Barreiras e facilitadores para a vacinação na América Latina: síntese temática de estudos qualitativos

Roberti, Javier; Ini, Natalí; Belizan, Maria; Alonso, Juan Pedro

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REVIEW • Cad. Saúde Pública 40 (6) • 2024 • https://doi.org/10.1590/0102-311XEN165023 copiar

Barreiras e facilitadores para a vacinação na América Latina: síntese temática de estudos qualitativos

Autoria SCIMAGO INSTITUTIONS RANKINGS

As vacinas são frequentemente subvalorizadas ou subutilizadas por uma série de razões. A hesitação vacinal é um desafio global, sendo uma ameaça à aceitação das vacinas e aos objetivos dos programas de imunização. O objetivo desta revisão é descrever barreiras e facilitadores para a vacinação na América Latina. O desenho do estudo foi uma revisão sistemática e síntese temática de estudos qualitativos sobre conhecimento ou atitudes de adultos, pais de crianças em idade de vacinação, adolescentes e profissionais de saúde sobre vacinação na América Latina. As bases de dados analisadas foram PubMed, CENTRAL, Scopus, LILACS, SciELO e CINAHL. Foram incluídos 56 estudos. Os facilitadores incluíram a ideia de que a vacinação era reconhecida como uma estratégia eficaz para prevenir doenças infecciosas e um requisito para o acesso à assistência social, escolaridade ou emprego. Além disso, recomendações de profissionais de saúde e experiências positivas com serviços de saúde também foram identificados como fatores facilitadores. Os principais obstáculos foram a falta de informação ou aconselhamento, problemas estruturais como escassez de vacinas e horário limitado de funcionamento, incapacidade de comprar vacinas pagas ou se transportar para unidades de saúde, certas crenças religiosas, concepções erradas sobre vacinas e preocupações de segurança. A pesquisa qualitativa pode contribuir para a compreensão das percepções e tomadas de decisão sobre a vacinação e para o desenvolvimento de políticas e intervenções para aumentar a cobertura vacinal.

