TABLE 3.
CERQual summary of qualitative findings
| Summary of review findings | Studies contributing to the review finding | Finding classification | Infectious respiratory diseases | GRADE-CERQual assessment of confidence in the evidence | Explanation of GRADE-CERQual assessment |
| Previous knowledge about diseases | |||||
| Lack of knowledge and familiarity with the disease | [45, 47, 71, 74, 89–91] | Barrier | COVID-19 Influenza TB |
High confidence | Included 7 studies. Minor concerns regarding methodological limitations. No or very minor concerns regarding coherence, adequacy and relevance. |
| Awareness about the seriousness of the outbreak | [38, 45, 47, 55, 60, 65, 68, 69, 78, 90, 93, 94, 97, 101, 102] | Facilitator | COVID-19 Influenza Pneumonia TB |
High confidence | Included 15 studies. Minor concerns regarding methodological limitations. No or very minor concerns regarding coherence, adequacy and relevance. |
| Absence or low perceived need to wear facemasks | [36, 46, 54, 62, 69, 78, 82] | Barrier | COVID-19 Influenza |
Moderate confidence | Included 7 studies. Moderate concerns regarding methodological limitations. |
| Knowledge about transmission of infectious respiratory diseases | [32, 40, 46, 49, 52, 60, 69, 78, 94] | Facilitator | COVID-19 Influenza |
Moderate confidence | Included 9 studies. Moderate concerns regarding methodological limitations. |
| Financial aspects | |||||
| Food and financial insecurity limiting adherence to nonpharmaceutical measures | [32, 37, 53, 58, 60, 82, 85, 87, 88, 90–94, 98] | Barrier | COVID-19 TB |
High confidence | Included 15 studies. Minor concerns regarding methodological limitations. No or very minor concerns regarding coherence, adequacy and relevance. |
| Food and financial insecurity limiting adherence to pharmacological treatment | [83, 84, 90, 91, 96, 102] | Barrier | TB | High confidence | Included 6 studies. Minor concerns regarding methodological limitations. No or very minor concerns regarding coherence, adequacy and relevance. |
| Financial and social support for pharmacological treatment | [56, 83, 90, 91, 93] | Facilitator | TB | Moderate confidence | Included 5 studies. Minor concerns regarding methodological limitations and adequacy. |
| Financial and social support for nonpharmaceutical measures | [32, 40, 51, 60, 80, 81, 87, 88, 98] | Facilitator | COVID-19 | Moderate confidence | Included 9 studies. Moderate concerns regarding methodological limitations. |
| Access to information | |||||
| Awareness about vaccination's benefits, safety and effectiveness | [35, 45, 55, 65, 69, 75, 99, 101] | Facilitator | Influenza Pneumonia Pertussis | High confidence | Included 8 studies. Minor concerns regarding methodological limitations. No or very minor concerns regarding coherence, adequacy and relevance. |
| Pre-warning from healthcare providers regarding how to cope with side-effects from vaccines | [35, 44, 74, 101] | Facilitator | Influenza COVID-19 Pneumonia |
High confidence | Included 4 studies. Minor concerns regarding methodological limitations. No or very minor concerns regarding coherence, adequacy and relevance. |
| Difficulties in accessing information via digital technologies | [32, 58, 64, 72, 82, 100] | Barrier | COVID-19 | High confidence | Included 6 studies. Minor concerns regarding methodological limitations. No or very minor concerns regarding coherence, adequacy and relevance. |
| Campaigns for pro-vaccination in social media and television, in addition to written or visual media | [35, 44, 45, 55, 58, 73, 99, 101] | Facilitator | COVID-19 Influenza Pneumonia Pertussis |
High confidence | Included 8 studies. Minor concerns regarding methodological limitations. No or very minor concerns regarding coherence, adequacy and relevance. |
| Misperceptions about vaccines' role, formulation process, testing, targets and vaccination protocols | [34, 35, 38, 42–45, 47, 48, 50, 55, 57–59, 65, 69, 71, 73, 74, 77, 79] | Barrier | COVID-19 Influenza Pneumonia Pertussis |
Moderate confidence | Included 21 studies. Moderate concerns regarding methodological limitations. |
| Lack of knowledge regarding government support for getting vaccinated and misperceptions about vaccine cost | [34, 35, 55, 69, 71, 75] | Barrier | COVID-19 Influenza Pneumonia |
Moderate confidence | Included 6 studies. Minor concerns regarding methodological limitations and adequacy. |
