6.3) 1206 (30.0) 804 (20.0) 227 (5.6) 220 (5.5) 46 (1.1) 109 (2.7)
38 (58.5) 18 (27.7) 9 (13.8) – 56 (86.2) 15.9 (4.5)
219 (54.8) 125 (31.3) 53 (13.3) – 164 (41.0) 6.1 (7.5)
1691 (42.0) 1471 (36.6) 830 (20.6) 31 (0.8) Not applicable Not applicable Not applicable
3 (4.7) 19 (29.7) 17 (26.6) 14 (21.9) 6 (9.4) 5 (7.8) Not obtained
14 (4.2) 106 (32.1) 95 (28.8) 82 (24.8) 25 (7.6) 8 (2.4) Not obtained 18 (0.4) 964 (24.0) 1221 (30.4) 314 (7.8) 1038 (25.8) 355 (8.8) 83 (2.1) 30 (0.7)
69.2 20.0 10.8
69.5 18.8 11.8
1861 (46.3) 954 (23.7) 1208 (30.0)
HCP, healthcare provider.
4
MacDougall DM, et al. BMJ Open 2015;5:e009062. doi:10.1136/bmjopen-2015-009062
Open Access Table 2 Healthcare provider attitudes about adult immunisation Synopsis of statements
Agreement
It is important for adults to receive all recommended vaccines according to provincial guidelines
Strongly agree/agree Neither agree nor disagree Disagree/strongly disagree Strongly agree/agree Neither agree nor disagree Disagree/strongly disagree Strongly agree/agree Neither agree nor disagree Disagree/strongly disagree Strongly agree/agree Neither agree nor disagree Disagree/strongly disagree Strongly agree/agree Neither agree nor disagree Disagree/strongly disagree Strongly agree/agree Neither agree nor disagree Disagree/strongly disagree Strongly agree/agree Neither agree nor disagree Disagree/strongly disagree Strongly agree/agree Neither agree nor disagree Disagree/strongly disagree Strongly agree/agree Neither agree nor disagree Disagree/strongly disagree Strongly agree/agree Neither agree nor disagree Disagree/strongly disagree Strongly agree/agree Neither agree nor disagree Disagree/strongly disagree
Vaccines are more important for children than adults
Vaccines that are recommended for adults should be available free of charge
I do not have enough time to administer vaccines to adult patients
It is difficult to keep track of adult patients’ vaccine status
I think there should be a national electronic vaccine registry that keeps track of all the vaccines that I administer to my patients
It is important to inform adult patients about the benefits and risks of adult vaccinations
It is difficult to keep up with vaccination recommendations for adults
It is important to use patient encounters as an opportunity to ask about their vaccine status
I do not have adequate storage facilities to provide adult vaccines
I am not sufficiently reimbursed to make offering adult immunisation worthwhile
Nurses (%)
Physicians (%)
Pharmacists (%)
87.1 9.4
90.6 9.0
91.5 6.5
3.5
0.4
2.0
40.6 16.8
46.9 19.5
41.3 21.0
42.6
33.6
37.8
91.6 5.9
86.0 11.5
81.8 9.3
2.5
2.5
9.0
15.8 31.2
25.1 19.8
33.5 35.8
53.0
55.0
30.8
70.3 14.4
68.1 16.3
83.0 11.0
15.3
15.6
6.0
83.7 11.4
75.4 18.1
84.8 10.5
5.0
6.5
4.8
96.0 3.0
91.5 6.7
93.8 5.3
1.0
1.8
1.0
54.5 16.3
54.7 19.8
64.3 22.0
29.2
25.5
13.8
93.6 5.4
85.7 11.9
82.3 14.5
1.0
2.5
3.3
19.3 29.7
24.6 16.8
30.0 19.8
51.0
58.6
50.3
12.4 42.6
43.7 23.7
52.3 33.0
45.0
32.6
14.8
p Value 0.0085
0.1370