Palavras-chave:
Hesitação Vacinal; Vacinação; Pesquisa Qualitativa; Revisão

STUDY (YEAR)	COUNTRY	SAMPLE SIZE	PRIMARY FOCUS/OBJECTIVE	DATA COLLECTION METHOD	DATA ANALYSIS
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Arams et al. ³⁹39. Arams R, Weinstock RE, Muresianu ES, O'Callaghan S, Tubridy E, Maita YT, et al. In the name of prevention: maternal perspectives on school-based HPV vaccination in rural southern Chile. Adolesc Health Med Ther 2021; 12:27-36. (2021)	Chile	30	Maternal factors and family dynamics that affect HPV vaccination behavior	Interviews	Grounded theory
Barbieri et al. ⁵⁵55. Barbieri CL, Couto MT. Decision-making on childhood vaccination by highly educated parents. Rev Saúde Pública 2015; 49:18. (2015)	Brazil	30	Parents’ decision-making process	Interviews	Content analysis
Barbieri et al. ⁴³43. Barbieri CLA, Couto MT, Aith FMA. A (não) vacinação infantil entre a cultura e a lei: os significados atribuídos por casais de camadas médias de São Paulo, Brasil. Cad Saúde Pública 2017; 33:e00173315. (2017)	Brazil	30	Deciding not to vaccinate	Interviews	Content analysis
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Barrington et al. ⁸¹81. Barrington C, Moreno L, Kerrigan D. Local understanding of an HIV vaccine and its relationship with HIV-related stigma in the Dominican Republic. AIDS Care 2007; 19:871-7. (2007)	Dominican Republic	25	HIV vaccine	Interviews	Content analysis
Bazán et al. ⁸⁴84. Bazán M, Villacorta E, Barbagelatta G, Jimenez MM, Goya C, Bartolini RM, et al. Health workers' attitudes, perceptions and knowledge of influenza immunization in Lima, Peru: a mixed methods study. Vaccine 2017; 35:2930-6. (2017)	Peru	70	Health professionals’ attitudes and influenza vaccine	Interviews	Thematic analysis
Bingham et al. ³⁸38. Bingham A, Drake JK, LaMontagne DS. Sociocultural issues in the introduction of human papillomavirus vaccine in low-resource settings. Arch Pediatr Adolesc Med 2009; 163:455-61. (2009)	Peru	299/50	Sociocultural issues of HPV vaccination	Interviews and focus groups	Table matrix technique
Burghouts et al. ⁴⁰40. Burghouts J, Del Nogal B, Uriepero A, Hermans PWM, de Waard JH, Verhagen LM. Childhood vaccine acceptance and refusal among Warao Amerindian caregivers in Venezuela: a qualitative approach. PLoS One 2017; 12:e0170227. (2017)	Venezuela	30	Vaccination in infants and children	Interviews	Thematic analysis
Calo et al. ⁷⁷77. Calo WA, Fernandez ME, Fernandez-Espada N, Colon-Lopez V. Exploring the role of ethnic identity on the attitudes towards HPV vaccine advertising among Puerto Ricans: a qualitative analysis. J Immigr Minor Health 2015; 17:314-7. (2015)	Puerto Rico	23	HPV vaccine and ethnic identity	Focus group	Thematic analysis
Carcelen et al. ⁵⁴54. Carcelen AC, Vilajeliu A, Malik F, Gilman RH, Omer S. Perceptions and attitudes towards vaccination during pregnancy in a peri urban area of Lima, Peru. Vaccine 2021; 39 Suppl 2:B27-33. (2021)	Peru	12	Pregnant women’s perceptions and attitudes towards vaccination	Interviews	Theoretical framework
Castillo-Neyra et al. ⁷¹71. Castillo-Neyra R, Buttenheim AM, Brown J, Ferrara JF, Arevalo-Nieto C, Borrini-Mayorí K, et al. Behavioral and structural barriers to accessing human post-exposure prophylaxis and other preventive practices in Arequipa, Peru, during a canine rabies epidemic. PLoS Negl Trop Dis 2020; 14:e0008478. (2020)	Peru	70	Rabies vaccines during the pandemic	Focus group	Thematic analysis
Clavé Llavall et al. ⁵⁸58. Clavé Llavall A, de Wildt G, Meza G, Tattsbridge J, Jones L. Nurses' and teachers' perceived barriers and facilitators to the uptake of the human papilloma virus (HPV) vaccination program in Iquitos, Peru: a qualitative study. PLoS One 2021; 16:e0255218. (2021)	Peru	21	Vaccination uptake in nurses and teachers	Interviews	Theory informed thematic analysis
Clavijo et al. ⁷⁹79. Clavijo GC, Arevalo JD, Pretel VLO, Gutiérrez JP. Percepciones sobre la vacunación de la rabia silvestre en población Awajún de la provincia de Condorcanqui, Amazonas, Perú, 2013. Physis (Rio J.) 2016; 26:201-24. (2016)	Peru	32	Perception of rabies vaccines	Interviews and observation	Thematic analysis
