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Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz
Apr, 2025;68 (4): 388-397.

[Pneumococcal vaccination in people aged 60 and over: relationships between vaccination intention, knowledge, and psychological reasons for the vaccination decision].

Hannah Nordmann, Sarah Anna Katharina Uthoff, Anna Zinkevich, Julia Iwen, Marc Biedermann, Lena Ansmann
Author Information
  1. Hannah Nordmann: Department f��r Versorgungsforschung, Abteilung Pr��ventions- und Rehabilitationsforschung, Carl von Ossietzky Universit��t Oldenburg, Ammerl��nder Heerstra��e 114-118, 26129, Oldenburg, Deutschland.
  2. Sarah Anna Katharina Uthoff: Department f��r Versorgungsforschung, Abteilung Pr��ventions- und Rehabilitationsforschung, Carl von Ossietzky Universit��t Oldenburg, Ammerl��nder Heerstra��e 114-118, 26129, Oldenburg, Deutschland.
  3. Anna Zinkevich: Department f��r Versorgungsforschung, Abteilung Pr��ventions- und Rehabilitationsforschung, Carl von Ossietzky Universit��t Oldenburg, Ammerl��nder Heerstra��e 114-118, 26129, Oldenburg, Deutschland. anna.zinkevich@uni-oldenburg.de.
  4. Julia Iwen: Abteilung Ambulante Versorgung, Verband der Ersatzkassen e.���V., Berlin, Deutschland.
  5. Marc Biedermann: Dezernat Sicherstellung und Versorgungsstruktur, Abteilung Versorgungsstruktur, Kassen��rztliche Bundesvereinigung, Berlin, Deutschland.
  6. Lena Ansmann: Department f��r Versorgungsforschung, Abteilung Pr��ventions- und Rehabilitationsforschung, Carl von Ossietzky Universit��t Oldenburg, Ammerl��nder Heerstra��e 114-118, 26129, Oldenburg, Deutschland.
PMID: 40014088 DOI: 10.1007/s00103-025-04012-w

Abstract

INTRODUCTION: Worldwide, pneumococci are the most common cause of morbidity and mortality from lower respiratory tract infections. Despite recommendations of the Standing Committee on Vaccination (STIKO), the vaccination rate against pneumococci in over 60-year-olds in Germany remains low. This study therefore investigates the associations between psychological reasons for (non-) vaccination, knowledge about pneumococci, age and gender, previous vaccination decisions, and pneumococcal vaccination intention in over 60-year-olds.
METHODS: The analysis is based on data from the study "ALtersspezifische Impfinanspruchnahme VErbessern," in which 1117 patients aged 60 and over were surveyed in 2022. In addition to the descriptive evaluation of the cross-sectional data, a Spearman correlation analysis was carried out. Predictive variables were also identified in a linear regression analysis.
RESULTS: Confidence in the safety of vaccination (�����=���0.514, p���<���0.001) and receiving the influenza vaccination (�����=���0.153, p���<���0.001) in the last season are the strongest predictors of pneumococcal vaccination intention. In addition, the perceived risk of pneumococcal infection (�����=���0.086, p���=���0.002) showed a significant positive correlation with vaccination intention. The regression analysis performed was able to explain 48.8% of the variance in vaccination intention (R���=���0.488).
DISCUSSION: Confidence and risk perception appear to be decisive factors in the decision to get vaccinated. Measures that address these aspects could increase vaccination intention. A joint administration of the influenza and pneumococcal vaccination could be useful, as receiving an influenza vaccination in the previous season showed a positive effect on the intention to get the pneumococcal vaccination.

Keywords

5C scale General practitioner practices Risk perception Theory of planned behavior Vaccine hesitancy

