Skip to main content

Advertisement

SpringerLink
Log in

Understanding factors associated with vaccine uptake and vaccine hesitancy in patients with rheumatoid arthritis: a scoping literature review

  • Review Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Due to higher risk of complications associated with vaccine-preventable infections (e.g., influenza, pneumococcus), patients with rheumatoid arthritis (RA) are a priority group for vaccination. However, vaccination rates among RA patients are low, indicating a need to understand the determinants of vaccine hesitancy in this group. This study conducted an evidence synthesis of various stakeholders’ (patients, physicians/rheumatologists) perspectives about the determinants of vaccine hesitancy and uptake among patients with RA. We searched three bibliographic and reference databases (PUBMED, PsychINFO, and SCOPUS) for relevant English or French articles published in peer-reviewed journals through July 2019 that conducted either qualitative or quantitative assessments of vaccine hesitancy or uptake. Key themes associated with vaccination hesitancy themes according to different stakeholders were extracted and summarized. Of 783 unique citations, 16 articles met the inclusion criteria. Most studies (78%; n = 134,787 RA patients) examined barriers reported by patients, 13% (n = 114) by rheumatologists. Two principal themes and six sub-themes associated with vaccination hesitancy were identified among both patients and rheumatologists: ‘social and contextual factors’ (including healthcare policies, access to care/high patient loads, and social/media influences) and ‘patient and provider factors’ (including patient understanding of benefits and risks, provider awareness of guidelines and perceived responsibility for vaccination, and implementation challenges). Determinants of vaccine hesitancy and uptake in RA identified by different stakeholders implicate patient-, provider-, and healthcare system‑related factors. This information is relevant for the design of interventions that target improving vaccine uptake in RA patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

The data used and analysed during this study are available from the corresponding author on reasonable request.

References

  1. WHO. Chronic disease and health promotion. Retrieved from https://www.who.int/chp/topics/rheumatic/en/2018

  2. Aletaha D, Smolen JS (2018) Diagnosis and management of rheumatoid arthritis: a review. Jama. 320:1360–1372

    Article  PubMed  Google Scholar 

  3. van den Hoek J, Boshuizen HC, Roorda LD, Tijhuis GJ, Nurmohamed MT, van den Bos GA, Dekker J (2017) Mortality in patients with rheumatoid arthritis: a 15-year prospective cohort study. Rheumatol Int 37:487–493

    Article  PubMed  Google Scholar 

  4. Listing J, Gerhold K, Zink A (2013) The risk of infections associated with rheumatoid arthritis, with its comorbidity and treatment. Rheumatology (Oxford, England) 52:53–61

    Article  CAS  PubMed  Google Scholar 

  5. Butler R, MacDonald NE (2015) Diagnosing the determinants of vaccine hesitancy in specific subgroups: the guide to tailoring immunization Programmes (TIP). Vaccine 33:4176–4179

    Article  PubMed  Google Scholar 

  6. van Wijhe M, McDonald SA, de Melker HE, Postma MJ, Wallinga J (2016) Effect of vaccination programmes on mortality burden among children and young adults in the Netherlands during the 20th century: a historical analysis. Lancet Infect Dis 16:592–598

    Article  PubMed  Google Scholar 

  7. World Health Organization (2019) Ten threats to global health in 2019. Retrieved January 2019

  8. MacDonald NE (2015) Vaccine hesitancy: definition, scope and determinants. Vaccine 33:4161–4164

    Article  PubMed  Google Scholar 

  9. Dube E, Vivion M, MacDonald NE (2015) Vaccine hesitancy, vaccine refusal and the anti-vaccine movement: influence, impact and implications. Expert Rev Vaccines 14:99–117

    Article  CAS  PubMed  Google Scholar 

  10. Dubé E, Gagnon D, Nickels E, Jeram S, Schuster M (2014) Mapping vaccine hesitancy—country-specific characteristics of a global phenomenon. Vaccine 32:6649–6654

    Article  PubMed  PubMed Central  Google Scholar 

  11. Larson HJ, Jarrett C, Eckersberger E, Smith DM, Paterson P (2014) Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: a systematic review of published literature, 2007-2012. Vaccine 32:2150–2159

    Article  PubMed  Google Scholar 

  12. Qendro T, de la Torre ML, Panopalis P, Hazel E, Ward BJ, Colmegna I et al (2019) Suboptimal immunization coverage among Canadian rheumatology patients in routine clinical care. J Rheumatol

  13. Furer V, Rondaan C, Heijstek MW, Agmon-Levin N, van Assen S, Bijl M, Breedveld FC, D'Amelio R, Dougados M, Kapetanovic MC, van Laar J, de Thurah A, Landewé RB, Molto A, Müller-Ladner U, Schreiber K, Smolar L, Walker J, Warnatz K, Wulffraat NM, Elkayam O (2020) 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 79:39–52

    Article  CAS  PubMed  Google Scholar 

  14. Singh JA, Saag KG, Bridges SL Jr, Akl EA, Bannuru RR, Sullivan MC et al (2016) 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Rheum 68:1–26

