A complex intervention on vaccination uptake among older adults (≥ 60 years) in Germany - a study protocol with a mixed methods design

BACKGROUND

The current uptake of many vaccinations recommended for persons aged 60 and older is unsatisfactory in Germany. Lack of confidence in the safety and efficacy of vaccinations, lack of knowledge and insecurities about possible side effects, and numerous pragmatic barriers are just some of the reasons to be mentioned. General practitioners (GPs) play a central role in the vaccination process. Therefore, effective interventions in this context are needed to address the various barriers and improve the vaccination uptake rates.

METHODS

A complex intervention will be implemented and evaluated in 1057 GPs' practices in two German federal states. The components include trainings for GPs and medical assistants on communication psychology, medical aspects, and organisational vaccination processes. The primary outcome influenza vaccination rate and the secondary outcomes vaccination uptake rate of other vaccinations as well as vaccine literacy of patients will be examined. The intervention will be evaluated in a mixed methods study with a controlled design. Survey data will be analysed descriptively and by using mean comparisons as well as multivariable multilevel analyses. The qualitative data will be analysed with qualitative content analysis. The secondary data will be analysed by using descriptive statistics, a pre-post comparison by performing mean comparisons, cluster analysis, and subgroup analyses.

DISCUSSION

In this study, a complex intervention to improve vaccination rates in GP practices for the vaccinations recommended for people aged 60 years and older will be implemented and evaluated. Additionally, improvements in patients' vaccine-related health literacy and knowledge, and patients' intention to get vaccinated are expected. The mixed methods design can deliver results that can be used to improve preventive health care for elderly people and to gain more knowledge on vaccination uptake and the intervention's effectiveness.

TRIAL REGISTRATION

Trial registration number: DRKS00027252 (retrospectively registered).

Decreasing vaccine hesitancy with extended health knowledge: Evidence from a longitudinal randomized controlled trial

This study assesses whether combining information about diseases and sequelae supports learning about disease risks and influences related health behavior (vaccination).

OBJECTIVE

To test whether extending knowledge about the risks of primary diseases (e.g., influenza) with causally linked secondary diseases (sequelae such as sepsis) can decrease vaccine hesitancy in older adults, who are especially vulnerable to primary and secondary diseases.

METHOD

In a preregistered longitudinal online experiment, 585 German participants > 60 years of age were randomly assigned to a 3 (time: before and after leaflet presentation, 3-month follow-up; within) × 3 (educational leaflet type: sepsis leaflet, traditional vaccination leaflet, and control leaflet; between) mixed-measurements design. The assessed outcomes were knowledge about influenza, pneumococci, and sepsis; risk perceptions; and immediate and long-term vaccination intention and behavior for pneumococcal and influenza vaccinations.

RESULTS

The sepsis leaflet immediately increased the knowledge about influenza (effect size, η² = .080), pneumococci (η² = .071) and sepsis (η² = .113), risk perceptions (η² = .007), and intentions for both vaccinations (both η² = .015). Behavior during the follow-up did not differ between the conditions. Additional mediation analysis showed that increased knowledge immediately after the experiment predicted increased risk perceptions and intentions 3 months later (b_influenza = .060; b_pneumococci = .055).

CONCLUSION

Because immediate increases in knowledge and risk perceptions did not change behavior in the long term, extended knowledge interventions might be more effective in locations where positive intention can directly turn into action, such as doctors' clinics. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Sample study protocol for adapting and translating the 5C scale to assess the psychological antecedents of vaccination

INTRODUCTION

Published in 2018, the 5C scale is psychometrically validated to assess five psychological antecedents of vaccination (confidence, complacency, constraints, calculation and collective responsibility). The original version offers a validated English and German scale to assess these determinants with a short 5-item scale (1 item per antecedent) and a long 15-item scale (3 items per antecedent). This sample study protocol provides a step-by-step guidance for the process of adapting the 5C scale to another country, language or cultural context. Data obtained from the 5C scale can support developing, implementing and evaluating an intervention and monitoring of general vaccine acceptance and demand.

METHODS AND ANALYSIS

Phase 1 comprises the adaptation of the 5C scale including the translation and back translation of the antecedents, an expert evaluation of the antecedents and the identification of new antecedents as well as a pretest. Phase 2 involves the validation of the translated and potentially expanded scale including the assessment of reliability, construct and concurrent validity of all items of the scale. Code for data analysis is provided.

