Barriers to Vaccine Uptake Among Older Adults: A Qualitative Community-Engaged Study

ABSTRACT Background Vaccine-preventable diseases pose significant health risks to older adults. Despite widespread vaccine availability, hesitancy related to uncertainty, misinformation, and access challenges continues to affect vaccination uptake, presenting an ongoing public health concern. Objective This study aimed to assess perceptions related to vaccination, develop age-appropriate educational strategies through community engagement, and evaluate changes in vaccine-related attitudes following an educational intervention among older adults in rural Delaware and Maryland. Study Design A mixed-methods approach was employed, combining quantitative surveys with qualitative focus groups and interviews to examine vaccination-related perceptions and experiences. Participants The study included 124 participants prior to the intervention and 89 participants following the intervention. Participants were older adults residing in Sussex County (Delaware) and Somerset and Wicomico Counties (Maryland). Analysis Quantitative data were analyzed using logistic regression, while qualitative data were analyzed thematically using inductive coding techniques. Comparisons between pre-and post-intervention findings examined changes in reported barriers, facilitators, perceptions, and confidence related to vaccination. Results Prior to the intervention, limited access to clear and reliable information (57.4%) and uncertainty toward public health guidance (36.8%) were commonly reported barriers, while family support and healthcare provider recommendations were identified as key facilitators. Following the intervention, reported barriers to vaccination decreased by 93%, and confidence in healthcare provider guidance increased by 190%. Educational materials were well received, with participants reporting improved understanding of vaccine effectiveness and safety, although some hesitation remained. Conclusion Educational interventions delivered through community-engaged approaches were associated with reduced barriers and increased confidence in vaccination among older adults. These findings highlight the value of targeted health education in supporting informed decision-making and suggest the need for continued public health efforts to sustain vaccine confidence. Further research is warranted to assess long-term outcomes and applicability across additional settings.