A qualitative study exploring healthcare providers’ and trainees’ barriers to COVID-19 and influenza vaccine uptake

Figures & data

Table 1. Participant characteristics and immunization status of healthcare providers and trainees who participated in one-on-one semi-structured interviews exploring barriers to vaccine uptake (n = 18).

Pseudonym	Gender	Primary profession	Immunization
			Influenza	COVID-19
Alejandra	Female	Medical Student	Yes	Yes; 3 doses
Claire	Female	Registered Nurse	Yes	Yes; 3 doses
Elisabeth	Female	Pharmacy Technician	Yes	Yes; 3 doses
Ellen	Female	Pharmacy Manager	Yes	Yes; 3 doses
Jade	Female	Medical Student	Yes	Yes; 3 doses
Jilo	Female	Nursing Student; Unit Clerk	Yes	Yes; 3 doses
Julian	Male	Medical Student	Yes	Yes; 3 doses
Katherine	Female	Nursing Student	Yes	Yes; 3 doses
Lindsay	Female	Undisclosed	Yes	Yes; 3 doses
Madeline	Female	Registered Nurse	Yes	Yes; 3 doses
Noelle	Female	Registered Dietitian	Yes	Yes; 3 doses
Rico	Male	Medical Student	Yes	Yes; 3 doses
Sayyid	Male	Medical Student	Yes	Yes; 3 doses
Selena	Female	Medical Student	Yes	Yes; 3 doses
Tony	Male	Medical Student	Yes	Yes; 3 doses
Victoria	Female	Registered Nurse	Yes	Yes; 3 doses
Wendy	Female	Medical Student	Yes	Yes; 3 doses
Xue	Female	Registered Nurse	No	Yes; 2 doses

Table

Domain or Category	Comments
Knowledge	Preferred channels; influence of mis/disinformation
Professional role and identity	Set of behaviours and personal qualities expressed in a social or work setting
Beliefs about capabilities	Confidence to carry out a set of behaviours
Beliefs about consequences	Exposure to or experience with COVID, including natural immunity; severity and susceptibility related to their individual factors
Product	Reputation, brand, and effectiveness; thoughts on boosters including within the context of variants; regulatory processes related to vaccine approval including pace of development; side effects, risk of vaccine, safety concerns; confidence in benefits; mRNA technology
Reinforcement	Increasing the probability of a response by demonstrating some stimulus-response relationship
Goals	Mental representations of outcomes or end states that an individual wants to achieve
Intentions	Conscious decision to perform a behaviour or a resolve to act in a certain way
Memory, attention, and decision processes	Retain information or focus selectively on the environment and choose between alternatives
Emotion	Complex affective factors which is experiential, behavioural, and physiological by which vaccine-related thoughts or events are processed
Behavioural regulation	Anything aimed at managing or changing objectively observed or measured actions
Environmental context and resources	Availability and ease of access on site
Social influence	Friends, family, colleagues, classmates, and significant other
Organizational factors	Goes beyond colleagues, and mentions work policies, provisions, etc.; pressure from workplace or educational institution
Cultural and societal factors	People from immigrant families, cultural beliefs, and familial norms
Policies	Impact of mandates, vaccine passports, did other mandates like travel play a role in decision?
Government and public health	Needs assessment on messaging and communication; preferred spokespersons; depth of information on efficacy and safety
Trust	Patient-provider trust; government-provider trust

