Challenges facing vaccinators in the 21^stcentury: results from a focus group qualitative study

Abstract

Introduction: Barriers to vaccination and the important role of healthcare professionals (HCPs) in influencing immunization decisions made by parents/patients have been well documented. Little information describes challenges that HCPs face in carrying out their role as vaccinators.Methods: We conducted a focus group study asking HCPs to describe their expectations as frontline vaccinators versus the day-to-day reality they faced. Participants described challenges impacting their ability and motivation as vaccinators, and proposed key solutions to the most important challenges. A total of 75 nurses and physicians (sixteen groups of frontline vaccinators) from the United Kingdom, United States, Germany and India participated in 2 hour focus-group discussions.Results: There was disconnect between how participants viewed their role in preserving population health when they started their career, and the reality of real-world practice today. Challenges experienced and reflected were similar across professional groups and countries. Low patient-level vaccine knowledge, patient miseducation, untimely vaccine information, frequently changing vaccine schedules, time pressures, lack of centralized record systems, pressure to achieve vaccination targets, and in some instances vaccine costs, all impacted the efficiency and enthusiasm of HCPs. Identified solutions by the same providers included improving patient-level information, equipping HCPs with effective information, and practical ways to reduce the vaccination burden by improved administrative processes and centralized recording coupled with delegating vaccinator roles.Conclusion: This focus group gives unique insights into needs of HCPs to fulfill their role as vaccinators. Supporting and equipping vaccinators is critical to the continuing success of vaccination programs and the proposed life-course immunization strategy. (Supplementary Appendix 1)

Health Care Professionals’ Perspectives on Life-Course Immunization: A Qualitative Survey from a European Conference

“…Overall, this survey shows the need for all stakeholders involved in the process of vaccination to work together to ensure that people may have long and healthy lives through LCI. This is in line with previous publications which recommend a multi-disciplinary approach involving all relevant stakeholders to ensure the successful implementation of LCI [11,12]. As an example, a similar cooperative approach achieved success in Italy, where a multi-disciplinary partnership of medical scientific societies representing public health, primary care and pediatrics successfully collaborated to produce three consecutive editions of the "Lifetime Immunization Schedule" [23].…”

“…Individual and focus group responses were analyzed following narrative analysis principles. Uncertainty surrounding current immunization guidelines, cost of vaccines, recurring vaccine stock shortages and misinformation about vaccines were all highlighted as challenges for the frontline HCPs [11]. These results emphasize the need to support vaccinators in their role to ensure that they can continue delivering on the success of vaccination programs and integrate the LCI strategy.…”

“…However, the reasons why practitioners often fail to deliver on their apparent enthusiasm for the importance of LCI was not captured through this survey but is potentially valuable in understanding the barriers related to LCI. This was part of our previous related work in which we conducted a focus group study asking HCPs to describe their expectations as frontline vaccinators versus the day-to-day reality they faced [11]. Participants from the focus group described challenges impacting their role as vaccinators and proposed key solutions to these challenges.…”

“…Participants from the focus group described challenges impacting their role as vaccinators and proposed key solutions to these challenges. Sixteen groups of HCPs from the US, Germany, UK and India, comprising a total of 75 nurse and physician vaccinators, participated in individual and focus group discussions in 2018 [11]. Individual and focus group responses were analyzed following narrative analysis principles.…”

“…Considering this situation, experts and institutions recommend extending the vaccine prevention strategy to a "life-course" approach that places emphasis on the need for vaccination against vaccine-preventable diseases through all stages of an individual's lifespan [11]. This vaccination strategy is called life-course immunization (LCI) [12,13].…”