The Impact of Interpersonal Processes on Vaccination Behaviors Among Hispanic Older Adults

Background and Purpose: Immunizations are crucial in preventing infectious diseases. However, recent data underscores disparities in vaccine uptake among Hispanics compared to other racial and ethnic groups. Only 24% of Hispanic individuals received the primary series of COVID-19 vaccines, contrasting with 38% of non-Hispanic White individuals. Similar patterns exist for influenza. Given the protective benefits of vaccines and the heightened vulnerability of Hispanic populations to infectious disease morbidity and mortality, reducing vaccine hesitancy among Hispanic older adults is crucial. Additionally, older adults are particularly susceptible due to the higher prevalence of chronic diseases. In 2020, older adults accounted for 53% of COVID-19-related hospitalizations and 80% of deaths, with similar trends in influenza mortality rates. Family and friends significantly influence older adults' vaccination behaviors, acting as sources of trust, information, and support, yet the extent of this influence among Hispanic older adults remains unclear. This review examines the role of interpersonal processes in vaccine behaviors among older Hispanic adults.

Methods: A systematic review using JBI methodology identified relevant literature. Inclusion criteria included English or Spanish articles, books, reports, and dissertations focusing on interpersonal processes' influence on vaccine behaviors among older Hispanic adults in the United States. All familial configurations were considered, with older adults defined as those aged 55 and above. The search spanned multiple databases, including MEDLINE (PubMed), PsycINFO (Ovid), Embase, CINAHL (EBSCOhost), AgeLine, ProQuest Social Sciences, and ProQuest dissertations. Two reviewers independently screened titles, abstracts, and full texts, with conflicts resolved through discussion. Eligible studies were critically appraised for methodological quality, and findings were synthesized and evaluated according to a predetermined protocol

Results: The systematic search identified 4,435 records, with 44 undergoing full-text review. Ultimately, 18 studies met the inclusion criteria, focusing on Hispanic older adults. Four themes emerged from the findings: i) Risk and Safety, ii) Advice Receiving and Emotional Support, iii) Sub-Groups and Intersections, and iv) Cultural Factors. Perceptions of vaccination risk and safety were crucial in 12 out of 18 studies. Emotional support from family and friends significantly influenced vaccine uptake in 12 of 18 studies. Cultural factors such as familismo and acculturation were key determinants of vaccination uptake in 8 out of 18 studies. However, only 5 studies reported results on the intersection of age and ethnicity, indicating a need for further research within this demographic. Lastly, none of the 4 studies that included sub-group samples synthesized results by group.

Conclusions and Implications: The findings underscore the pivotal role of interpersonal dynamics in shaping vaccine behaviors among Hispanic older adults. Family and social networks serve as influential factors in forming attitudes and behaviors related to vaccination. Addressing the heterogeneity within the Hispanic population of cultural considerations is paramount in designing effective interventions to promote vaccination uptake within this demographic. By focusing on interpersonal processes, interventions can be better targeted and more effective in addressing the unique needs of this population, ultimately contributing to improved public health outcomes and reduced burden of infectious diseases.