Psychological determinants of vaccination behavior against COVID-19 and influenza of chronically ill in German primary care – a cross-sectional survey

Linda Sanftenberg, Simon Keppeler, Nadine Heithorst, Tobias Dreischulte, Marco Roos, Philipp Sckopke, Markus Bühner, Jochen Gensichen

Keywords: primay care; mental health; chronically ill; vaccination; behaviour change

Background:

Vaccines against COVID-19 and influenza are safe and provide good protection from sever infections. They are highly recommended for vulnerable patients with chronic diseases. In many cases, these patients suffer from psychological comorbidities like depression and anxiety disorders. Chronically ill adults are mainly vaccinated in primary care, but vaccination rates remain insufficient.

Research questions:

The aim of this study is to analyze the associations of depression and anxiety disorder on vaccination behavior against COVID-19 and seasonal Influenza in chronically ill primary care patients.

Method:

For this cross-sectional observational study, a paper-based survey was conducted from July- December 2022 in Bavaria, Germany. We invited adult primary care patients suffering from one or more chronic health conditions (diabetes typ 1/2, asthma bronchiale/chronic obstructive pulmonary disease, coronary heart disease or breast cancer). Besides sociodemographics, we analysed symptoms of depression (PHQ-9) and anxiety disorder (OASIS), social activity (LSNSN), patient activation (PAM), physician-patient relationship (PRA) and antecedents of vaccination behavior (5C). Descriptive statistics and linear mixed-effects regression models were calculated.

Results:

We analyzed data of n=795 study participants. Major depression was suspected in 18.4%, and anxiety disorder in 20.3% of them. Concerning vaccinations against COVID-19, depression was negatively associated with trust in vaccine safety (item „Confidence“ β = -0.04, 95% CI [-0.07, -0.01]) and positively associated with subjectively perceived structural barriers to get vaccinated (item „Constraints“, β = 0.02, 95% CI [0.001; 0.04]). Concerning vaccinations against influenza, depression did not show any association with vaccination behavior. Higher age, male sex, higher education, high scores of self-activation, and a good physician-patient relationship were associated with a positive vaccination behavior.

Conclusions:

To address low confidence in the safety and efficacy of vaccinations, targeted educational interventions like communication-based short interventions in primary care might be useful. Subjectively perceived constraints might be addressed by regular personalized reminder systems.

Points for discussion:

What details have to be considered in the developement of a communication-based intervention (in terms of feasibility, acceptance and relevance to European primary care)?

How should we integrate non-medical primary care professionals (physician assistants, nurses, pharmacists etc.) in the upcoming intervention?

To which other vulnerable patient groups could these results possibly be transferrable?