Facilitators to strengthening vaccine uptake post-pandemic amongst underserved populations considering social norms and health beliefs: a global systematic review

Abstract

Reasons for low vaccine uptake include personal, physical, and societal barriers, which are not well understood for specific underserved communities, particularly ethnic minority and migrant groups. We reviewed gaps to understanding low vaccination uptake in underserved populations globally and summarise key determinants associated with vaccination uptake considering social norms and health beliefs. Methods Published literature was searched using PubMed, MEDLINE, EMBASE; PSYCHINFO and Web of Science from 2020 to 2024 for primary research, with no restrictions on language; to understand uptake of COVID-19 and other vaccinations considering social norms and health beliefs in underserved groups. 55, 925 papers were screened, and 37 studies included from regions including Europe, USA, UK, African, South-Asian, and South-East Asian regions. Findings A total of 37 studies were included. Four themes pertinent to behavioural outcomes were identified in relation to vaccine uptake across ethnic groups, ethnic minority, and underserved groups, including: Influences of Health Belief Systems, Behaviours and Vaccine Uptake; Role of Social and Cultural norms, and Vaccine Uptake; Provision of Information and Vaccine Uptake; and Trust and Vaccine Uptake. We found vaccine uptake was linked with socio-demographic factors, particularly age, gender and ethnicity. There were similarities between first generation migrants and ethnic minority groups from USA or UK, and those from other regions. Younger, male and individuals from rural regions from their own native countries were also less likely to take up vaccination. Societal influences and norms were found to be significant predictors of vaccine uptake. Discussion We reviewed, how social norms and health beliefs interplay with vaccine uptake in underserved groups and report facilitators to overcome vaccine hesitancy across these population groups. There is a need to provide adequate, tailored information to combat misinformation, through trusted messengers or gatekeepers to overcome the misconceptions around vaccine, by gaining the trust of underserved groups. Discussion This review provides an overview of how social norms and health beliefs interplay with vaccine uptake in underserved and ethnic groups. It reports facilitators to overcome the barriers associated with vaccine hesitancy across these population groups. There is a need to provide and spread adequate and tailored information to combat misinformation, through trusted messengers or gatekeepers, which in turn could overcome misconceptions around vaccination, by gaining the trust of underserved groups, through support programmes facilitating vaccine uptake.