A mixed-methods study to identify factors associated with MenACWY vaccine uptake, barriers and motivations towards vaccination among undergraduate students

Abstract

Background: In response to an outbreak of severe meningococcal disease caused by serogroup W, the UK introduced the meningococcal ACWY (MenACWY) for adolescents and new university students as a control measure. Objective: To estimate MenACWY vaccine uptake and identify factors associated with uptake, barriers and motivations towards vaccination among university students. Design: Mixed methods including a cross-sectional survey, 7 interviews and 1 focus group. Setting: A Scottish university between April and May 2016. Methods: Inclusion criteria were <25 years and attending university for the first time (MenACWY eligible). All first-year undergraduates ( n = 5,808) were invited to take part in the survey via email, and qualitative participants were recruited through the survey. The final sample consisted of 768 students, representing 13% (768/5,808) of the target population. Results: MenACWY uptake among the sample was 71.5% (549/768). Older students (22–24 years) were less likely than younger students (18 years) to have been vaccinated [adjusted odds ratio (aOR) = 0.21; 95% confidence interval (CI) = 0.06–0.77], and male students were less likely to be vaccinated than female students (aOR = 0.667; 95% CI = 0.45–0.96). In comparison to international students, domestic students had a significantly higher odds of vaccination (aOR = 3.89; 95% CI = 2.64–5.72). Communication barriers were most frequently identified as reasons for non-vaccination. Most vaccination occurred before starting university (76.7%, 421/549), highlighting access barriers. Meningococcal disease knowledge was low; a significant association ( p < 0.001) was found between knowledge and vaccination uptake. Some participants were unaware of their vaccination history. They perceived meningococcal disease as severe, but disease risk as low. Key motivations were knowledge of the benefits of vaccines, influence of others and social responsibility. Conclusion: Students outside main UK-based, core age cohorts were under-immunised and focused efforts are needed to improve vaccination rates. Future student vaccination programmes could focus on raising awareness of the serious implications of meningococcal disease. Additional benefit may be gained from emphasising the benefits of vaccinations for society as a whole.