ETHICS AND DISSEMINATION

The University of Erfurt's institutional review board provided ethical clearance (EV-201900416.2). The authors suggest and encourage publicly sharing all data obtained from the translated 5C scale (eg, on publication). The materials and the code for data analysis to support the process described in this protocol are available in https://osf.io/2agxe/. Sharing data on vaccine acceptance and demand is in the public and the scientific interest and will facilitate gaining a global overview of its current state and development over time. The authors of the original 5C scale are currently working on an online platform to facilitate publishing the data and to visualise the psychological antecedents across different countries.

Using attachment and relational perspectives to understand adaptation and resilience among immigrant and refugee youth

Migration is a critical issue for child development in the 21st century. We expand on García Coll et al.'s (1996) integrative model of minority child development by drawing from principles of attachment theory and interpersonal relationships research to offer new insights into how youth manage and respond to migration experiences. Immigrant and refugee youth should experience better outcomes to the extent that they (a) maintain strong relationships with caregivers and peers who provide a sense of closeness, safety, and confidence during the process of adjusting to this life transition and (b) find ways to establish a sense of connection and belonging to the new people, places, communities, and social networks within which they now live. Strong bonds to people and connection to places (both familiar and new) can counter the social stratification consequences to minority youth development that are well articulated in García Coll et al.'s integrative model. The need for new and better strategies that promote the positive development of immigrant and refugee youth within their families, schools, workplaces, and communities is crucial, not only for individuals and families but for society as a whole. (PsycINFO Database Record

[Psychological antecedents of vaccination: definitions, measurement, and interventions]

Vaccinations are among the safest and most effective ways to prevent morbidity and mortality from severe infectious diseases - both on an individual and societal level. Despite the availability of safe and effective vaccines some people decide against vaccination, which leads to recurrent outbreaks of vaccine-preventable diseases. In order to achieve the common goals of eliminating certain infectious diseases and to protect individual health, it is necessary to understand the antecedents of (non-)vaccination.The 5C model describes five relevant psychological antecedents of vaccination: confidence, complacency (risk perceptions), constraints (barriers), calculation (extent of information search), and collective responsibility (willingness to protect the community). This contribution provides an overview of how these antecedents can be measured on an individual level and how interventions should be designed and evaluated to address the respective antecedents.Data from Germany show that structural changes to reduce practical barriers are important to improve vaccine uptake. Thus, it is also important to address aspects beyond confidence.

Beyond confidence: Development of a measure assessing the 5C psychological antecedents of vaccination

BACKGROUND

Monitoring the reasons why a considerable number of people do not receive recommended vaccinations allows identification of important trends over time, and designing and evaluating strategies to address vaccine hesitancy and increase vaccine uptake. Existing validated measures assessing vaccine hesitancy focus primarily on confidence in vaccines and the system that delivers them. However, empirical and theoretical work has stated that complacency (not perceiving diseases as high risk), constraints (structural and psychological barriers), calculation (engagement in extensive information searching), and aspects pertaining to collective responsibility (willingness to protect others) also play a role in explaining vaccination behavior. The objective was therefore to develop a validated measure of these 5C psychological antecedents of vaccination.

METHODS AND FINDINGS

Three cross-sectional studies were conducted. Study 1 uses factor analysis to develop an initial scale and assesses the sub-scales' convergent, discriminant, and concurrent validity (N = 1,445, two German convenience-samples). In Study 2, a sample representative regarding age and gender for the German population (N = 1,003) completed the measure for vaccination in general and for specific vaccinations to assess the potential need for a vaccine-specific wording of items. Study 3 compared the novel scale's performance with six existing measures of vaccine hesitancy (N = 350, US convenience-sample). As an outcome, a long (15-item) and short (5-item) 5C scale were developed as reliable and valid indicators of confidence, complacency, constraints, calculation, and collective responsibility. The 5C sub-scales correlated with relevant psychological concepts, such as attitude (confidence), perceived personal health status and invulnerability (complacency), self-control (constraints), preference for deliberation (calculation), and communal orientation (collective responsibility), among others. The new scale provided similar results when formulated in a general vs. vaccine-specific way (Study 2). In a comparison of seven measures the 5C scale was constantly among the scales that explained the highest amounts of variance in analyses predicting single vaccinations (between 20% and 40%; Study 3). The present studies are limited to the concurrent validity of the scales.

CONCLUSIONS

The 5C scale provides a novel tool to monitor psychological antecedents of vaccination and facilitates diagnosis, intervention design and evaluation. Its short version is suitable for field settings and regular global monitoring of relevant antecedents of vaccination.