title: The challenge of vaccinating adults: attitudes and beliefs of the Canadian public and healthcare providers.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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-to-date. 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.
authors.affiliation: Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Nova Scotia, Canada School of Nursing, St. Francis Xavier University, Nova Scotia, Canada.
authors.forename: D M
authors.initials: DM
authors.lastname: MacDougall
authors.affiliation: Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Nova Scotia, Canada School of Nursing, Dalhousie University, Nova Scotia, Canada Department of Pediatrics, Dalhousie University, Nova Scotia, Canada.
authors.forename: B A
authors.initials: BA
authors.lastname: Halperin
authors.affiliation: Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Nova Scotia, Canada.
authors.forename: D
authors.initials: D
authors.lastname: MacKinnon-Cameron
authors.affiliation: Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Nova Scotia, Canada.
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.affiliation: Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Nova Scotia, Canada Department of Medicine, Dalhousie University, Nova Scotia, Canada.
authors.forename: S A
authors.initials: SA
authors.lastname: McNeil
authors.affiliation: Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Nova Scotia, Canada Department of Pediatrics, Dalhousie University, Nova Scotia, Canada Department of Community Health and Epidemiology, Dalhousie University, Nova Scotia, Canada.
authors.forename: J M
authors.initials: JM
authors.lastname: Langley
authors.affiliation: Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Nova Scotia, Canada Department of Pediatrics, Dalhousie University, Nova Scotia, Canada Department of Microbiology & Immunology, Dalhousie University, Nova Scotia, Canada.
authors.forename: S A
authors.initials: SA
authors.lastname: Halperin
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002170:Canada; D015721:Diphtheria-Tetanus-Pertussis Vaccine; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D022283:Herpesvirus Vaccines; D006801:Humans; D007252:Influenza Vaccines; D008297:Male; D008875:Middle Aged; D022242:Pneumococcal Vaccines; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000523:psychology*; D055815:Young Adult
chemical_list: D015721:Diphtheria-Tetanus-Pertussis Vaccine; D022283:Herpesvirus Vaccines; D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines
keywords: PUBLIC HEALTH