| Insufficient information and fake news about nonpharmaceutical measures | [32, 36, 39, 40, 46, 48, 52–54, 56, 58, 60, 62–64, 67, 69, 76, 78, 82, 85, 86, 95, 97, 100] | Barrier | COVID-19 Influenza Pneumonia TB |
Moderate confidence | Included 25 studies. Major concerns regarding methodological limitations. |
| Misperceptions about vaccines' effectiveness, safety and side effects | [33, 35, 38, 42, 45, 55, 57, 58, 61, 65, 70, 71, 73–75, 77, 101] | Barrier | COVID-19 Influenza Pneumonia Pertussis |
Low confidence | Included 17 studies. Moderate concerns regarding methodological limitations. Minor concerns regarding coherence. |
| Lack of knowledge about vaccine availability | [34, 41, 69, 74, 77, 99] | Barrier | COVID-19 Influenza Pneumonia |
Low confidence | Included 6 studies. Moderate concerns regarding methodological limitations. Minor concerns regarding adequacy. |
| Fake news (misinformation and disinformation) about vaccines | [35, 45, 58, 77, 79] | Barrier | COVID-19 Influenza Pneumonia |
Low confidence | Included 5 studies. Minor concerns regarding methodological limitations, coherence and adequacy. |
| Quality information released by religious leaders | [86, 99] | Facilitator | COVID-19 Influenza |
Very low confidence | Included 2 studies. Major concerns regarding adequacy due to limited information. Minor concerns regarding methodological limitations. |
| Quality information on nonpharmaceutical measures on specialist websites, social media and television | [39, 98] | Facilitator | COVID-19 | Low confidence | Included 2 studies. Moderate concerns regarding methodological limitations and adequacy. |
| Sense of collective responsibility | |||||
| The sense of collective responsibility to protect self and others through nonpharmaceutical measures | [37, 39, 46–50, 52, 53, 56, 60, 62, 67, 68, 72, 76, 78, 80, 98] | Facilitator | COVID-19 Influenza TB |
High confidence | Included 19 studies. Minor concerns regarding methodological limitations. No or very minor concerns regarding coherence, adequacy and relevance. |
| Positive attitudes and engagement with vaccination to maintain health and protect others | [34, 35, 38, 41–43, 45, 55, 59, 69, 70, 74, 94, 99, 101] | Facilitator | COVID-19 Influenza Pneumonia |
Moderate confidence | Included 15 studies. Moderate concerns regarding methodological limitations. |
| Indiscipline and lack of collective responsibility for other people | [32, 39, 40, 46, 50, 52–54, 60, 62, 63, 67, 68, 76, 81, 86, 92, 98, 100] | Barrier | COVID-19 | Moderate confidence | Included 19 studies. Moderate concerns regarding methodological limitations. |
| Accessibility and availability of measures | |||||
| Access barriers and conflicts of time to take the vaccination | [34, 35, 45, 55, 57, 58, 61, 70, 71, 73, 74, 79, 99] | Barrier | COVID-19 Influenza Pneumonia Pertussis |
High confidence | Included 13 studies. Minor concerns regarding methodological limitations. No or very minor concerns regarding coherence, adequacy and relevance. |
| Easily accessible locations for vaccination and pharmacological treatment | [35, 41, 61, 73, 83, 91] | Facilitator | Influenza Pneumonia Pertussis TB |
Moderate confidence | Included 6 studies. Moderate concerns regarding methodological limitations. |
| Need to travel to have access to pharmaceutical and nonpharmaceutical measures | [32, 50, 51, 84, 91, 93, 102] | Barrier | COVID-19 TB | High confidence | Included 7 studies. Minor concerns regarding methodological limitations. |
| Logistical difficulties in acquiring facemasks | [32, 78] | Barrier | COVID-19 Influenza |
Moderate confidence | Included 2 studies. Minor concerns regarding methodological limitations and adequacy. |
| The practicality of hand hygiene (handwashing and antiseptics) | [60, 69] | Facilitator | COVID-19 Influenza |
Low confidence | Included 2 studies. Moderate concerns regarding methodological limitations. Minor concerns regarding coherence and adequacy. |
| The availability of facemasks | [32, 40] | Facilitator | COVID-19 | Very low confidence | Included 2 studies. Major concerns regarding methodological limitations. Moderate concerns regarding adequacy. |
| Psycho-cognitive factors | |||||
| Fear of vaccination (e.g. fear of injections, pain and side-effects) | [35, 41, 45, 50, 55, 57, 61, 71, 74, 75, 99] | Barrier | COVID-19 Influenza Pneumonia Pertussis |
High confidence | Included 11 studies. Minor concerns regarding methodological limitations. No or very minor concerns regarding coherence, adequacy and relevance. |
