Vaccination uptake amongst older adults from minority ethnic backgrounds: A systematic review.

BACKGROUND: Older adults from minority ethnic backgrounds are at increased risk of contracting COVID-19 and developing severe infection and have increased risk of mortality. Whilst an age-based vaccination approach prioritising older groups is being implemented worldwide, vaccine hesitancy is high amongst minority ethnic groups. METHODS AND FINDINGS: We conducted a systematic review and convergent synthesis to systematically examine perceptions of vaccinations amongst older adults from minority ethnic backgrounds. We included studies that reported on perceptions, beliefs, and attitudes towards vaccinations in older adults aged ≥65 years from a minority ethnic background. We excluded studies of vaccinations in investigation or development, studies focused on specific medical conditions, studies where ethnic background or age group was unidentifiable, systematic reviews, editorials, and conference abstracts. We searched MEDLINE, Embase, Virtual Health Library, Web of Science, Cochrane Library, medRxiv, and PROSPERO databases from inception to 15 July 2021. Risk of bias for studies was assessed using the Mixed Methods Appraisal Tool. The quality of evidence of collective outcomes was estimated using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) framework. A total of 28 eligible studies conducted between 1997 and 2020 were included in the final analysis (17 quantitative surveys, 8 focus group or interview studies, 2 mixed methods studies, and 1 case-control study). The majority were US studies in English or Spanish, except for 6 studies set in Hong Kong, 2 studies in Japan, 1 study in Brazil, and 1 multi-centre study (including China, Indonesia, Turkey, South Korea, Greece, UK, Brazil, and Nigeria). In total, 28,262 individuals with an estimated mean age of 69.8 years were included, 63.2% of whom were female. We summarised the common concepts and themes across studies and populations using a convergent synthesis analysis. Thirteen themes categorised as barriers or facilitators were identified and grouped into structural factors-healthcare provider and system related, patient related, and policy and operational-and were analysed by minority ethnic group. The main limitation of the study was the predominance of studies from the US and East Asia. CONCLUSIONS: In this systematic review, we found that factors influencing vaccination uptake involve healthcare provider and system, patient-related, and governance-level factors that are specific to the older ethnic minority community being served. The evidence included in this review is supported by high or moderate certainty and can be translated to practice and policy. A tailored, multi-level approach combining increased education, access, and culturally competent discussions with trusted healthcare professionals to address health beliefs can maximise the potential impact of widespread vaccination policies.

'It's like juggling fire daily': Well-being, workload and burnout in the British NHS - A survey of 721 physicians.

BACKGROUND: Physicians are at higher risk for burnout than workers in other fields. Burnout negatively impacts physician health, care delivery and healthcare cost. Existing studies quantify the workforce affected by burnout whilst qualitative studies use specific specialty groups limiting generalisability of solutions. This is important given increased stress during the COVID-19 pandemic. OBJECTIVE: The study aimed to understand the causes of work-related burnout, identify what supportive resources physicians utilise, and to propose solutions. METHODS: A questionnaire was circulated between March and May 2019 via the 'Doctors' Association UK' website and social media. RESULTS: 721 responses were received. 94%of respondents worked in the NHS, with over half being either general practitioners (GPs) or consultants. One in two (53%) respondents felt unable to raise workplace concerns regarding wellbeing, stress or workload. Almost all respondents (97%) felt the NHS has a culture of viewing excessive stress and workload as the norm. Three themes emerged from qualitative analysis: negative workplace culture; high workload and lack of resources; and generational change. CONCLUSIONS: Respondents described system-level factors which negatively impacted their wellbeing whilst organisations focused on physician-level factors. The research literature supports multi-level change beyond the individual tackling work unit and organisational factors. These include providing infrastructure to allow delegation of administrative work and physical space for relaxation and flexible work with time for leave. At a national level, there is greater urgency for an increase in healthcare funding and resourcing especially during increased clinician workloads during a pandemic where burnout rates will increase.