Exploring the attitudes and practices of adult service users and providers towards vaccination in non-primary care settings: A mixed methods scoping review.

BACKGROUND: There are several identified service user and provider barriers which lead to missed vaccination opportunities for adults within primary care. Programs delivering vaccination in non-primary care settings, such as in emergency departments, hospitals, specialist clinic and non-medical settings may assist in filling these gaps, especially among under-served populations. While expanding the locations in which vaccines are provided may improve uptake, there is a need to explore service user and provider attitudes towards delivery. OBJECTIVES: This scoping review aims to explore perceptions and attitudes of adult service users and providers towards receiving and delivering vaccination in non-primary care settings and identify how attitudes relate to determinants of vaccine compliance. METHODS: This scoping review was conducted in accordance with Joanna Briggs Institute (JBI) guidance for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Studies that focused on attitudes and perceptions of adult service users and providers towards the delivery of influenza, COVID-19, pneumococcal, and herpes zoster vaccines in non-primary care settings were included. Primary, peer-reviewed studies published in English from 01/01/2010 to 31/12/2023 were sought. Studies that focused on vaccination in primary care settings, the operational delivery of vaccination programs and interventions, children or adolescents less than 18 years, pregnant women, and healthcare workers receiving vaccination for occupational purposes were excluded. RESULTS: 30 studies were included for final analysis in this study. 22 were cross-sectional studies, and 19 were published in the United States. 15 studies were conducted in non-medical settings and 11 in the emergency department. Findings showed that service users were receptive towards vaccination in non-primary care settings and were especially motivated by the convenience of non-medical settings such as workplaces, mobile clinics, drive through clinics, and faith-based organisations. A number of service user barriers were reported to vaccine acceptance, including low confidence in vaccines, fear of adverse effects, and low risk perception of infection. Findings of the included studies highlight a number of provider attitudinal barriers to the delivery of vaccinations outside of primary care, such as considering the process too time-consuming, costly, and detracting from the purpose of their work, although the number of studies assessing provider attitudes were limited. CONCLUSION: Overall, there is a limited amount of evidence available regarding the attitudes to vaccination in non-primary care settings, especially among providers. There is a need for more study in this area to strengthen understanding of attitudes towards vaccination delivery in these settings. Mapping of available studies suggests there is a high acceptance level among service users towards vaccination in non-primary care settings, especially those in non-medical settings who lack routine access to the healthcare system. Further exploration of this and expansion of programs may serve to improve vaccine access and assist in overcoming inequity.