Infectious diseases are a major cause of illness and death among older adults. Vaccines can prevent some of these diseases but the uptake of vaccination among older adults varies across settings and groups. Communication with their healthcare worker can help older people makes decisions about vaccination and this is explored in the July 2021 Cochrane qualitative evidence synthesis of healthcare workers’ perceptions and experiences of communicating with people over 50 about vaccination. In this podcast, two authors of this synthesis, Simon Lewin from the Norwegian Institute of Public Health and the Norwegian University of Science and Technology, and Claire Glenton from the Western Norway University of Applied Sciences, discuss why they did the review and what they found.
Mike: Hello, I'm Mike Clarke, podcast editor for the Cochrane Library. Infectious diseases are a major cause of illness and death among older adults. Vaccines can prevent some of these diseases but the uptake of vaccination among older adults varies across settings and groups. Communication with their healthcare worker can help older people makes decisions about vaccination and this is explored in the July 2021 Cochrane qualitative evidence synthesis of healthcare workers’ perceptions and experiences of communicating with people over 50 about vaccination. In this podcast, two authors of this synthesis, Simon Lewin from the Norwegian Institute of Public Health and the Norwegian University of Science and Technology, and Claire Glenton from the Western Norway University of Applied Sciences, discuss why they did the review and what they found.
Simon: Hello Claire, first of all, could you explain why healthcare workers’ perceptions and experiences of communicating with older adults about vaccination are important?
Claire: Hello Simon. Yes, let’s start there . Several vaccines are available to older adults, including for seasonal influenza, pneumococcal diseases and COVID‐19. But we know that older adults don’t always use the vaccines available to them.
Healthcare workers, such as general practitioners and primary care nurses, can play an important role in helping older people make decisions about vaccines, so it’s important that they have good communication skills. In this review, we explored healthcare workers’ perceptions and experiences about vaccine communication. This information can help us train and support healthcare workers and design good communication strategies, which brings us to what we found.
Simon: Thanks. We included 11 qualitative studies. These were published between 2007 and 2019, before the COVID-19 pandemic. The studies focused on doctors, nurses, pharmacists and others working in hospitals, clinics, pharmacies and nursing homes. These studies discussed different types of vaccines and all were from high‐income countries. We paid attention to this when grading our confidence in the findings.
Claire: Yes, we downgraded our confidence in several of the findings. One reason for this was that the findings were based on studies from only a few countries and we were unsure about the relevance of these findings to other settings. Another reason for downgrading was that some findings were based on only small amounts of data.
Simon: Yes, and I can add that we had moderate to high confidence in several of the findings. For instance, one high confidence finding was that healthcare workers reported that older adults asked about vaccination to different extents. This ranged from not asking about vaccines at all, to great demand for information. Also, we have moderate confidence in the finding that when vaccination was discussed, healthcare workers described older adults as having a lack of information and fears and concerns about vaccines among older adults. Misinformation was also present.
Claire: Another moderate confidence finding concerned the ways in which healthcare workers discussed vaccines with older adults. Different healthcare workers had different views about the aim of vaccination communication, and about their own roles and the roles of older adults in decisions about vaccines. Some healthcare workers thought it was important to provide information but they emphasised that older adults’ had the right and the responsibility to decide for themselves. A second group of healthcare workers used information to persuade and convince older adults to vaccinate. These healthcare workers wanted to increase 'compliance' with health advice and 'improve' vaccination rates. And in some cases they also wanted to gain financial benefits by increasing vaccination rates. And finally a third group of healthcare workers tailored their approach to what they believed the older adult needed or wanted.
Simon: Yes. And we also found that healthcare workers believed that older adults' decisions could be influenced by several factors. These included the nature of the relationship between workers and patients; the healthcare worker's status; and the extent to which they led by example. This was a low confidence finding.
In addition, we identified factors that are likely to influence how communication takes place. These included issues tied to healthcare workers' views and experiences regarding the diseases in question and the vaccines. Also important were healthcare workers’ views and experiences of the organisational and practical implementation of vaccine services.
So, Claire, how can this be taken further?
Claire: We used our findings to develop some questions that we hope can help planners and programme managers plan or implement strategies for vaccination communication between healthcare workers and older adults. These are available in the review.
Simon: Thanks. To finish, listeners can find the open access full review and a user-friendly summary if they go to CochraneLibrary.com and type “communicating with people over 50” in the search box.