    Google Scholar 

  15. Grant MJ, Booth A (2009) A typology of reviews: an analysis of 14 review types and associated methodologies. Health Inf Libr J 26:91–108

    Article  Google Scholar 

  16. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ (Clinical research ed) 339:b2700

    Article  PubMed  PubMed Central  Google Scholar 

  17. Bedford H, Attwell K, Danchin M, Marshall H, Corben P, Leask J (2018) Vaccine hesitancy, refusal and access barriers: the need for clarity in terminology. Vaccine 36:6556–6558

    Article  PubMed  Google Scholar 

  18. Clarke V, Braun V (2018) Using thematic analysis in counselling and psychotherapy research: a critical reflection. Couns Psychother Res 18:107–110

    Article  Google Scholar 

  19. Clarke V, Braun V (2017) Thematic analysis. J Posit Psychol 12:297–298

    Article  Google Scholar 

  20. John WS, Johnson P (2000) The pros and cons of data analysis software for qualitative research. J Nurs Scholarsh 32:393–397

    Article  Google Scholar 

  21. Dube E, MacDonald NE (2016) Managing the risks of vaccine hesitancy and refusals. Lancet Infect Dis 16:518–519

    Article  PubMed  Google Scholar 

  22. WHO. Report of the SAGE working group on vaccine hesitancy. Retrieved from https://www.who.int/immunization/programmes_systems/vaccine_hesitancy/en/2014

  23. Baker DW, Brown T, Lee JY, Ozanich A, Liss DT, Sandler DS, Ruderman EM (2016) A multifaceted intervention to improve influenza, pneumococcal, and herpes zoster vaccination among patients with rheumatoid arthritis. J Rheumatol 43:1030–1037

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Brocq O, Acquacalda E, Berthier F, Albert C, Bolla G, Millasseau E et al (2016) Influenza and pneumococcal vaccine coverage in 584 patients taking biological therapy for chronic inflammatory joint: a retrospective study. Joint Bone Spine : revue du rhumatisme 83:155–159

    Article  PubMed  Google Scholar 

  25. Broderick R, Ventura I, Soroosh S, Franco L, Giles JT (2018) Reducing missed opportunities for influenza vaccination in patients with rheumatoid arthritis: evaluation of a multisystem intervention. J Rheumatol

  26. Costello R, Winthrop KL, Pye SR, Brown B, Dixon WG (2016) Influenza and pneumococcal vaccination uptake in patients with rheumatoid arthritis treated with immunosuppressive therapy in the UK: a retrospective cohort study using data from the clinical practice research datalink. PLoS One 11:e0153848

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  27. Feuchtenberger M, Kleinert S, Schwab S, Roll P, Scharbatke EC, Ostermeier E, Voll RE, Schäfer A, Tony HP (2012) Vaccination survey in patients with rheumatoid arthritis: a cross-sectional study. Rheumatol Int 32:1533–1539

    Article  PubMed  Google Scholar 

  28. Haroon M, Adeeb F, Eltahir A, Harney S (2011) The uptake of influenza and pneumococcal vaccination among immunocompromised patients attending rheumatology outpatient clinics. Joint Bone Spine : revue du rhumatisme 78:374–377

    Article  PubMed  Google Scholar 

  29. Hmamouchi I, Winthrop K, Launay O, Dougados M (2015) Low rate of influenza and pneumococcal vaccine coverage in rheumatoid arthritis: data from the international COMORA cohort. Vaccine 33:1446–1452

    Article  PubMed  Google Scholar 

  30. Krasselt M, Ivanov JP, Baerwald C, Seifert O (2017) Low vaccination rates among patients with rheumatoid arthritis in a German outpatient clinic. Rheumatol Int 37:229–237

    Article  CAS  PubMed  Google Scholar 

  31. Luque Ramos A, Hoffmann F, Callhoff J, Zink A, Albrecht K (2016) Influenza and pneumococcal vaccination in patients with rheumatoid arthritis in comparison with age- and sex-matched controls: results of a claims data analysis. Rheumatol Int 36:1255–1263

    Article  CAS  PubMed  Google Scholar 

  32. McCarthy EM, Azeez MA, Fitzpatrick FM, Donnelly S (2012) Knowledge, attitudes, and clinical practice of rheumatologists in vaccination of the at-risk rheumatology patient population. J Clin Rheumatol 18:237–241

    Article  PubMed  Google Scholar 

  33. Muniz LF, Silva CR, Costa TF, da Mota LMH (2014) Vaccination in patients from Brasília cohort with early rheumatoid arthritis. Rev Bras Reumatol 54:349–355

    Article  PubMed  Google Scholar 

  34. Nguyen M, Lindegaard H, Hendricks O, Friis-Moller N (2017) Factors associated with influenza and pneumococcal vaccine uptake among rheumatoid arthritis patients in Denmark invited to participate in a pneumococcal vaccine trial (Immunovax_RA). Scand J Rheumatol 46:446–453