References

  1. G. B. D. Lower Respiratory Infections Collaborators (2018) Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990���2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis 18:1191���1210. https://doi.org/10.1016/S1473-3099(18)30310-4 [DOI: 10.1016/S1473-3099(18)30310-4]
  2. ECDC (2023) Factsheet about pneumococcal disease. https://www.ecdc.europa.eu/en/pneumococcal-disease/facts . Zugegriffen: 11. Sept. 2024
  3. RKI (2023) Aktualisierung der Empfehlungen der STIKO zur Standardimpfung von Personen ������60 Jahre sowie zur Indikationsimpfung von Risikogruppen gegen Pneumokokken. In: Epidemiologisches Bulletin. https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2023/Ausgaben/39_23.pdf?__blob=publicationFile . Zugegriffen: 14. Okt. 2024
  4. Baffour Awuah G, Tanaka LF, Eberl M et al (2024) Analysis of health claims data on vaccination coverage in older adults in Bavaria, Germany: Influenza, pneumococcus and herpes zoster. Vaccine 42:126354. https://doi.org/10.1016/j.vaccine.2024.126354 [DOI: 10.1016/j.vaccine.2024.126354]
  5. RKI (2022) Impfquoten bei Erwachsenen in Deutschland ��� Aktuelle Daten und Informationen zu Infektionskrankheiten und Public Health. In: Epidemiologisches Bulletin. https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2022/Ausgaben/49_22.pdf?__blob=publicationFile . Zugegriffen: 14. Okt. 2024
  6. MacDonald NE, SAGE Working Group on Vaccine Hesitancy (2015) Vaccine hesitancy: Definition, scope and determinants. Vaccine 33:4161���4164. https://doi.org/10.1016/j.vaccine.2015.04.036 [DOI: 10.1016/j.vaccine.2015.04.036]
  7. Betsch C, Schmid P, Heinemeier D, Korn L, Holtmann C, Bohm R (2018) Beyond confidence: Development of a measure assessing the 5C psychological antecedents of vaccination. PLoS ONE 13:e208601. https://doi.org/10.1371/journal.pone.0208601 [DOI: 10.1371/journal.pone.0208601]
  8. Betsch C, Schmid P, Korn L et al (2019) Impfverhalten psychologisch erkl��ren, messen und ver��ndern. Bundesgesundheitsbl 62:400���409. https://doi.org/10.1007/s00103-019-02900-6 [DOI: 10.1007/s00103-019-02900-6]
  9. Heinemeier D, Schmid P, Eitze S, Betsch C (2023) Influenza and pneumococcal vaccine hesitancy in the elderly population: Results from two representative surveys in. Preprint, Germany https://doi.org/10.21203/rs.3.rs-3542384/v110.21203/rs.3.rs-3542384/v1 [DOI: 10.21203/rs.3.rs-3542384/v110.21203/rs.3.rs-3542384/v1]
  10. Wismans A, Thurik R, Baptista R, Dejardin M, Janssen F, Franken I (2021) Psychological characteristics and the mediating role of the 5C Model in explaining students��� COVID-19 vaccination intention. PLoS ONE 16:e255382. https://doi.org/10.1371/journal.pone.0255382 [DOI: 10.1371/journal.pone.0255382]
  11. Sieverding M, Zintel S, Schmidt L, Arbogast AL, von Wagner C (2023) Explaining the intention to get vaccinated against COVID-19: General attitudes towards vaccination and predictors from health behavior theories. Psychol Health Med 28:161���170. https://doi.org/10.1080/13548506.2022.2058031 [DOI: 10.1080/13548506.2022.2058031]
  12. Nicholls LAB, Gallant AJ, Cogan N, Rasmussen S, Young D, Williams L (2021) Older adults��� vaccine hesitancy: Psychosocial factors associated with influenza, pneumococcal, and shingles vaccine uptake. Vaccine 39:3520���3527. https://doi.org/10.1016/j.vaccine.2021.04.062 [DOI: 10.1016/j.vaccine.2021.04.062]
  13. Schmid P, Rauber D, Betsch C, Lidolt G, Denker ML (2017) Barriers of Influenza Vaccination Intention and Behavior���A Systematic Review of Influenza Vaccine Hesitancy. PLoS ONE 12(e0170550):2005���2016. https://doi.org/10.1371/journal.pone.0170550 [DOI: 10.1371/journal.pone.0170550]
  14. Eitze S, Heinemeier D, Schmid-Kupke NK, Betsch C, Vaccination60+ Study Group (2021) Decreasing vaccine hesitancy with extended health knowledge: Evidence from a longitudinal randomized controlled trial. Health Psychol 40:77���88. https://doi.org/10.1037/hea0001045 [DOI: 10.1037/hea0001045]
