Barriers and facilitators to RSV vaccine acceptance among pregnant women and older adults in Hong Kong: a qualitative study guided by the Theoretical Domains Framework

Respiratory syncytial virus (RSV) poses a significant health risk to pregnant women, infants, and older adults, yet vaccine uptake remains suboptimal globally. This study aimed to explore the barriers and facilitators influencing RSV vaccine acceptance among pregnant women and older adults in Hong Kong. A qualitative design was employed, involving semi-structured interviews with pregnant women and older adults in Hong Kong. The interview guide was informed by the Theoretical Domains Framework (TDF) to capture behavioural determinants across 14 domains. Data were analyzed using thematic analysis, combining deductive coding based on TDF domains with inductive identification of emergent themes. Barriers and facilitators were further categorized to facilitate interpretation. Of the 24 participants included in this study, 9 expressed willingness to receive RSV vaccination, while 15 expressed unwillingness. Commonly reported barriers included financial concerns, worries about potential side effects, and limited knowledge about RSV and its vaccines. Trust in healthcare professionals and government authorities was commonly recognized as a facilitator. Additional facilitators included the availability of fee waivers or subsidies, access to more comprehensive vaccine information, and influence from community members, family, and friends. Knowledge gaps, safety concerns, financial considerations, and social influence were recurring themes in RSV vaccination decision-making, while trust in healthcare providers and government authorities was a salient facilitator. Future research should apply behavioural frameworks to design and evaluate targeted interventions that can be scaled within Hong Kong’s healthcare system.