| Forgetting to use nonpharmaceutical measures | [46, 62, 72, 76, 78, 80, 82] | Barrier | COVID-19 Influenza |
High confidence | Included 7 studies. Minor concerns regarding methodological limitations. No or very minor concerns regarding coherence, adequacy and relevance. |
| Fear of stigmatisation | [46, 52, 56, 58, 82–85, 87, 89–93] | Barrier | COVID-19 TB | Moderate confidence | Included 14 studies. Minor concerns regarding methodological limitations and coherence. |
| Personal beliefs against the adoption of nonpharmaceutical measures | [32, 46, 53, 54, 58, 60, 62, 69, 82, 84, 87, 89, 91–93] | Barrier | COVID-19 Influenza TB |
Moderate confidence | Included 15 studies. Moderate concerns regarding methodological limitations. |
| Individual perceptions of self-defence and self-efficacy with own health | [34, 35, 38, 43, 45, 55, 58, 65, 71, 73–75, 79, 100, 101] | Barrier | COVID-19 Influenza Pneumonia Pertussis |
Moderate confidence | Included 15 studies. Minor concerns regarding methodological limitations and coherence |
| Fatalism | [69, 70, 74] | Barrier | COVID-19 Influenza |
Low confidence | Included 3 studies. Minor concerns regarding methodological limitations. Moderate concerns regarding adequacy. |
| Lack of social interaction and physical contact | [32, 37, 52–54, 60, 62, 63, 68, 69, 76, 82, 84, 85, 87, 92, 93, 100] | Barrier | COVID-19 Influenza TB |
Moderate confidence | Included 18 studies. Moderate concerns regarding methodological limitations. |
| Health policies | |||||
| Dissatisfaction with supportive policies, health services and professional care | [32, 53, 56, 58, 60, 66, 68, 82–85, 87–91, 93, 94] | Barrier | COVID-19 TB | High confidence | Included 18 studies. Minor concerns regarding methodological limitations. No or very minor concerns regarding coherence, adequacy and relevance. |
| Dissatisfaction related to pharmacological treatment regimen and healthcare | [56, 84, 90, 91, 96, 102] | Barrier | TB | Moderate confidence | Included 6 studies. Minor concerns regarding methodological limitations, adequacy and relevance. |
| Free vaccine or government financial support for vaccinating | [35, 45, 55, 70, 71, 75] | Facilitator | COVID-19 Influenza Pneumonia |
Moderate confidence | Included 6 studies. Minor concerns regarding methodological limitations and adequacy. |
| The direct or indirect warning to wear facemasks and physical distancing (e.g. social pressure, the example of other people) | [40, 46, 48, 49, 63, 68, 69, 78, 87] | Facilitator | COVID-19 Influenza |
Moderate confidence | Included 9 studies. Moderate concerns regarding methodological limitations. |
| Contact tracing measures and testing | [32, 53, 72, 80] | Facilitator | COVID-19 | Low confidence | Included 4 studies. Minor concerns regarding methodological limitations. Moderate concerns regarding adequacy. |
| Lack of obligation and monitoring for adherence to nonpharmaceutical measures | [39, 40, 62, 64, 67, 76, 92, 93, 95, 100] | Barrier | COVID-19 TB | Low confidence | Included 10 studies. Major concerns regarding methodological limitations. |
| Socio-environmental factors | |||||
| Poor sanitation conditions, access to water and housing | [32, 51, 52, 54, 60, 76, 82, 85, 87, 88, 91, 94, 95, 97, 98, 102] | Barrier | COVID-19 TB | High confidence | Included 16 studies. Minor concerns regarding methodological limitations. No or very minor concerns regarding coherence, adequacy and relevance. |
| Impossibility of working from home | [37, 52, 54, 60, 62, 85, 98] | Barrier | COVID-19 | High confidence | Included 7 studies. Minor concerns regarding methodological limitations. No or very minor concerns regarding coherence, adequacy and relevance. |
| Cultural differences and communication problems to follow guidelines for nonpharmaceutical measures | [39, 53, 58, 60, 64, 67, 68, 82, 87, 100] | Barrier | COVID-19 | High confidence | Included 10 studies. Minor concerns regarding methodological limitations. No or very minor concerns regarding coherence, adequacy and relevance. |
| Difficulties with breathing, discomfort and social inconvenience with the use of facemasks | [36, 46, 69, 76, 78] | Barrier | COVID-19 Influenza |
Moderate confidence | Included 5 studies. Moderate concerns regarding methodological limitations. |
| Personal factors (e.g. ethnicity, anti-vaccination groups and deprived areas) | [50, 73, 94] | Barrier | COVID-19 Pertussis |
Low confidence | Included 3 studies. Minor concerns regarding methodological limitations. Moderate concerns regarding adequacy. |
