In Canada, 10,000 hospitalizations and 3,000 deaths are attributed annually to influenza in older adults (ie. > 65 years old). They are a high-risk group which represents 14% of the Canadian population. The annual uptake of influenza vaccine among older adults remains approximately 70%, which is below the recommended 80% target set by the National Advisory Committee on Immunization (NACI). This sub-optimal vaccine coverage elevates the health risk in this population, with increased comorbidity complications, emergency hospitalization, secondary pneumonia, and flu-related deaths. The Influenza vaccine have been proven to be the most effective way of avoiding influenza-related health complications. The scope of this project is to assess and verify the factors that contribute to vaccination hesitancy (ie. refusal or reluctance for vaccination) in older adults, and subsequently to ideate and co-create a targeted strategy to increase vaccine uptake. This will be conducted in three phases; a quantitative phase, a qualitative phase, and a co-creation of a targeted strategy. The Toronto Translational Framework will be used to discover and define the needs to frame the problem space. This project has received approval from the Research Ethics Board of the University of Toronto. An electronic survey was created using a validated survey questionnaire from the World Health Organisation - Strategic Advisory Group of Experts on Immunization. It was distributed online using the survey monkey platform through our stakeholders’ network (National Initiative for the Care of the Elderly) in order to understand the knowledge, attitudes, behaviors, and barriers associated with influenza vaccination. A total of 80 survey responses across Canada were used for analysis. The inclusion criteria included older adults more than 65 years of age from the general population, who are residents of Canada and understand English. Preliminary results demonstrate that 95% of responders agree that vaccines are a good way to protect personal and population health, yet 37% disagree that vaccines are effective. Almost all respondents agree that Influenza is a serious disease, however 20% believe there is insufficient evidence that vaccination prevents influenza. Although 91% had easy access to the influenza vaccine, 12% are opposed to receiving the influenza vaccine for religious reasons (12%), influence from other people (12%), or for medical reasons (4%). Other reasons for vaccine hesitancy include perceived side effects, vaccine ineffectiveness, and belief in alternative ways for preventing influenza. These results will assist us in understanding the needs and barriers associated with influenza vaccination.
Subsequently, these findings will be validated through a focus group (n=10) and participants will be encouraged to share their thoughts and personal experiences of the factors contributing to vaccination hesitancy. The interviews will be conducted by three researchers to ensure reflexivity, followed by member checking and analysed using the Quirkos software to elucidate thematic nodes. The biggest barrier will be validated by the focus group session. Using the Toronto Translational Framework, we will ideate with our stakeholder and co-create a targeted strategy focusing on increasing influenza vaccine uptake. Implementing this strategy will provide better health outcomes by increasing vaccine coverage to the recommended NACI goal of 80% for optimum immunity.

Capstone Team: 

Muhammad Ibrar Mustafa
Peter Papageorgiou
Eric Rotgaus


Capstone Advisory Committee:

No items found


TRP Faculty Lead:

Dr. Joseph Ferenbok