  15. Fan C���W, Chen IH, Ko N���Y et al (2021) Extended theory of planned behavior in explaining the intention to COVID-19 vaccination uptake among mainland Chinese university students: an online survey study. Hum Vaccin Immunother 17:3413���3420. https://doi.org/10.1080/21645515.2021.1933687 [DOI: 10.1080/21645515.2021.1933687]
  16. Xia S, Liu J (2014) A belief-based model for characterizing the spread of awareness and its impacts on individuals��� vaccination decisions. J R Soc Interface 11:20140013. https://doi.org/10.1098/rsif.2014.0013 [DOI: 10.1098/rsif.2014.0013]
  17. Avramidis I, Pagkozidis I, Domeyer PJ et al (2024) Exploring Perceptions and Practices Regarding Adult Vaccination against Seasonal Influenza, Tetanus, Pneumococcal Disease, Herpes Zoster and COVID-19: A Mixed-Methods Study in Greece. Vaccines 12:80. https://doi.org/10.3390/vaccines12010080 [DOI: 10.3390/vaccines12010080]
  18. Gazibara T, Kovacevic N, Kisic-Tepavcevic D et al (2019) Flu vaccination among older persons: study of knowledge and practices. J Health Popul Nutr 38:2. https://doi.org/10.1186/s41043-018-0159-8 [DOI: 10.1186/s41043-018-0159-8]
  19. Sprenger R, Hackl D, Kossack N, Schiffner-Rohe J, Wohlleben J, von Eiff C (2022) Pneumococcal vaccination rates in immunocompromised patients in Germany: A retrospective cohort study to assess sequential vaccination rates and changes over time. PLoS ONE 17:e265433. https://doi.org/10.1371/journal.pone.0265433 [DOI: 10.1371/journal.pone.0265433]
  20. Poethko-M��ller C, Schmitz R (2013) Impfstatus von Erwachsenen in Deutschland. Bundesgesundheitsbl 56:845���857. https://doi.org/10.1007/s00103-013-1693-6 [DOI: 10.1007/s00103-013-1693-6]
  21. Klett-Tammen CJ, Krause G, Seefeld L, Ott JJ (2016) Determinants of tetanus, pneumococcal and influenza vaccination in the elderly: a representative cross-sectional study on knowledge, attitude and practice (KAP). Bmc Public Health 16:121. https://doi.org/10.1186/s12889-016-2784-8 [DOI: 10.1186/s12889-016-2784-8]
  22. Gatwood CC���Y, Shuvo S et al (2021) Role of social determinants of health in pneumococcal vaccination among high-risk adults. Vaccine 39:1951���1962. https://doi.org/10.1016/j.vaccine.2021.02.061 [DOI: 10.1016/j.vaccine.2021.02.061]
  23. Wang Z, Fang Y, Ip M, Lau M, Lau JTF (2021) Facilitators and barriers to completing recommended doses of pneumococcal vaccination among community-living individuals aged ������65 years in Hong Kong���a population-based study. Hum Vaccin Immunother 17:527���536. https://doi.org/10.1080/21645515.2020.1776545 [DOI: 10.1080/21645515.2020.1776545]
  24. Ajzen I (1991) The theory of planned behavior. Organ Behav Hum Decis Process 50:179���211. https://doi.org/10.1016/0749-5978(91)90020-T [DOI: 10.1016/0749-5978(91)90020-T]
  25. Catalano HP, Knowlden AP, Birch DA, Leeper JD, Paschal AM, Usdan SL (2017) Using the Theory of Planned Behavior to predict HPV vaccination intentions of college men. J Am Coll Health 65:197���207. https://doi.org/10.1080/07448481.2016.1269771 [DOI: 10.1080/07448481.2016.1269771]
  26. Agarwal V (2014) A/H1N1 vaccine intentions in college students: an application of the theory of planned behavior. J Am Coll Health 62:416���424. https://doi.org/10.1080/07448481.2014.917650 [DOI: 10.1080/07448481.2014.917650]
  27. Uthoff SAK, Zinkevich A, Franiel D et al (2023) A complex intervention on vaccination uptake among older adults (���/= 60 years) in Germany���a study protocol with a mixed methods design. BMC Prim Care 24:148. https://doi.org/10.1186/s12875-023-02101-w [DOI: 10.1186/s12875-023-02101-w]
