Universal tetanus, diphtheria, acellular pertussis (Tdap) vaccination of adults: What Canadian health care providers know and need to know

Abstract

The tetanus, diphtheria, and acellular pertussis vaccine (Tdap) is recommended for all adults in both Canada and the United States. There are few data on the proportion of Canadian adults vaccinated with Tdap; however, anecdotal reports indicate that uptake is low. This study aimed to explore the knowledge, attitudes, beliefs, and behaviors of Canadian health care providers (HCPs) in an attempt to identify potential barriers and facilitators to Tdap uptake. HCPs were surveyed and a geographic and practice representative sample was obtained (N D1,167). In addition, 8 focus groups and 4 interviews were conducted nationwide. Results from the survey indicate that less than half (47.5%) of all respondents reported being immunized with Tdap themselves, while 58.5% routinely offer Tdap to their adult patients. Knowledge scores were relatively low (63.2% correct answers). The best predictor of following the adult Tdap immunization guidelines was awareness of and agreement with those recommendations. Respondents who were aware of the recommendations were more likely to think that Tdap is safe and effective, that their patients are at significant risk of getting pertussis, and to feel that they have sufficient information (p < 0.0001 for each statement). Focus group data supported the survey results and indicated that there are substantial gaps in knowledge of pertussis and Tdap among Canadian HCPs. Lack of public knowledge about adult immunization, lack of immunization registries, a costing differential between Td and Tdap, workload required to deliver the vaccine, and vaccine hesitancy were identified as barriers to compliance with the national recommendations for universal adult immunization, and suggestions were provided to better translate recommendations to front-line practitioners.

The challenge of vaccinating adults: attitudes and beliefs of the Canadian public and healthcare providers

“…We used a mixed method, sequential, explanatory design consisting of quantitative data collection and analysis (survey) followed by qualitative data collection and analysis (focus groups); 11 12 details of the methodology have previously been published. 13 Focus groups were chosen rather than interviews in order to get a concentrated set of observations over a short period of time. As well, interaction among participants increases their sense of cohesiveness and increases their willingness to explore and clarify individual and shared perspectives.…”

“…Thematic analysis was initiated concurrent with the first focus group as previously described. 13 Two research team members (DMM, KW) individually coded the data using the process of thematic analysis. Both read all transcripts to generate an initial set of codes and then collated according to similarities and related patterns as well as for differences, followed by combining and cataloguing similar patterns into subthemes (NUD*IST software version N9, Sage Publications Ltd, London, UK).…”

Routine immunization of adults by pharmacists: Attitudes and beliefs of the Canadian public and health care providers

“…Thematic analysis was initiated concurrent with the first focus group as previously described. 35,36 Transcripts were labeled and categorized by 2 investigators according to similarities and related patterns as well as for differences, followed by combining and cataloguing similar patterns into subthemes (NUD Ã IST software version N9, Sage Publications Ltd, London, UK).…”

Challenges in adult vaccination

“…This is associated with inconsistent or infrequent advice and recommendations by healthcare providers regarding the need and benefits of vaccination across all ages including the older adults [10,35], and a number of studies have identified uncertainty about vaccine effectiveness as a frequent reason for not recommending or accepting routine adult vaccination [36,62,79]. Other reasons for not recommending or providing adult vaccination include confusion or uncertainty regarding recommended schedules and a lower priority of adult vaccination within overall preventive measures [81].…”

“…Disparities in uptake exist, with some countries reporting lower vaccine coverage in ethnic minorities and in uninsured individuals, and this is typically accompanied by lower awareness in these populations, and also in differences in provider recommendations [10,25,35,37,81,82]. In older adults, living alone is also associated with lower uptake of influenza vaccination, suggesting a social dimension to the problem [83].…”