Understanding barriers and enablers for vaccination against COVID-19 and influenza among healthcare workers: a mixed-methods study nested within the UK SIREN cohort.

Dominic Sparkes; Katie Munro; Atiya Kamal; Jack Haywood; Anna Howells; Sarah Foulkes; Sophie Russell; Naomi Platt; Jonathan Broad; Colin S. Brown; Susan Hopkins; Jasmin Islam; Victoria Hall

doi:10.1136/bmjopen-2025-113889

Understanding barriers and enablers for vaccination against COVID-19 and influenza among healthcare workers: a mixed-methods study nested within the UK SIREN cohort.

Dominic Sparkes
, Katie Munro
, Atiya Kamal
, Jack Haywood
, Anna Howells
, Sarah Foulkes
, Sophie Russell
, Naomi Platt
, Jonathan Broad
, Colin S. Brown
, Susan Hopkins
, Jasmin Islam
, Victoria Hall^*

^*Corresponding author for this work

Birmingham City University

UK Health Security Agency
Public Health Wales

Research output: Contribution to journal › Article › peer-review

1 Citation (SciVal)

Abstract

Objectives To investigate vaccination coverage for influenza and COVID-19 in the SARS-CoV-2 immunity and reinfection evaluation (SIREN) study cohort of healthcare workers (HCWs) between 2020 and 2023 and explore vaccination enablers and barriers.

Design A mixed-methods study nested within SIREN, a multicentre prospective cohort study of HCWs across the UK. Quantitative and qualitative methods were used sequentially, using an expansion/explanation function, enabling emergent themes observed from the quantitative stage to be explored in the qualitative stage.

Setting SIREN sites include secondary care centres and community mental health trusts in the UK.

Participants Quantitative analysis was conducted on data from 6048 participants. Participants were representative of the HCW workforce, with the majority being women (83%) and of white ethnicity (88%). Nurses made up the largest occupational group (33%). Qualitative analysis of data from 24 participants including five focus groups (n=21) and three semistructured interviews (n=3); 82% women, 26% minority ethnic, all working age from across the UK.

Primary outcome measures Quantitative: vaccine coverage for COVID-19 and influenza vaccines by demographic with multivariable logistical regression used to assess differences. Qualitative: thematic analysis to explore reasons behind the results seen in the quantitative stage.

Results COVID-19 vaccination was initially high; 97% received two doses and 94% a first booster. However, coverage was reduced to 77%, for the second booster. Influenza vaccination coverage was lowest in 2020–2021 (46%), increasing to 73% in 2021–2022 and to 79% in 2022–2023. In 2022–2023, vaccination coverage was higher for influenza than for COVID-19. High vaccine coverage for both COVID-19 and influenza was observed in doctors, pharmacists and therapists. Porters, healthcare assistants and staff from minority ethnic groups had lower vaccine coverage for both COVID-19 and influenza. Four themes were identified: (1) attitudes towards vaccination changed throughout the COVID-19 pandemic; (2) HCWs used data to inform vaccination decisions; (3) poor communication in healthcare settings contributed to a reduction in vaccination; (4) there were both positive and negative impacts of the COVID-19 vaccine on influenza vaccine uptake and other vaccination programmes.

Conclusions Between 2020 and 2023 in our cohort, COVID-19 vaccination coverage decreased, whereas influenza increased. Our study found attitudes to both vaccines have shifted, becoming more favourable to influenza and less to COVID-19 boosters. Barriers to COVID-19 boosters, including concerns about side effects and vaccine effectiveness, need to be addressed with improved communication on the benefits and adverse events. Future vaccination strategies should address the differences we have identified in vaccine coverage across demographics and occupational groups, including continued efforts to improve vaccine equity.

