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Kafadar, A.H. (2025) Improving vaccination programmes and experiences for people with dementia and their carers in the United Kingdom. PhD thesis, University of Nottingham.

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Abstract

Introduction

Vaccine hesitancy poses a significant public health challenge. Despite the critical importance of vaccination for protecting People with Dementia (PwD) and their carers from infectious diseases such as COVID-19 and influenza, factors influencing their vaccination decisions remain understudied.

This thesis aimed to investigate vaccination experiences in PwD and their carers to: (1) identify factors affecting vaccine thoughts and behaviours; (2) compare influenza and COVID-19 vaccination experiences; and (3) develop a framework to inform best practice guidelines for future vaccination programmes to reduce vaccine hesitancy and enhance vaccination rates in the United Kingdom.

Methods

The research employed a comprehensive mixed-methods approach, including: an umbrella review of COVID-19 vaccine hesitancy factors (n=31); a systematic review of UK interventions to improve all kinds of vaccine uptake and reduce vaccine hesitancy (n=50); qualitative interviews with people with young-onset dementia and their carers (n=50); a mixed-method online survey of PwD and their carers (n=551), and a Patient Public Involvement (PPI) consultation workshop (n=7) to evaluate findings and develop a framework.

Results

This thesis identified 79 factors associated with vaccine hesitancy in the general population, revealing a significant gap in understanding of dementia-specific considerations. Multidimensional interventions combining organisational, recipient-oriented, and provider-oriented approaches were found to be the most effective in reducing vaccine hesitancy and increasing vaccine uptake. Dementia-specific factors affecting vaccination included physical and emotional challenges during vaccination, additional carer burden, carers' perception of necessity, and concerns about vaccines worsening dementia symptoms. Despite these barriers, vaccination rates among PwD and carers were higher than in the general UK population.

From these findings, a comprehensive framework was developed with six domains for improving vaccination programmes for PwD and their carers: (1) developing structures and procedures; (2) enhancing communication and engagement with PwD and their carers; (3) improving access; (4) knowledge dissemination; (5) developing competencies and attitudes; and (6) designing public health-oriented vaccination programmes.

Conclusion

This thesis demonstrates that addressing vaccine hesitancy in PwD and their carers requires multidisciplinary and individualised approaches. The developed framework takes the first step towards having evidence-based guidance to improve vaccination experiences for PwD and their carers, ensuring equitable and high-quality care for PwD and their carers while providing a foundation for future targeted interventions in vulnerable populations.

Item Type:	Thesis (University of Nottingham only) (PhD)
Supervisors:	Jones, K.A. Dening, T.
Keywords:	Vaccination hesitancy; Dementia; Carers; Vulnerable populations; COVID vaccine; Influenza vaccine
Subjects:	W Medicine and related subjects (NLM Classification) > WA Public health W Medicine and related subjects (NLM Classification) > WT Geriatrics. Chronic disease
Faculties/Schools:	UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID:	81896
Depositing User:	KAFADAR, AYSEGUL
Date Deposited:	31 Dec 2025 04:40
Last Modified:	31 Dec 2025 04:40
URI:	https://eprints.nottingham.ac.uk/id/eprint/81896

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