Vaccine attitudes among young adults in Asia: a systematic review

Figures & data

Figure 1. Terms used in literature search

Figure 2. Flow chart of study selection for systematic review

Table 1. Number of included studies by country/area and vaccine

	HPV vaccine	Hepatitis B vaccine	Seasonal influenza vaccine/H1N1 Influenza vaccine	Measles vaccine	Cholera vaccine	Rubella vaccine	Pertussis vaccine	Multiple vaccines	Total
mainland China	8	5	4/1					1	19
Hong Kong	5		4/1						10
Korea	3		5	1					9
Malaysia	4								4
Japan	1		4/1	1				1	8
Singapore	2								2
Vietnam	1					1			2
India	1		1/1						3
Pakistan			2				1		3
Bangladesh					2				2
Nepal	1	1							2
Taiwan	1		/1						2
Thailand	1		1						2
Total	28	6	21/5	2	2	1	1	2	68

Figure 3. Participants’ intention for receiving HPV vaccine in relevant included studies

Figure 4. Participants’ influenza vaccine coverage in relevant included studies

Table 2. Factors(promoters/P or barriers/B) relevant with HPV vaccine attitude

SAGE Model Level	Factors relevant with HPV vaccine attitude	Number of included studies	Examples
Contextual influences	Age	2	E.g., Age group 20 ~ 35 years (P)
	Level of education	2	E.g., Education level above junior school (P)
	Religion/Culture/Gender	6	E.g., Hindus religionand Dalit caste more willing to be vaccinated than other religions and other castes, respectively (P) Embarrassment of discussing sexual activity/HPV/related vaccines (B)
	Income	3	E.g., Amount of income were positively related to intention to be vaccinated (P)
	Marital status	1	E.g., Celibacy (P)
	Family decision making	2	E.g., Lack of parental support(B)
	Access to vaccination	1	E.g., Inconvenience of getting the vaccination(B)
	Characteristics of the work/study orgnization	2	E.g., Being from a key university (P) Students on health-related courses (P)
	Information provision	5	E.g., Inadequate information (B) “school should provide more information” was identified as one of independent significant factors for initiation of vaccination (action and intention). Insufficient information from primary-care doctors (B)
Individual/social influences	Awareness/knowledge of HPV/HPV vaccine/HPV related diseases	6	E.g., Having the knowledge of “condoms cannot fully prevent the transmission of HPV” (P)
	Perceived disease susceptibility	6
	Perceived disease severity	3
	Perceived vaccine benefits	6
	Perceived vaccine safety	3
	Sex behavior/experiences	10	E.g., “Ever had sex” (P), “engaging mostly in receptive anal sex “ (P) and “never using a condom in anal sex in the past 6 months”among MSM (P), “commercial sex with women” (P), “sexually active at an early age” (P), “multiple sex partners” (P),”being low risk due to an absence of sexual contact” (B)
	Recommendations from significant others	2	E.g., “Recommendations from significant others” was identified as one of predictors of HPV vaccination intention(P) lack of positive discussion among peers (B)
	Sex parterners’ approval	1
	Experience with past vaccination	1	E.g., with vaccination experience outside the National Expanded Program on Immunization (P)
	Family/individual history of related diseases	1	“Family history of gynecologic cancer”, and “personal history of gynecological visit”(P) ever receiving HIV related services (P)
Vaccine and vaccination-specific influences	Characteristics of the vaccine	3	E.g., Perceived embarrassment at receiving an STI vaccine (B)
	Vaccine cost	8	B

Table 3. Factors (promoters/P or barriers/B) relevant with participants’ attitude toward influenza vaccine

Factors(promoters/P or barriers/B)	Number of included studies, examples
	General population	Healthcare workers	Pregnant women
Contextual influences
Age	2, e.g., aged 30–49 (B)		1, e.g., aged < 25 years (B)
Level of education	3, e.g., People with low-levle education have a higher vaccination rate (B) People with high-level education (P)		1, e.g., the odds of receiving vaccine were 4.01 times higher for master’s than undergraduate students. (P)
Religion/Culture/Gender	2, Female(B) (P)
Policy	1, e.g., vaccination for free (P)	1, e.g., not compulsory for health care professionals to receive influenza vaccine (B)
Amount of income	2, (P)
Access to vaccination		1, don’t know where to get it (B)	1, e.g., poor knowledge about availability of vaccine (B)
Characteristics of the work/study organization	2, e.g., Participants from school of Bio-sciences and Bio-technology (P) participants with physical jobs(P)	1, e.g., working in surgical department (P)
Information provision	2, e.g., receiving a notice from a public health organization (P)
Willing to pay at a higher price	1, (P)
Family composition	2, Number of children in a family(B)
Media campaign	1
Individual/social influences
Awareness/knowledge of influenza/influenza vaccine	3, e.g., having the knowledge that influenza vaccine is required annually, or wanted to avoid becoming infected with influenza virus (P)
Perceived disease susceptibility	5, e.g., worried about a possible new pandemic (P)		5, e.g., feeling healthy and thinking it is unnecessary(B)
Perceived disease severity	3		2
Perceived vaccine benefits	2	1	2
Perceived vaccine side effects	2	1	1, e.g., fearing harm to the baby(B)
Perceived vaccine safty			1
Recommendations from significant others	2, e.g., recommendations from HCW or family members (P)		2, lack of recommendation from health care providers (B)
Experience with past vaccination	5, e.g., vaccinated in the previous year (P)		1, e.g., having had influenza vaccine at least once (P)
Family/individual history of related diseases/childbirth	1, e.g., with underlying diseases (B)		1, experience of childbirth(P)
Health behavior	1, receiving a health checkup (P), smoking or drinking (B)
No time to receive vaccine	1(B)
Needle fear	1(B)	1
High levels of cues to action			1, (P)
Vaccine and vaccination-specific influences
characteristics of the vaccine	1, e.g., Do not to be an experimental animals (B)
vaccine cost	2