Original language	English
Article number	e113889
Journal	BMJ Open
Volume	15
Issue number	12
DOIs	https://doi.org/10.1136/bmjopen-2025-113889
Publication status	Published (VoR) - 17 Dec 2025

Funding

We would also like to thank the help and support offered by the Berkshire Research Ethics Committee and the HDR-UK for winter pressures funding and to UKHSA for core SIREN study funding. Thanks also to all the research team and site staff not mentioned above. The SIREN study was funded by the UK Health Security Agency; the UK Department of Health and Social Care with contributions from the governments in Northern Ireland, Wales and Scotland; the National Institute for Health Research (NIHR200927); Health Data Research UK (HDR UK) (HDRUK2022.0322); and the Medical Research Council (MR/W02067X/1). The funders of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report. We would also like to thank the help and support offered by the Berkshire Research Ethics Committee and the HDR-UK for winter pressures funding and to UKHSA for core SIREN study funding. Thanks also to all the research team and site staff not mentioned above. The SIREN study was funded by the UK Health Security Agency; the UK Department of Health and Social Care with contributions from the governments in Northern Ireland, Wales and Scotland; the National Institute for Health Research (NIHR200927); Health Data Research UK (HDR UK) (HDRUK2022.0322); and the Medical Research Council (MR/W02067X/1). The funders of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report.

Funders	Funder number
Health Data Research UK	HDRUK2022.0322
UK Department of Health and Social Care
National Institute for Health and Care Research	NIHR200927
Medical Research Council	MR/W02067X/1

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Sparkes, D., Munro, K., Kamal, A., Haywood, J., Howells, A., Foulkes, S., Russell, S., Platt, N., Broad, J., Brown, C. S., Hopkins, S., Islam, J., & Hall, V. (2025). Understanding barriers and enablers for vaccination against COVID-19 and influenza among healthcare workers: a mixed-methods study nested within the UK SIREN cohort. BMJ Open, 15(12), Article e113889. https://doi.org/10.1136/bmjopen-2025-113889

@article{486f063b2cde4d01823d0c76991f7264,

title = "Understanding barriers and enablers for vaccination against COVID-19 and influenza among healthcare workers: a mixed-methods study nested within the UK SIREN cohort.",

abstract = "Objectives To investigate vaccination coverage for influenza and COVID-19 in the SARS-CoV-2 immunity and reinfection evaluation (SIREN) study cohort of healthcare workers (HCWs) between 2020 and 2023 and explore vaccination enablers and barriers. Design A mixed-methods study nested within SIREN, a multicentre prospective cohort study of HCWs across the UK. Quantitative and qualitative methods were used sequentially, using an expansion/explanation function, enabling emergent themes observed from the quantitative stage to be explored in the qualitative stage. Setting SIREN sites include secondary care centres and community mental health trusts in the UK. Participants Quantitative analysis was conducted on data from 6048 participants. Participants were representative of the HCW workforce, with the majority being women (83\%) and of white ethnicity (88\%). Nurses made up the largest occupational group (33\%). Qualitative analysis of data from 24 participants including five focus groups (n=21) and three semistructured interviews (n=3); 82\% women, 26\% minority ethnic, all working age from across the UK. Primary outcome measures Quantitative: vaccine coverage for COVID-19 and influenza vaccines by demographic with multivariable logistical regression used to assess differences. Qualitative: thematic analysis to explore reasons behind the results seen in the quantitative stage. Results COVID-19 vaccination was initially high; 97\% received two doses and 94\% a first booster. However, coverage was reduced to 77\%, for the second booster. Influenza vaccination coverage was lowest in 2020{\textendash}2021 (46\%), increasing to 73\% in 2021{\textendash}2022 and to 79\% in 2022{\textendash}2023. In 2022{\textendash}2023, vaccination coverage was higher for influenza than for COVID-19. High vaccine coverage for both COVID-19 and influenza was observed in doctors, pharmacists and therapists. Porters, healthcare assistants and staff from minority ethnic groups had lower vaccine coverage for both COVID-19 and influenza. Four themes were identified: (1) attitudes towards vaccination changed throughout the COVID-19 pandemic; (2) HCWs used data to inform vaccination decisions; (3) poor communication in healthcare settings contributed to a reduction in vaccination; (4) there were both positive and negative impacts of the COVID-19 vaccine on influenza vaccine uptake and other vaccination programmes. Conclusions Between 2020 and 2023 in our cohort, COVID-19 vaccination coverage decreased, whereas influenza increased. Our study found attitudes to both vaccines have shifted, becoming more favourable to influenza and less to COVID-19 boosters. Barriers to COVID-19 boosters, including concerns about side effects and vaccine effectiveness, need to be addressed with improved communication on the benefits and adverse events. Future vaccination strategies should address the differences we have identified in vaccine coverage across demographics and occupational groups, including continued efforts to improve vaccine equity.",

