Discussing Barriers and Facilitators to Influenza and Pneumococcal Vaccines in Patients With RA

patient vaccination, vaccine, influenza, pneumonia
Researchers studied the perspectives of patients with rheumatoid arthritis and RA providers to understand the barriers and facilitators regarding coverage of the influenza and pneumococcal vaccines.

Acknowledgement of the perceived barriers to influenza and pneumococcal vaccination among patients with rheumatoid arthritis (RA) and the implementation of specific strategies to address vaccine hesitancy may increase vaccination coverage in this population, according to study results published in Rheumatology.

Vaccination against influenza and pneumonia is an essential part of care for patients with RA, yet coverage has been reported to be suboptimal.

To better understand the barriers and facilitators to vaccination in RA, 4 focus groups including patients with RA and 4 focus groups including RA health care providers were conducted, along with 8 semi-structured, open-ended individual interviews with vaccine-hesitant patients with RA. Transcripts of these sessions were imported to the MAXQDA software and analyzed using the World Health Organization (WHO) Strategic Advisory Group of Experts on Immunization framework.

A total of 54 participants were included in the analysis, of whom the majority were middle-aged women. Patients’ hesitancy to receive a vaccine was found to be influenced by contextual factors, individual and social group factors, and vaccine and vaccination-specific issues, based on the WHO Strategic Advisory Group of Experts on Immunization model.

As barriers to vaccination, participants from both groups identified negative influences from the media, distrust in the health system and the pharmaceutical industry, patients’ previous negative experiences with vaccination, lack of vaccine knowledge and awareness, concerns about safety and efficacy, difficulties in accessing vaccines, health care workers’ lack of time to discuss vaccination, parents’ negative attitudes toward vaccines, and lack of a primary care physician.

While costs and concerns about new vaccine formulations were specific to patients, health care workers identified as barriers patients’ different cultural backgrounds, poor communication among themselves, rheumatologists’ lack of experience in recommending vaccines, the lack of awareness of vaccine recommendations specific to patients with RA, their limited persuasive skills, and rheumatologists not considering vaccines as a priority.

Proposed measures to improve vaccination included media promotion of vaccines and vaccine awareness, advertisements from nonprofit organizations, education focused specifically on the needs of patients with RA, more communication styles and reminders, improved access to vaccines, more health care worker advice and reassurance, along with engagement with other health care professionals, such as pharmacists.

The study had several limitations: It was conducted at a single center and may not have reflected the opinions of patients and health care workers; and patients participating in focus groups may have had more favorable vaccine attitudes, suggesting that some barriers may have been missed.

Researchers concluded, “Promoting RA patient-centered care grounded in the principle of trust that is respectful of, and responsive to, individual patient preferences, needs and values is essential to achieve recommended vaccination targets.”


Colmegna I, Valerio V, Boucher VG, et al. Barriers and facilitators to influenza and pneumococcal vaccine hesitancy in rheumatoid arthritis: a qualitative study. Rheumatology (Oxford). Published online June 4, 2021. doi:10.1093/rheumatology/keab471