A thematic analysis of flu vaccine hesitance in ethnically minoritised communities in Liverpool

Powell, A ORCID: 0000-0002-4879-4124, Van Hout, MC ORCID: 0000-0002-0018-4060, Connors, D and Montgomery, C ORCID: 0000-0003-2805-5807 (2025) A thematic analysis of flu vaccine hesitance in ethnically minoritised communities in Liverpool. PLOS One, 20 (11). e0333602-e0333602. ISSN 1932-6203

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Abstract

Background
Seasonal influenza causes around 15,000 deaths yearly in the United Kingdom. Low vaccine uptake is more prominent in ethnically minoritised communities and deprived areas, leading to poorer outcomes.

Aims
To understand influenza vaccine hesitance in ethnically minoritised communities in Liverpool from multistakeholder perspectives.

Methods
Semi-structured interviews and focus groups were conducted with members of the public (n = 55), community engagement workers (n = 14), primary healthcare staff (n = 20), and policy professionals (n = 10). Data were analysed thematically.

Results
Six themes were identified. Beliefs about vaccine safety, necessity, and efficacy often arose from misinformation, misunderstanding, or negative experience. Trust in vaccine information depended on source familiarity, credibility, and perceived intentions, while trust in the healthcare system had decreased due to cultural and COVID-19 concerns. Accessibility of accurate vaccine information was poor, due to language and literacy barriers. Community opinions/experience shaped perceptions, while community organisations were trusted but needed resources/stability. Healthcare staff described low morale, time/resource constraints, and uncertainty in addressing cultural concerns. Ultimately, Alliance indicated a desire for better integration between healthcare and communities, particularly for developing/distributing accurate, culturally relevant, and accessible information.

Conclusion
To address influenza vaccine hesitance, stakeholders should collaborate to improve access to reliable information (to support development of pro-vaccine beliefs) via tailored communication and culturally informed training for healthcare staff; aim to increase trust by, for example, ensuring access to familiar staff and employing community members; and foster alliance via long-term support of community organisations through funding, accurate information, and training.

Item Type:	Article
Uncontrolled Keywords:	General Science & Technology
Subjects:	B Philosophy. Psychology. Religion > BF Psychology R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions:	Psychology (from Sep 2019)
Publisher:	Public Library of Science (PLoS)
Date of acceptance:	16 September 2025
Date of first compliant Open Access:	4 November 2025
Date Deposited:	04 Nov 2025 14:53
Last Modified:	04 Nov 2025 15:00
DOI or ID number:	10.1371/journal.pone.0333602
Editors:	Berrou, I
URI:	https://researchonline.ljmu.ac.uk/id/eprint/27488

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