author = "Dominic Sparkes and Katie Munro and Atiya Kamal and Jack Haywood and Anna Howells and Sarah Foulkes and Sophie Russell and Naomi Platt and Jonathan Broad and Brown, \{Colin S.\} and Susan Hopkins and Jasmin Islam and Victoria Hall",

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2025.",

year = "2025",

month = dec,

day = "17",

doi = "10.1136/bmjopen-2025-113889",

language = "English",

volume = "15",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "12",

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Sparkes, D, Munro, K, Kamal, A, Haywood, J, Howells, A, Foulkes, S, Russell, S, Platt, N, Broad, J, Brown, CS, Hopkins, S, Islam, J & Hall, V 2025, 'Understanding barriers and enablers for vaccination against COVID-19 and influenza among healthcare workers: a mixed-methods study nested within the UK SIREN cohort.', BMJ Open, vol. 15, no. 12, e113889. https://doi.org/10.1136/bmjopen-2025-113889

TY - JOUR

T1 - Understanding barriers and enablers for vaccination against COVID-19 and influenza among healthcare workers: a mixed-methods study nested within the UK SIREN cohort.

AU - Sparkes, Dominic

AU - Munro, Katie

AU - Kamal, Atiya

AU - Haywood, Jack

AU - Howells, Anna

AU - Foulkes, Sarah

AU - Russell, Sophie

AU - Platt, Naomi

AU - Broad, Jonathan

AU - Brown, Colin S.

AU - Hopkins, Susan

AU - Islam, Jasmin

AU - Hall, Victoria

PY - 2025/12/17

Y1 - 2025/12/17

N2 - Objectives To investigate vaccination coverage for influenza and COVID-19 in the SARS-CoV-2 immunity and reinfection evaluation (SIREN) study cohort of healthcare workers (HCWs) between 2020 and 2023 and explore vaccination enablers and barriers. Design A mixed-methods study nested within SIREN, a multicentre prospective cohort study of HCWs across the UK. Quantitative and qualitative methods were used sequentially, using an expansion/explanation function, enabling emergent themes observed from the quantitative stage to be explored in the qualitative stage. Setting SIREN sites include secondary care centres and community mental health trusts in the UK. Participants Quantitative analysis was conducted on data from 6048 participants. Participants were representative of the HCW workforce, with the majority being women (83%) and of white ethnicity (88%). Nurses made up the largest occupational group (33%). Qualitative analysis of data from 24 participants including five focus groups (n=21) and three semistructured interviews (n=3); 82% women, 26% minority ethnic, all working age from across the UK. Primary outcome measures Quantitative: vaccine coverage for COVID-19 and influenza vaccines by demographic with multivariable logistical regression used to assess differences. Qualitative: thematic analysis to explore reasons behind the results seen in the quantitative stage. Results COVID-19 vaccination was initially high; 97% received two doses and 94% a first booster. However, coverage was reduced to 77%, for the second booster. Influenza vaccination coverage was lowest in 2020–2021 (46%), increasing to 73% in 2021–2022 and to 79% in 2022–2023. In 2022–2023, vaccination coverage was higher for influenza than for COVID-19. High vaccine coverage for both COVID-19 and influenza was observed in doctors, pharmacists and therapists. Porters, healthcare assistants and staff from minority ethnic groups had lower vaccine coverage for both COVID-19 and influenza. Four themes were identified: (1) attitudes towards vaccination changed throughout the COVID-19 pandemic; (2) HCWs used data to inform vaccination decisions; (3) poor communication in healthcare settings contributed to a reduction in vaccination; (4) there were both positive and negative impacts of the COVID-19 vaccine on influenza vaccine uptake and other vaccination programmes. Conclusions Between 2020 and 2023 in our cohort, COVID-19 vaccination coverage decreased, whereas influenza increased. Our study found attitudes to both vaccines have shifted, becoming more favourable to influenza and less to COVID-19 boosters. Barriers to COVID-19 boosters, including concerns about side effects and vaccine effectiveness, need to be addressed with improved communication on the benefits and adverse events. Future vaccination strategies should address the differences we have identified in vaccine coverage across demographics and occupational groups, including continued efforts to improve vaccine equity.