  28. Betsch C, Haase N, Renkewitz F, Schmid P (2015) The narrative bias revisited: What drives the biasing influence of narrative information on risk perceptions? Judgm decis mak 10:241���264. https://doi.org/10.1017/S1930297500004654 [DOI: 10.1017/S1930297500004654]
  29. Sedgwick P (2014) Spearman���s rank correlation coefficient. BMJ 349:g7327. https://doi.org/10.1136/bmj.g7327 [DOI: 10.1136/bmj.g7327]
  30. Cohen J (1988) Statistical power analysis for the behavioral sciences. Erlbaum, Hillsdale, NJ u.���a.
  31. IBM Corp. (2023) IBM SPSS Statistics for Macintosh. In, Armonk, NY: IBM CorpZugegriffen: 30. Sept. 2024
  32. Lin C, Parker T, Pejavara K, Smith D, Tu R, Tu P (2022) ���I Would Never Push a Vaccine on You���: A Qualitative Study of Social Norms and Pressure in Vaccine Behavior in the U.S. Vaccines 10:1402. https://doi.org/10.3390/vaccines10091402 [DOI: 10.3390/vaccines10091402]
  33. Terry DL, Hui PA, Terry CP, Trabold A (2021) Vaccine hesitancy among college students and individuals seeking healthcare: A social norms perspective. J Am Coll Health. https://doi.org/10.1080/07448481.2022.2086009:1-6 [DOI: 10.1080/07448481.2022.2086009]
  34. Gatwood RS, Shuvo SA et al (2022) Social determinants of health and adult influenza vaccination: a nationwide claims analysis. J Manag Care Spec Pharm 28:196���205. https://doi.org/10.18553/jmcp.2022.28.2.196 [DOI: 10.18553/jmcp.2022.28.2.196]
  35. Gilchrist SA, Nanni A, Levine O (2012) Benefits and effectiveness of administering pneumococcal polysaccharide vaccine with seasonal influenza vaccine: an approach for policymakers. Am J Public Health 102:596���605. https://doi.org/10.2105/ajph.2011.300512 [DOI: 10.2105/ajph.2011.300512]
  36. Zhang X, Guo Y, Zhou Q, Tan Z, Cao J (2021) The Mediating Roles of Medical Mistrust, Knowledge, Confidence and Complacency of Vaccines in the Pathways from Conspiracy Beliefs to Vaccine. Hesitancy Vaccines 9:1342. https://doi.org/10.3390/vaccines9111342 [DOI: 10.3390/vaccines9111342]
  37. Limbu YB, Gautam RK, Zhou W (2022) Predicting Vaccination Intention against COVID-19 Using Theory of Planned Behavior: A Systematic Review and Meta-Analysis. Vaccines. https://doi.org/10.3390/vaccines10122026 [DOI: 10.3390/vaccines10122026]
  38. Domnich A, Grassi R, Fallani E et al (2021) Changes in Attitudes and Beliefs Concerning Vaccination and Influenza Vaccines between the First and Second COVID-19 Pandemic Waves: A Longitudinal Study. Vaccines 9:1016. https://doi.org/10.3390/vaccines9091016 [DOI: 10.3390/vaccines9091016]
  39. Kong G, Lim N���A, Chin YH, Ng YP, Amin Z (2022) Effect of COVID-19 Pandemic on Influenza Vaccination Intention: A Meta-Analysis and Systematic Review. https://doi.org/10.3390/vaccines10040606
  40. Gallant AJ, Nicholls LAB, Rasmussen S, Cogan N, Young D, Williams L (2021) Changes in attitudes to vaccination as a result of the COVID-19 pandemic: A longitudinal study of older adults in the UK. PLoS ONE 16:e261844. https://doi.org/10.1371/journal.pone.0261844 [DOI: 10.1371/journal.pone.0261844]
  41. Faller H, Reusch A, Vogel H (2019) F��rderung und Erhaltung von Gesundheit: Pr��vention. In: Faller H, Lang H (Hrsg) Medizinische Psychologie und Soziologie. Springer, Berlin, Heidelberg, S 363���396 [DOI: 10.1007/978-3-662-57972-5_10]
  42. Destatis (2024) ��ltere Frauen sind in der Mehrheit. https://www.destatis.de/DE/Themen/Querschnitt/Demografischer-Wandel/Aeltere-Menschen/geschlechter.html#:~:text=Die%20Zahl%20der%20hochbetagten%20Frauen,die%20Gruppe%20der%20%C3%84lteren%20pr%C3%A4gen . Zugegriffen: 11.2024

MeSH Term

Humans
Germany
Male
Female
Middle Aged
Aged
Pneumococcal Vaccines
Intention
Health Knowledge, Attitudes, Practice
Pneumococcal Infections
Aged, 80 and over
Vaccination
Cross-Sectional Studies

Chemicals

Pneumococcal Vaccines
English Abstract Journal Article

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