| Cultural differences and communication problems to vaccination | [44, 58, 59, 79, 94] | Barrier | COVID-19 Influenza Pneumonia |
Low confidence | Included 5 studies. Minor concerns regarding methodological limitations. Moderate concerns regarding adequacy. |
| Difficulties in adopting physical distancing and self-isolation in crowded places and public transport | [37, 39, 48, 51, 53, 54, 68, 76, 95, 97] | Barrier | COVID-19 | Moderate confidence | Included 10 studies. Moderate concerns regarding methodological limitations. |
| Social role in the family structure and household dynamics | [52, 54, 64, 66, 68, 93] | Barrier | COVID-19 TB | High confidence | Included 6 studies. Minor concerns regarding methodological limitations and adequacy. |
| Self-perception of susceptibility | |||||
| Perception of personal and environmental vulnerability | [35, 41, 45, 55, 64, 67, 68, 74, 75, 101] | Facilitator | COVID-19 Influenza Pneumonia |
High confidence | Included 10 studies. Minor concerns regarding methodological limitations. None or very minor concerns regarding coherence, adequacy and relevance. |
| Scepticism, conspiracy theories, and scientific denialism | [32, 33, 35, 38, 40, 41, 43, 46, 52–55, 58–60, 62, 65, 68, 69, 72–74, 76, 79, 82, 87, 88, 94, 95, 98–101] | Barrier | COVID-19 Influenza Pneumonia Pertussis |
High confidence | Included 34 studies. Moderate concerns regarding methodological limitations. |
| Trust in authorities, health professionals and close people | |||||
| Lack of recommendations from health professionals to take the vaccine | [34, 35, 43, 44, 47, 50, 55, 57–59, 61, 65, 71, 73, 74, 77, 79, 101] | Barrier | COVID-19 Influenza Pneumonia Pertussis |
High confidence | Included 18 studies. Minor concerns regarding methodological limitations. No or very minor concerns regarding coherence, adequacy and relevance. |
| Faith and positive attitudes of engagement for adopting prevention and control measures | [32, 37, 46, 52, 53, 56, 60, 65, 68, 72, 87, 98] | Facilitator | COVID-19 Influenza Pertussis TB |
High confidence | Included 12 studies. Minor concerns regarding methodological limitations. No or very minor concerns regarding coherence, adequacy and relevance. |
| Recommendations from health professionals, religious leaders or family members to avoid the vaccine | [35, 41, 45, 55, 58, 71, 73, 75, 99] | Barrier | COVID-19 Influenza Pertussis Pneumonia |
High confidence | Included 9 studies. Minor concerns regarding methodological limitations. No or very minor concerns regarding coherence, adequacy and relevance. |
| Previous and successful experience with vaccination | [71, 74, 77, 94] | Facilitator | COVID-19 Influenza Pneumonia |
High confidence | Included 4 studies. Minor concerns regarding methodological limitations. No or very minor concerns regarding coherence, adequacy and relevance. |
| Vaccine recommendations from clinicians and encouragement by nurses, family members and friends | [34, 35, 38, 41–45, 55, 59, 61, 65, 69, 71, 73–75, 99, 101] | Facilitator | COVID-19 Influenza Pneumonia Pertussis |
Moderate confidence | Included 19 studies. Moderate concerns regarding methodological limitations. |
| Previous unfortunate experiences with vaccination, healthcare providers or other health services | [33, 35, 42, 59, 73, 74, 101] | Barrier | Influenza, Pneumonia Pertussis |
Moderate confidence | Included 7 studies. Moderate concerns regarding methodological limitations. |
| Encouragement of health professionals, family and friends to adhere to pharmacological treatment | [56, 89–91, 102] | Facilitator | TB | Moderate confidence | Included 5 studies. Minor concerns regarding methodological limitations and adequacy. |
| Trust in health, political and religious authorities for adopting nonpharmaceutical measures | [32, 39, 40, 46, 48, 49, 53, 60, 85, 86, 92] | Facilitator | COVID-19 | Moderate confidence | Included 11 studies. Moderate concerns regarding methodological limitations. |
Objective: to identify, appraise and synthesise qualitative research evidence on the barriers to and facilitators of population adherence to prevention and control measures of coronavirus disease 2019 (COVID-19) and other respiratory infectious diseases. Perspective: experiences and attitudes of the population about prevention and control measures of COVID-19 and other respiratory infectious diseases. GRADE-CERQual: Grading of Recommendations, Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research; TB: tuberculosis.