AB - Objectives To investigate vaccination coverage for influenza and COVID-19 in the SARS-CoV-2 immunity and reinfection evaluation (SIREN) study cohort of healthcare workers (HCWs) between 2020 and 2023 and explore vaccination enablers and barriers. Design A mixed-methods study nested within SIREN, a multicentre prospective cohort study of HCWs across the UK. Quantitative and qualitative methods were used sequentially, using an expansion/explanation function, enabling emergent themes observed from the quantitative stage to be explored in the qualitative stage. Setting SIREN sites include secondary care centres and community mental health trusts in the UK. Participants Quantitative analysis was conducted on data from 6048 participants. Participants were representative of the HCW workforce, with the majority being women (83%) and of white ethnicity (88%). Nurses made up the largest occupational group (33%). Qualitative analysis of data from 24 participants including five focus groups (n=21) and three semistructured interviews (n=3); 82% women, 26% minority ethnic, all working age from across the UK. Primary outcome measures Quantitative: vaccine coverage for COVID-19 and influenza vaccines by demographic with multivariable logistical regression used to assess differences. Qualitative: thematic analysis to explore reasons behind the results seen in the quantitative stage. Results COVID-19 vaccination was initially high; 97% received two doses and 94% a first booster. However, coverage was reduced to 77%, for the second booster. Influenza vaccination coverage was lowest in 2020–2021 (46%), increasing to 73% in 2021–2022 and to 79% in 2022–2023. In 2022–2023, vaccination coverage was higher for influenza than for COVID-19. High vaccine coverage for both COVID-19 and influenza was observed in doctors, pharmacists and therapists. Porters, healthcare assistants and staff from minority ethnic groups had lower vaccine coverage for both COVID-19 and influenza. Four themes were identified: (1) attitudes towards vaccination changed throughout the COVID-19 pandemic; (2) HCWs used data to inform vaccination decisions; (3) poor communication in healthcare settings contributed to a reduction in vaccination; (4) there were both positive and negative impacts of the COVID-19 vaccine on influenza vaccine uptake and other vaccination programmes. Conclusions Between 2020 and 2023 in our cohort, COVID-19 vaccination coverage decreased, whereas influenza increased. Our study found attitudes to both vaccines have shifted, becoming more favourable to influenza and less to COVID-19 boosters. Barriers to COVID-19 boosters, including concerns about side effects and vaccine effectiveness, need to be addressed with improved communication on the benefits and adverse events. Future vaccination strategies should address the differences we have identified in vaccine coverage across demographics and occupational groups, including continued efforts to improve vaccine equity.

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Understanding barriers and enablers for vaccination against COVID-19 and influenza among healthcare workers: a mixed-methods study nested within the UK SIREN cohort.

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