Exploring community health workers' perspectives on recommending influenza vaccination to older adults: a phenomenological study.

Background: Influenza endangers older adults' health and is preventable through vaccination, yet coverage remains suboptimal. Although community health workers (CHWs) are essential to promote influenza vaccine uptake, limited research examines their recommendation behaviours. This study examines the characteristics of CHWs' influenza vaccination recommendation behaviours by investigating their lived experiences and perceptions.

Methods: Under the guidance of the Theory of Planned Behaviour (TPB), this phenomenological study recruited 15 purposively sampled CHWs in Shanghai from November to December 2022. Semi-structured interviews were conducted, and thematic analysis was performed using Colaizzi's seven-step framework with NVivo 12. A 5-point Likert-type question measured vaccination willingness.

Results: Amongst the CHWs, nine were highly willing to recommend, whilst six were willing. Five themes were identified: (i) Ambivalent about expected value and anticipated result, (ii) Conservative to recommend oriented to older people's needs, (iii) Responsive to social expectations and significant others, (iv) Limited by self-ability and realistic condition, and (v) Aware of opportunities and challenges from COVID-19.

Conclusion: CHWs exhibit risk-averse recommendation patterns, prioritizing professional reputation and liability mitigation. This study highlights the need for supportive environments that enable CHWs to adopt proactive recommendation strategies, strengthen reciprocal trust, and leverage new media to enhance vaccination efforts effectively.