    Article  PubMed  Google Scholar 

  35. Sandler DS, Ruderman EM, Brown T, Lee JY, Mixon A, Liss DT, Baker DW (2016) Understanding vaccination rates and attitudes among patients with rheumatoid arthritis. Am J Manag Care 22:161–167

    PubMed  Google Scholar 

  36. Silva CAA, Terreri MTRA, Aikawa NE, Carvalho JF, Pileggi GCS, Ferriani VPL, Barbosa CM, Hilário MO, Jesus AA, Sallum AM, Lotito AP, Liphaus BL, Magalhães CS, Len CA, Okuda EM, Campos LM, Carvalho LM, Ronchezel MV, dos Santos M, Romanelli PR, Marini R, Pereira RM, Sacchetti SB, Lotufo S, Bastos WA (2010) Vaccination practice in children with rheumatic disease. Rev Bras Reumatol 50:351–361

    Article  PubMed  Google Scholar 

  37. Sowden E, Mitchell WS (2007) An audit of influenza and pneumococcal vaccination in rheumatology outpatients. BMC Musculoskelet Disord 8:58

    Article  PubMed  PubMed Central  Google Scholar 

  38. Subesinghe S, Rutherford AI, Ibrahim F, Harris H, Galloway J (2016) A large two-centre study in to rates of influenza and pneumococcal vaccination and infection burden in rheumatoid arthritis in the UK. BMC Musculoskelet Disord 17:322

    Article  PubMed  PubMed Central  Google Scholar 

  39. Dubé E, Gagnon D, MacDonald NE (2015) Strategies intended to address vaccine hesitancy: review of published reviews. Vaccine 33:4191–4203

    Article  PubMed  Google Scholar 

  40. Eskola J, Duclos P, Schuster M, MacDonald NE (2015) How to deal with vaccine hesitancy? Vaccine 33:4215–4217

    Article  PubMed  Google Scholar 

  41. Jarrett C, Wilson R, O’Leary M, Eckersberger E, Larson HJ (2015) Strategies for addressing vaccine hesitancy – a systematic review. Vaccine 33:4180–4190

    Article  PubMed  Google Scholar 

  42. Prochaska JO, Velicer WF (1997) The transtheoretical model of health behavior change. Am J Health Promot 12:38–48

    Article  CAS  PubMed  Google Scholar 

  43. Deci EL, Ryan RM (1985) Intrinsic motivation and self-determination in human behavior. Plenum, New York

    Book  Google Scholar 

  44. Bandura A (1977) Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 84:191–215

    Article  CAS  PubMed  Google Scholar 

  45. Beck AT (1979) Cognitive therapy of depression. Guilford Press, New York

    Google Scholar 

  46. Beck AT (1993) Cognitive therapy: past, present, and future. J Consult Clin Psychol 61:194

    Article  CAS  PubMed  Google Scholar 

  47. Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, Eccles MP, Cane J, Wood CE (2013) The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med 46:81–95

    Article  PubMed  Google Scholar 

  48. Attwell K, Wiley KE, Waddington C, Leask J, Snelling T (2018) Midwives' attitudes, beliefs and concerns about childhood vaccination: a review of the global literature. Vaccine 36:6531–6539

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We acknowledge investigator support from the Fonds de la recherche du Quebec – Santé (FRQS, KLL) and scholarship support from the Canadian Institutes of Health Research (CIHR, VGB), the FRQS (VGB, SL), and the J.A. De Seve Foundation (CG).

Funding

This work was funded by an operating grant from the Canadian Initiative for Outcomes in Rheumatology cAre (CIORA), Canadian Rheumatology Association; the Fonds de la Recherche du Québec en Santé (#34757); and scholarship support from the Canadian Institutes of Health Research (CIHR, 2018-2021).

Author information

Authors and Affiliations

  1. Department of Psychology, Université du Québec à Montréal (UQAM), CP 8888, Sucursale Centre-Ville, Montréal, Quebec, H3C 3P8, Canada

    Vincent Gosselin Boucher, Claudia Gemme, Sara Labbe & Kim L. Lavoie

  2. Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l’Ile-de-Montréal (CIUSSS-NIM), Hôpital du Sacré-Coeur, Montréal, Canada

    Vincent Gosselin Boucher, Claudia Gemme, Sara Labbe & Kim L. Lavoie

  3. Department of Educational and Counselling Psychology, McGill University, Montréal, Canada

    Sandra Pelaez

Authors
  1. Vincent Gosselin Boucher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sandra Pelaez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Claudia Gemme
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sara Labbe
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kim L. Lavoie
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vincent Gosselin Boucher.

Ethics declarations

Disclosures

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Boucher, V.G., Pelaez, S., Gemme, C. et al. Understanding factors associated with vaccine uptake and vaccine hesitancy in patients with rheumatoid arthritis: a scoping literature review. Clin Rheumatol 40, 477–489 (2021). https://doi.org/10.1007/s10067-020-05059-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-020-05059-7

Keywords

Search

Navigation