D102-15 Factors Associated With Vaccine Decision Making - A Qualitative Study Among Patients With Chronic Lung Disease

Abstract Rationale Vaccines are vital to preventative medicine, but vaccine uptake is highly variable and is influenced by several factors. As part of an initiative by the Centers for Disease Control and Prevention and Council of Medical Specialty Services to increase vaccination rates among vulnerable populations, the American Thoracic Society funded 8 health systems to study and implement change to increase vaccine uptake. As part of this initiative, we sought to understand how patients with chronic lung diseases approach decision making surrounding vaccination with the goal of optimizing vaccine counseling and education in clinic. Methods We conducted in-person and telephone-based patient semi-structured interviews among adult pulmonary clinic patients in an urban safety-net health system between September 2024 - April 2025. Participants were invited to participate via a phone call 1-2 weeks after a clinic visit. Participants were categorized as fully (had received both influenza and COVID-19 vaccines in the preceding three years) or partially vaccine accepting (had received one of the two) or fully hesitant (had received neither). Interview questions assessed participants’ perspectives on why they chose to receive or decline influenza and COVID-19 vaccines. Thematic analysis was conducted using inductive and deductive strategies. Results Eighteen interviews were conducted and were split evenly between fully vaccine accepting, partially vaccine accepting and fully vaccine hesitant patients (n = 6 in each group). Qualitative analysis (see themes in Table 1) revealed that vaccine acceptance was motivated by several factors, including fear of illness, work or family mandates, and altruism. In risk-benefit analyses, these influences outweighed perceived risks related to vaccines and ultimately led to vaccination. In partially or fully vaccine hesitant participants, there was medical mistrust surrounding vaccine development. Participants described feeling betrayed if they were vaccinated but still fell ill. All participants were willing to discuss vaccines with physicians, though vaccine hesitant patients described feeling that there was less counseling surrounding vaccination after they declined a vaccine. They were also more likely to seek out vaccine information from other sources including web-based resources and personal contacts. All participants felt they could access vaccines easily if they wished. Conclusions Decision-making surrounding vaccines for patients with chronic lung diseases was complex and multifactorial. Future work should focus on improving vaccine education strategies within the clinic and providing information in varied formats to meet the needs of our patient population. Implementation-focused efforts are essential to assess practical, sustainable approaches for integrating these strategies into routine clinical care. This abstract is funded by: CDC, T32 HS029585