Meningococcal ACWY (MenACWY) vaccine uptake, and barriers and motivations towards vaccination, in undergraduate students: a mixed-methods study. (November 2017)

• Record Type: Journal Article
• Authors: Trayner, Kirsten M A; Cameron, J Claire; Anderson, Niall
• Is Part Of: Lancet. Volume 390(2017)Supplement 3
• Page Start: S89
• Publication Date: 2017-11
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Medicine; Electronic journals; Periodicals; 610.5
• DOI: 10.1016/S0140-6736(17)33024-6
• Languages: English
• ISSNs: 0140-6736

Abstract

Abstract: Background: High uptake of meningococcal ACWY (MenACWY) vaccine is considered fundamental for generating herd immunity across all age groups. We aimed to estimate MenACWY uptake, and identify any barriers and motivations towards vaccinations, among university students. Methods: Our study used a mixed-methods approach. An online cross-sectional survey assessed vaccination uptake and qualitative data were obtained via one focus group [all vaccinated], and seven interviews [six vaccinated, one unvaccinated]) between April 21 and May 27, 2016. The inclusion criteria were age less than 25 years and attendance at university for the first time (MenACWY eligible). All first year undergraduates at the University of Edinburgh (n=5808) were invited to take part in the survey via email, and participants for the qualitative study were recruited through a question at the end of the survey. The primary outcome was MenACWY uptake, and secondary outcomes were barriers and motivations towards vaccination. Quantitative data were analysed with χ 2 tests and non-parametric tests, and a logistic regression model was used to assess confounding. Bias was assessed by comparing the demographics of the sample with the target population. Qualitative data were analysed with the principles of grounded theory. Findings: 768 students (13%) took part in the survey. MenACWY uptake was 71·5% (549/768), but was significantly lower (p<0.0001) n those presumed to be international students (those educated outside of the UK; 44%, 71/549), and older students (21–25 years; 39·1%, 31/549). Communication barriers (lack of information) were most frequently identified as reasons for non-vaccination ("Not enough information" 35%, 76/219; "Did not know about a vaccine" 34·3%, 75/219; "Had a vaccine in the past" 26%, 57/219). Most vaccination occurred before starting university (76·7%, 421/549), highlighting access barriers to vaccination. Knowledge about meningococcal disease was low; a significant association (p<0.0001) was found between knowledge and vaccination. In the qualitative study, participants were unaware of their vaccination history. They perceived meningococcal disease as severe (because of potential complications such as limb loss), but disease risk as low. Key motivations identified were knowledge of the benefits of vaccines, influence of others, and social responsibility. Interpretation: Students outside main UK-based, core age cohorts were underimmunised, and targeted efforts are needed for these groups. To encourage vaccination, future student vaccination programmes could focus on raising awareness of the serious implications of disease (eg, limb loss). Additional value would be gained from emphasising the benefits of vaccinations for society as a whole. Funding: University of Edinburgh.