Cordoba-Sanchez et al. ³⁷37. Cordoba-Sanchez V, Tovar-Aguirre OL, Franco S, Arias Ortiz NE, Louie K, Sanchez GI, et al. Perception about barriers and facilitators of the school-based HPV vaccine program of Manizales, Colombia: a qualitative study in school-enrolled girls and their parents. Prev Med Rep 2019; 16 Suppl 1:100977. (2019)	Colombia	110	Barriers and facilitators for HPV vaccination in school children	Interviews and focus groups	Content analysis
Costa e Silva et al. ⁷³73. Costa e Silva SP, Menandro MC. Representations of the elderly on the influenza vaccine. Ciênc Saúde Colet 2013; 18:2179-88. (2013)	Brazil	30	Social representations of the influenza vaccine	Interviews	Thematic analysis
Couto & Barbieri ⁴²42. Couto MT, Barbieri CL. Care and (non)-vaccination in the context of high-income and well-schooled families in Sao Paulo in the state of Sao Paulo, Brazil. Ciênc Saúde Colet 2015; 20:105-14. (2015)	Brazil	15	Vaccine refusal in high-income families	Interviews	Content analysis
Duarte et al. ⁷⁵75. Duarte DC, Oliveira VC, Guimarães EAA, Viegas SMF. Vaccination access in primary care from the user's perspective: senses and feelings about healthcare services. Escola Anna Nery Rev Enferm 2019; 23:e20180250. (2019)	Brazil	74	Feelings and perceptions regarding vaccination in primary health care	Interviews	Thematic content analysis
Duarte et al. ⁴⁷47. Duarte DC, Viegas S, Lanza FM, Oliveira VC. Vaccination as a scheduled demand: a day in the life of users. Rev Bras Enferm 2020; 73:e20180451. (2020)	Brazil	74	Vaccination as a scheduled demand and access	Interviews	Thematic content analysis
Duarte et al. ⁵⁶56. Duarte DC, Viegas SMF, Augusto TFS, Oliveira VC, Martins JRT, Tholl AD. Organizational aspects and a schedule for access to vaccination from users' perspective. Texto & Contexto Enferm 2021; 30:e20190101. (2021)	Brazil	74	Access to vaccination and its organizational aspects in primary health care	Interviews	Thematic content analysis
Escobar-Díaz et al. ⁷⁰70. Escobar-Díaz F, Osorio-Merchán MB, De la Hoz-Restrepo F. Reasons some children under 5 do not get vaccinated in four Colombian cities. Rev Panam Salud Pública 2017; 41:e123. (2017)	Colombia	36	Reasons for refusing vaccination	Interviews and focus groups	Thematic analysis
Fernández et al. ⁶⁷67. Fernández ME, Le Y-CL, Fernández-Espada N, Calo WA, Savas LS, Vélez C, et al. Knowledge, attitudes, and beliefs about human papillomavirus (HPV) vaccination among Puerto Rican mothers and daughters, 2010: a qualitative study. Prev Chronic Dis 2014; 11:E212. (2014)	Puerto Rico	30	Perception of the HPV vaccine	Focus group	Grounded theory
Figueiredo et al. ⁴¹41. Figueiredo GLA, Pina JC, Tonete VLP, Lima RAG, Mello DF. Experiences of families in the immunization of Brazilian children under two years old. Rev Latinoam Enferm 2011; 19:598-605. (2011)	Brazil	22	Experiences of immunization in children	Interviews	Thematic analysis
Fleming et al. ⁵⁷57. Fleming JA, Baltrons R, Rowley E, Quintanilla I, Crespin E, Ropero A-M, et al. Implementation of maternal influenza immunization in El Salvador: experiences and lessons learned from a mixed-methods study. Vaccine 2018; 36:4054-61. (2018)	El Salvador	326	Maternal immunization against influenza	Interviews and focus groups	Thematic analysis
Galea et al. ⁸²82. Galea JT, Monsour E, Nureña CR, Blas MM, Brown B. HPV vaccine knowledge and acceptability among Peruvian men who have sex with men and transgender women: a pilot, qualitative study. PLoS One 2017; 12:e0172964. (2017)	Peru	36	Knowledge and acceptance of the HPV vaccine	Interviews and focus groups	Content analysis
Garcia et al. ⁵⁹59. Garcia PJ, George PE, Romero C, Soto G, Carcamo C, Bayer AM. "The flu... is a little more complicated than a cold": knowledge, beliefs, and practices related to influenza and influenza vaccination among at-risk populations and health professionals in Peru. Vaccine 2020; 38:7688-95. (2020)	Peru	66	Knowledge of influenza and immunization	Interviews and focus groups	Thematic analysis
Gonçalves & Machado ³⁶36. Gonçalves S, Machado M. Opinion of a group of caretakers concerning the basic immunization. Rev Rene 2008; 9:45-51. (2008)	Brazil	16	Immunization in carers	Interviews	Content analysis
González-Block et al. ⁶⁰60. González-Block MA, Pelcastre-Villafuerte BE, Knauth DR, Fachel-Leal A, Comes Y, Noboa L, et al. Influenza vaccination hesitancy in large urban centers in South America. Qualitative analysis of confidence, complacency and convenience across risk groups. PLoS One 2021; 16:e0256040. (2021)	Brazil, Chile, Paraguay, Peru, and Uruguay	150	Confidence, complacency and convenience of influenza vaccination	Focus group	Content analysis
