Barriers and enablers to influenza vaccination uptake in adults with chronic respiratory conditions: applying the behaviour change wheel to specify multi-levelled tailored intervention content

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Objective: To specify intervention content to enhance influenza vaccination uptake among adults with chronic respiratory conditions using the Behaviour Change Wheel (BCW).

Design: Cross-sectional, multi-modal data collection and theory-informed analysis and expert stakeholder engagement.

Methods: Content analysis was used to identify barriers and enablers to influenza vaccination from nine focus groups (n=38), individual interviews (n=21) and open-ended survey responses (n=101). The Theoretical Domains Framework (TDF) and the BCW were used to specify evidence-based and theoretically-informed recommendations. Expert stakeholders refined recommendations using the Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Equity (APEASE) criteria to yield a range of potentially actionable ideas.

Results: TDF analysis identified perceptions of vaccine side effects (beliefs about consequences [BACons]) was the most common barrier to vaccination, followed by time constraints (environmental context and resources [ECR]) and fear of needles (Emotion). Enablers included protection from influenza (BACons), receiving reminders (ECR) and support from others (Social Influences) These factors mapped to seven BCW intervention functions and 22 behaviour change techniques.

Conclusions: Factors affecting vaccine uptake are multifaceted and multileveled. The study suggested a suite of complementary multi-level intervention components to enhance vaccination uptake involving a range of diverse actors, intervention recipients and settings.
Original languageEnglish
Number of pages20
JournalPsychology and Health
Early online date30 Jul 2021
Publication statusE-pub ahead of print - 30 Jul 2021


  • influenza vaccination
  • vaccine hesitancy
  • behaviour change wheel
  • theoretical domains framework
  • behaviour change techniques

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