Barriers to influenza vaccination in older adults with chronic diseases: Insights from a COM-B model–based meta-analysis

This study investigated barriers to influenza vaccination among older adults with chronic diseases through a systematic review of 21 studies (391 467 participants, 13 countries) following PRISMA guidelines. According to the COM-B framework, barriers in the capability (OR = 1.47), opportunity (OR = 2.07) and motivation (OR = 1.35) dimensions significantly influenced influenza vaccination behaviors. The strongest predictors included no prior vaccination history (OR = 3.17), exposure to negative vaccine advice (OR = 2.96), and limited healthcare utilization (OR = 2.3). Findings emphasize that structural interventions targeting the opportunity dimension-particularly government-funded vaccination programs- exhibit the greatest potential for improving influenza vaccination coverage. Prioritizing policy-level initiatives over individual-level education campaigns may yield more equitable and sustainable outcomes in this high-risk group.