Neufeind Julia, Betsch Cornelia, Habersaat Katrine Bach, Eckardt Matthias, Schmid Philipp, Wichmann Ole
Charité University Medicine Berlin, Berlin, Germany; Department for Infectious Disease Epidemiology, Immunization Unit, Robert Koch Institute, Berlin, Germany.
Center for Empirical Research in Economics and Behavioral Sciences (CEREB), University of Erfurt, Erfurt, Germany; Media and Communication Science, University of Erfurt, Erfurt, Germany.
Vaccine. 2020 Jun 2;38(27):4252-4262. doi: 10.1016/j.vaccine.2020.04.052. Epub 2020 May 12.
In Germany, vaccination gaps exist mainly among adolescents and adults. Family physicians (FPs) administer adult vaccines. FPs strongly influence the vaccination behavior and attitudes of their patients, so their own vaccination-related attitudes and behaviors are critical to achieve high vaccination coverage. The aim of this study was to identify determinants of FPs' own vaccination uptake and their recommendation behavior.
700 FPs participated in a random sampled telephone survey. Respondents were interviewed in both their roles as vaccine recipients and vaccine providers. Thus, participants indicated their own vaccination status and recommendation behavior as primary outcomes. Primary determinants were the 5C psychological antecedents of vaccination. In addition, participants indicated demographic data and other barriers towards vaccination. Association between outcome and determinants were examined using logistic regression models.
Around 60% of physicians reported to be vaccinated against influenza, pertussis and hepatitis B, and the majority claimed to recommend vaccines to patients. Own vaccination status was significantly associated with the recommendation of vaccines. Of the psychological determinants confidence in the safety of vaccines was associated with own vaccination and recommendation behavior. Collective responsibility, constraints and complacency were associated with own vaccination status. Being from western Germany and being a homeopathic FP were independently associated with lower own vaccination behavior. Vaccine shortages (52.5%) and cost coverage problems (25.6%) were reported frequently as system-related barriers. There was a perception that the National Immunization Technical Advisory Group was influenced by other interests (14.8%) and that people are vaccinated against too many diseases (8%). Around 40% had implemented an office-based reminder system.
FPs' vaccination behaviors are associated with various psychological determinants and additional barriers. In particular, confidence can leverage FPs' vaccination behaviors. Promoting office-based reminder systems, reducing system-related barriers, and building trust in official recommendations are additional measures to improve adult vaccination in Germany.
在德国，疫苗接种缺口主要存在于青少年和成年人中。家庭医生负责为成年人接种疫苗。家庭医生对患者的疫苗接种行为和态度有很大影响，因此他们自身与疫苗接种相关的态度和行为对于实现高疫苗接种覆盖率至关重要。本研究的目的是确定家庭医生自身疫苗接种率及其推荐行为的决定因素。
700名家庭医生参与了一项随机抽样电话调查。受访者分别以疫苗接种者和疫苗提供者的身份接受访谈。因此，参与者表明了他们自身的疫苗接种状况和推荐行为作为主要结果。主要决定因素是疫苗接种的5C心理前因。此外，参与者还表明了人口统计学数据和其他疫苗接种障碍。使用逻辑回归模型检验结果与决定因素之间的关联。
约60%的医生报告接种了流感、百日咳和乙肝疫苗，大多数人声称会向患者推荐疫苗。自身疫苗接种状况与疫苗推荐显著相关。在心理决定因素中，对疫苗安全性的信心与自身疫苗接种和推荐行为相关。集体责任、限制和自满与自身疫苗接种状况相关。来自德国西部以及是顺势疗法家庭医生与较低的自身疫苗接种行为独立相关。疫苗短缺（52.5%）和费用覆盖问题（25.6%）被频繁报告为与系统相关的障碍。有人认为国家免疫技术咨询小组受到其他利益的影响（14.8%），并且人们接种的疾病过多（8%）。约40%的人实施了基于办公室的提醒系统。
家庭医生的疫苗接种行为与各种心理决定因素和其他障碍相关。特别是，信心可以促进家庭医生的疫苗接种行为。推广基于办公室的提醒系统、减少与系统相关的障碍以及建立对官方建议的信任是改善德国成人疫苗接种的其他措施。