Table

Theme	Domain or construct	Illustrative quote(s) on facilitators and barriers to vaccine uptake
Making informed health decisions with an added responsibility to protect oneself and patients	Knowledge	Rico: In the peak of when the vaccines were coming out, I was constantly browsing PubMed, NCBI and looking for papers with actual credible authors. Making sure that they've had past publications and trying to see whether or not I could actually validate the studies based on the way they were carried out. Selena: I actually love Twitter as well. There are a lot of good people on Twitter that – and not to say that I take what I read on Twitter as fact. I definitely like reading dialogues on Twitter. I think those have been really informative to get both sides. Real life experiences. Victoria: … misinformation, it's been a thing to manage, and I do wish we would have been given resources as nurses on how to deal with misinformation, how to deal with like commonly asked questions, and how to explain the vaccines [sic] mechanism action, and the easy way how to explain the reason you get boosters, or the reason you need two doses. The reasons why there's different vaccines in the country like Moderna, Pfizer mostly. I think we aren't being provided with enough resources … [It] would have been nice to see more action on misinformation because morally and personally it's just really discouraging to see those types of things. Jade: There are a lot of barriers that can prevent patients from being able to get the vaccine and one of the barriers I think is misinformation surrounding the vaccine and how difficult it is to get reliable information about the vaccine. Lindsay: It was the 60s and 70s where these influential vaccines were initiated, and we all got them as kids or you know, great majority of kids get them, and I have no problem with that. So, knowing that, you know, those six or seven we all get as kids eradicated horrible viruses gives me a bit more comfort in trusting science and getting whatever comes our way now.
	Professional role and identity	Katherine: As a future health care professional, I feel like I need to model that. I feel like people would judge me if I was providing this care to these people and I was not vaccinated myself. Wendy: Obviously, I'm pro-vaccine. I'm a medical student. Jade: There's definitely a social responsibility and a professional responsibility to get vaccinated, but I wouldn't say that that really influenced my decision because my views are so aligned with those responsibilities. They exist, but I don't think they influenced me too much.
	Beliefs about consequences	Sayyid: I think by getting vaccinated for both influenza and COVID, I hope that I'm doing my best to protect these people [even] if I don't know them, but especially as a healthcare professional, you know? When I work in a hospital or clinic, I see these people. We're in the same room … breathing … we're in the same space. And so I think it's really important to consider these people and say, ‘Yes, I'm protecting myself, but the bigger reason is I'm protecting the people around me,’ which is so so important. Because we have to look out for each other I think as a community and the healthcare system.
	Emotions	Alejandra: … I was super happy after getting all my vaccines. I just felt really positive. Tony: I think that when you want to decide to get a vaccination, that is a long-term decision that you are making about your own body. You're putting something that can have effects on you, and you need to study that, and I think that your decision shouldn't be related to your mood. That's just my own opinion. Sayyid: I try not to let emotions get in the way of logical thought. Claire: I do feel sketchy about what I gave to my body. I do and I did feel that way, even receiving the vaccines and the long-term effects of it because as much as they say Oh, they have been studied. There's no possible way the long-term effects have been studied with it being around for such a short period of time.
A pro-vaccine social network, widespread accessibility, and pursuing a sense of normalcy	Social influences	Xue: My husband I guess was the biggest influencer on me. Noelle: I remember speaking to a couple of my friends were nurses and they sent me links to study on it. Sayyid: My roommate (a medical student, confirmed earlier in the interview) actually does a lot of research on COVID – not for work, but because he finds it fascinating. When we have dinner or we meet up during the day, he tells me something he learned today from the vaccine, and so that helped improve my knowledge.
	Societal and cultural norms	Claire: I feel if I wasn't vaccinated, I would feel like a black sheep. Like I said, the two colleagues that I do know that were unvaccinated struggled heavily with mental health and feeling ostracized and people looked at them differently. Elisabeth: I just want this to be over. Like, I want to stop opening up the news everyday it's like ‘COVID article, COVID article, COVID this, COVID that.’ The whole reason that the majority of people get vaccinated, like, let's get most people vaccinated, is so that we can stop talking about this, you know? So that it can become like the flu where it's not a big deal. Every year, we just get our shot and move on and stop talking about [it].
	Environment, organizational context, and resources	Jilo: For the first one, it was a little bit more stressful and frustrating to deal with that provincial website. Wendy: I was one of the earlier ones who got – who was eligible for the first dose – and through my school it was pretty easy to book. So I mean, they did it at my school. It was right across the street from me, so it was pretty easy. Yeah, I had no problems booking it. Wendy: Now, I'm more inclined to get the flu shot because I'd be around a lot more people and people who are immunocompromised especially in the hospital. So yeah, I’d say it definitely changed my perspective a little bit. Julian: I'm sure you heard about, you know, those nurses and other physicians that were no longer allowed to come into hospitals and whatnot once policies changed for COVID-19. And same thing with the flu. It's also mandatory for us to go and do that. Ellen: When we were first getting it and there was no online booking system in place for the first three hours of the day, our phones would ring nonstop, and we had five lines and every single line would be ringing with people trying to call and make an appointment and we were never in control of how many vaccines we got. It was the Ministry [of Health] sent us what they felt like we should have.
Seeking a more nuanced, respectful, and calculated approach to vaccine communication and policy implementation	Skepticism of pharmaceutical companies	Ellen: … we kind of knew it wasn't effective against the current (Omicron) variant of COVID-19. Personally, I didn't really see a point in getting a third dose of something that wasn't really doing much. But I was also influenced by the fact that I already had COVID a year ago. So between having the virus and then also getting the vaccine, that was the only time I really questioned like, What's the point of doing this third dose if it's minimally effective? Madeline: Whenever people ask me questions like, Oh, how do you know this is safe? I always give the example [of] things we put in our body that we absolutely have no idea, and we still do it. One example I always give is, I used to be on birth control, and I think it's still not very well understood and something I had gone off later on down the road just because of how much it was affecting me. Xue: I would rather not get a vaccine unless I absolutely had to. And I feel that way about everything, like medication in general. So unless it was absolutely necessary, or I found it absolutely necessary, I would rather avoid putting something like that into my body.
	Government and public health	Selena: It's required for school, it's required for travel, and things like that might be looked at as incentives. Personally, those were just bonuses for me. I think I would have, whether it was required for anything or not, I would have gotten it. Claire: Communication was incredibly poor throughout it all. It's so great … back and forth, back and forth. Going into work and new rules each day, each week. And then us having to relate this back to our patients and families. It was a very great time of trying to figure out what is going on and I do appreciate that it was like that for everybody. This isn't just a single personal experience. But could it have been better handled? Yes. Do I know how? No. Elisabeth: Every once in a while, you get someone still coming in just now for their first [COVID-19 vaccine dose] and they're angry like they're not happy about it. And I've had people sit in that counselling room with me just complaining. Like, while I sit there, just angry about being supposedly forced into getting the vaccine and for whatever reason the government or the workplace or to go to restaurants, and they're not happy about it. Sayyid: [Ottawa Public Health's] website does a really great job of disseminating [sic] myths about the vaccine and COVID. I follow them on Twitter, and they do a fantastic job of kind of just like, if they hear something that was misinformation, they post on Twitter and they explain why it's factually incorrect. Or they'll do something and then amplify [that message] and say, ‘Oh, look, we have COVID vaccines available here. Here are the ones you have available. Here's the evidence behind it.’

Data availability statement

Participants did not provide consent for their data to be made publicly available. However, we will supply the relevant code files in the appendix. Output files derived from the analyses can be provided upon request.

Acknowledgements

The authors would like to thank the participants who generously gave their time to share their experiences for this study. We would also like to thank the Canadian Public Health Association and Melissa Wong for their in-kind assistance with participant recruitment.