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Table 3 Reasons for vaccine acceptance or refusal among elderly adults

From: Social determinants of health and seasonal influenza vaccination in adults ≥65 years: a systematic review of qualitative and quantitative data

Reasons for acceptance Reasons for refusal
Personal facilitators Personal barriers
Positive attitude to prevention. Desire to avoid flu Not knowledgeable about flu or severity of flu
Recommended by physician or nurse, by mail, or personally Low educational attainment, low health-related printed literacy
Recommended by friend or relative Misconceptions about immunization in adults
Being knowledgeable about the severity of the flu Perception of low susceptibility to the disease due to good health status: “Not likely to contract influenza”
Having “not very good health” Lack of knowledge about indications of influenza vaccine in general or for himself
Having a chronic condition that puts them at higher risk for getting the flu Unjustified medical reasons (allergy to drugs, chronic illness)
Having had a job that puts them at a higher risk for getting the flu Lack of interest, forgot to get it, never considered it before
Positive prior experiences with the vaccine or only mild side effects Anecdotes or prior negative experiences with the vaccine
Benefits of the flu shot Concerns or fears about risks of the flu shot
Prevention Side effects, pain, fear of injections
Decreases symptom severity of the flu Fear of undisclosed shot contents
Greater ability to do day-to-day activities Misconception of getting influenza from the vaccine
“Do not pass influenza to my family and friends” Disbelief in vaccine efficacy
Perceived consequences: thought that unvaccinated persons would probably contract influenza Previous bad reactions and past problems with flu shot batches
Free vaccine: Social Security pays for it Accessibility problems: transport, distance, convenience, unable to attend because ill health, language
Getting older Cost: patient unable to afford the shot. Lack of knowledge about insurance coverage
Structural facilitators Structural barriers
Physician’s recommendation/reminder to get the shot Word of mouth from the community to not get a flu shot
Visits to the physician Irregular or lack of preventive healthcare
Word-of-mouth from the community to get a flu shot Doctor did not recommended the vaccine, missed opportunities
Written or visual media promoting flu shot use Lack of access
Vaccine is free or low cost Regarding vaccine shortage
Type of physician Regarding location access