Attitudes, barriers, and facilitators to adherent completion of the recombinant zoster vaccine regimen in Canada: Qualitative interviews with healthcare providers and patients

ABSTRACT

This qualitative, cross-sectional study aimed to understand the barriers and facilitators related to the adherence and completion of the recombinant zoster vaccine (RZV) two-dose series in Canada, as perceived by healthcare providers (HCPs) and patients. Data collection occurred via 60-minute concept elicitation interviews with 12 HCPs (4 physicians, 2 nurse practitioners, 6 pharmacists) who had prescribed and/or administered RZV in Canada, and 21 patients aged ≥50 years who had received ≥1 dose of RZV. Patients were categorized as adherent (received both doses within the recommended 2-to-6-month timeframe; n = 11) or non-adherent (received only one dose or second dose outside the recommended timeframe; n = 10). Interview transcripts were coded and analyzed using a two-part thematic analysis approach. HCP-identified barriers to RZV adherence included high out-of-pocket cost, inconsistent/lack of health plan coverage, inconvenient processes for accessing RZV, and patient forgetfulness. HCP-identified facilitators included desire for shingles protection, HCP encouragement, and reminders. Barriers to RZV adherence identified by patients included lack of HCP knowledge/experience with RZV, receiving unreliable/confusing information, having unpleasant/severe side effects following the first dose, high out-of-pocket cost, lack of insurance coverage, and forgetfulness. Patient-identified facilitators included self-motivation, financial support, convenient processes for obtaining RZV, and reminders. In conclusion, many factors can influence RZV series completion and adherence among adults in Canada, including cost, insurance coverage, HCP knowledge and encouragement, and reminders. Awareness of these factors may inform HCPs in helping patients overcome barriers and identify opportunities for future consideration, facilitating protection against herpes zoster.

GRAPHICAL ABSTRACT

KEYWORDS:

• Canada
• herpes zoster
• vaccines
• varicella zoster virus

Acknowledgments

The authors acknowledge Cindy Umanzor-Figueroa and Bonita Basnyat, former employees of Quality Metric Inc., Johnston, RI, United States, for data management and analysis, and Roeland Van Kerckhoven, GSK, Belgium for publication management. The authors also thank Costello Medical for editorial assistance and publication coordination, on behalf of GSK, and acknowledge Ellie Fung, Costello Medical, UK for medical writing and editorial assistance based on authors’ input and direction.

Disclosure statement

Sydney George, Jessica Regan: Employees of GSK; Amnah Awan: Former employee of GSK and current employee of AbbVie; Meaghan O’Connor, April Foster, Kimberly Raymond: Employees of Quality Metric hired by GSK to conduct the study; Iris Gorfinkel: Received funding from over 60 clinical trials from numerous pharmaceutical companies and clinical research organizations, received funding from the National Institute of Health, received educational grants from GSK and Merck, and sat on the GSK Shingrix Advisory Board; Shelly A McNeil: Received grants and personal fees not related to this work from GSK, Merck, Pfizer, and Sanofi.

Data availability statement

The datasets generated and/or analyzed during the current study are not publicly available due to maintaining participant confidentiality in qualitative interview recordings. Interview guides used are available upon request from the corresponding author.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (WIRB-Copernicus Group Institutional Review Board [tracking number: 20210320; approval granted 1 March 2021]) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Authors’ contributions

Substantial contributions to study conception and design, analysis, or interpretation of the data: Amnah Awan, Meaghan O’Connor, April Foster, Kimberly Raymond, Iris Gorfinkel, Shelly A McNeil; drafting the article or revising it critically for important intellectual content: Sydney George, Jessica Regan, Amnah Awan, Meaghan O’Connor, April Foster, Kimberly Raymond, Iris Gorfinkel, Shelly A McNeil; final approval of the version of the article to be published: Sydney George, Jessica Regan, Amnah Awan, Meaghan O’Connor, April Foster, Kimberly Raymond, Iris Gorfinkel, Shelly A McNeil.

Supplementary data

Supplemental data for this article can be accessed on the publisher’s website at https://doi.org/10.1080/21645515.2024.2317595.

Additional information

Funding

This study was sponsored by GlaxoSmithKline Biologicals SA [Study identifier: 214093]. Support for third-party writing assistance for this article, provided by Costello Medical, was funded by GSK in accordance with Good Publication Practice (GPP) 2022 guidelines (https://www.ismpp.org/gpp-2022).