González-Block et al. ⁷7. Gonzalez-Block MA, Arroyo-Laguna J, Rodríguez-Zea B, Pelcastre-Villafuerte BE, Gutiérrez-Calderón E, Díaz-Portillo SP, et al. The importance of confidence, complacency, and convenience for influenza vaccination among key risk groups in large urban areas of Peru. Hum Vaccin Immunother 2021; 17:465-74. (2021)	Peru	28	Confidence in the influenza vaccine	Focus group	Qualitative analysis
Handy et al. ⁵⁰50. Handy LK, Maroudi S, Powell M, Nfila B, Moser C, Japa I, et al. The impact of access to immunization information on vaccine acceptance in three countries. PLoS One 2017; 12:e0180759. (2017)	Dominican Republic	96	Access to information on vaccination	Focus group	Deductive approach based on conceptual framework
Islam et al. ⁶¹61. Islam JY, Hoyt AM, Ramos S, Morgan K, Kim CJ, Sanjose S, et al. Acceptability of two- versus three-dose human papillomavirus vaccination schedule among providers and mothers of adolescent girls: a mixed-methods study in five countries. Cancer Causes Control 2018; 29:1115-30. (2018)	Argentina	23	Mothers’ rationale regarding their preferences for HPV vaccination	Focus group	Thematic analysis
Liebermann et al. ³⁵35. Liebermann E, Van Devanter N, Frias Gúzman N, Ompad D, Shirazian T, Healton C. Parent-level barriers and facilitators to HPV vaccine implementation in Santo Domingo, Dominican Republic. J Community Health 2020; 45:1061-6. (2020)	Dominican Republic	64	Barriers and facilitators for HPV vaccination	Focus group	Content analysis
Malik et al. ⁷²72. Malik AF, Belizan M, Gutierrez M, Vilajeliu A, Sanclemente LN, Gonzalez Casanova I, et al. Pregnant women's perspectives about maternal immunization in Latin America. Vaccine 2021; 39 Suppl 2:B44-9. (2021)	Argentina, Brazil, Honduras, Mexico, and Peru	162	Pregnancy and immunization	Interviews and focus groups	Thematic analysis
Malik et al. ⁶²62. Malik FA, Alonso JP, Sanclemente LN, Vilajeliu A, Gutierrez M, Gonzalez-Casanova I, et al. Health care providers perspectives about maternal immunization in Latin America. Vaccine 2021; 39 Suppl 2:B50-4. (2021)	Argentina, Brazil, Honduras, Mexico, and Peru	33	Health care providers	Interviews	Thematic analysis
Marbán-Castro et al. ⁴⁹49. Marbán-Castro E, Villén-Gonzalvo A, Enguita-Fernández C, Romero-Acosta KC, Marín-Cos A, Arrieta GJ, et al. Acceptability of a hypothetical Zika vaccine among women from Colombia and Spain exposed to ZIKV: a qualitative study. Vaccines (Basel) 2020; 8:580. (2020)	Colombia	30	Acceptance of a hypothetical vaccine against Zika	Interviews	Grounded theory
Melo et al. ³⁴34. Melo MCP, Santos MM, Mendes RNC, Sales JRP, Silva RM. Perception of adolescents on immunization in a public school in Petrolina - PE. REME Rev Min Enferm 2013; 17:374-80. (2013)	Brazil	14	Adolescents’ perception of vaccination	Interviews	Content analysis
Morais & Quirino ³³33. Morais A, Quirino M. Prática de imunização da criança prematura. Ciênc Cuid Saúde 2010; 9:350-7. (2010)	Brazil	7	Immunization and premature babies	Interviews	Content analysis
Muyulema et al. ⁶³63. Muyulema R, Guerrero Guerrero E, Melendres I. Conocimiento vaccinal en madres con hijos menores de 5 años. Revista Digital de Postgrado 2020; 9:e197. (2020)	Ecuador	26	Mothers’ knowledge of vaccination	Interviews	Thematic analysis
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Oliveira et al. ⁶⁶66. Oliveira VC, Tavares LOM, Maforte NTP, Silva LNLR, Rennó HMS, Amaral GG, et al. A percepção da equipe de enfermagem sobre a segurança do paciente em sala de vacinação. Rev Cuid (Bucaramanga) 2018; 10:e590. (2018)	Brazil	124	Influenza vaccine for workers	Experience-based narratives	NA
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Petrocy & Katz ⁸³83. Petrocy A, Katz ML. Cervical cancer and HPV: knowledge, attitudes, beliefs, and behaviors among women living in Guatemala. J Health Care Poor Underserved 2014; 25:624-36. (2014)	Guatemala	40	Attitudes and beliefs regarding cervical cancer and the HPV vaccine	Interviews	Content analysis
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[1] Correspondence
J. Roberti Instituto de Efectividad Clínica y Sanitaria. Ravignani 2024, Buenos Aires / CF - 1425, Argentina. javierroberti@gmail.com