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Abstract Background In June 2009, the World Health Organization declared an A(H1N1) influenza pandemic. In October 2009, the largest vaccination campaign in Canadian history began. The aim of this study was to document paediatricians' knowledge, attitudes and practices (KAP) regarding A(H1N1) pandemic influenza and its prevention by vaccination just after the beginning of the A(H1N1) vaccination campaign and to compare the results with those obtained before campaign initiation. Methods A self-administered mail-based questionnaire was sent to all Canadian paediatricians. Questionnaires were analyzed in two subsets: those received before and after the beginning of the vaccination campaign. Results Overall the response rate was 50%. Respondents' characteristics were comparable between the two subsets. Before the beginning of the campaign, 63% of paediatricians perceived A(H1N1) pandemic infection as a serious disease, that would occur frequently without vaccination compared to more than 75% after. Before the vaccination campaign, half of respondents or less thought that the A(H1N1) vaccine was safe (50%) and effective (35%) compared to 77% and 72% after. The proportion of paediatricians who reported they had received sufficient information on A(H1N1) vaccine increased from 31% before to 73% after the beginning of the vaccination campaign. The majority of respondents intended to get vaccinated against A(H1N1) influenza themselves (84% before and 92% after). Respondents' intention to recommend the A(H1N1) vaccine to their patients increased from 80% before the beginning of the campaign to 92% after. In multivariate analysis, the main determinants of paediatricians' intention to recommend the A(H1N1) vaccine were their intention to get vaccinated against A(H1N1) influenza themselves and a belief that A(H1N1) vaccine would be well accepted by health professionals who administer vaccines to the public. Conclusion Results of this study show important increases in physicians' level of confidence about A(H1N1) vaccine's safety and immunogenicity and their willingness to recommend this vaccine to their patients. These changes could be explained, at least partially, by the important effort done by public health authorities to disseminate information regarding A(H1N1) vaccination.

Abstract Background The negative consequences of acute otitis media (AOM) on the quality of life (QOL) of children and their families need to be measured to assess benefits of preventive interventions. Methods A new questionnaire was specifically designed for use in telephone surveys. A random sample of Canadian families was selected using random-digit dialling. Caregivers of children 6-59 months of age who experienced at least one AOM episode during the last 12 months were interviewed. Multidimensional severity and global QOL scores were measured both for affected children and their caregivers. Internal consistency of scores was assessed using standard tests. Results Of the 502 eligible caregivers who completed the survey, 161 (32%) reported at least one AOM episode during the last 12 months and these cases were included in the analysis. Average severity was 2.6 for children and 2.4 for caregivers on a 1 to 4 scale (maximum severity). Cronbach alpha values were 0.78 and 0.81 for the severity score of children and caregivers respectively. Average QOL was 3.4 for children and 3.5 for caregivers on a 1 to 5 scale (best QOL). There was moderate to high correlation between severity and QOL scores, and between these scores and duration of AOM episodes. Conclusions The questionnaire was easy to use during telephone interviews and results suggest good reliability and validity of the different scores to measure AOM severity and QOL of children and their caregivers during an AOM episode.

Abstract Background One of the main determinants of public immunization success is health professionals' support and recommendations. Little is known about the physicians' level of support and intentions regarding A(H1N1) pandemic influenza vaccination. The aim of this survey was to document Canadian family physicians' and paediatricians' knowledge, attitudes and practices (KAP) as well as their intentions regarding A(H1N1) pandemic influenza vaccines right before the beginning of the largest immunization campaign in Canadian history. Findings A self-administered, anonymous, mail-based questionnaire was sent to a random sample of family physicians and to all paediatricians practicing in Canada. All 921 questionnaires received by October 29 2009 were included in the analysis. Between 72% and 92% of respondents agreed with the statements regarding vaccine safety, effectiveness and acceptability. More than 75% of respondents intended to recommend the A(H1N1) pandemic influenza vaccine to their patients and to get vaccinated themselves. The most significant factors associated with the intention to recommend A(H1N1) pandemic vaccines were physicians' intention to be vaccinated against influenza themselves and the perceived acceptability of the vaccine by the vaccinators. Conclusions Most Canadian family physicians and paediatricians surveyed were supportive of the A(H1N1) pandemic influenza vaccination before its implementation and large media coverage.

Physician recommendations can reduce vaccine hesitancy (VH) and improve uptake yet are often done poorly and can be improved by early-career training. We examined educational interventions for medical students in Western countries to explore what is being taught, identify effective elements, and review the quality of evidence. A mixed methods systematic narrative review, guided by the JBI framework, assessed the study quality using MERSQI and Cote & Turgeon frameworks. Data were extracted to analyze content and framing, with effectiveness graded using value-based judgment. Among the 33 studies with 30 unique interventions, effective studies used multiple methods grounded in educational theory to teach knowledge, skills, and attitudes. Most interventions reinforced a deficit-based approach (assuming VH stems from misinformation) which can be counterproductive. Effective interventions used hands-on, interactive methods emulating real practice, with short- and long-term follow-ups. Evidence-based approaches like motivational interviewing should frame interventions instead of the deficit model.

We sought in-depth understanding on the evolution of factors influencing COVID-19 booster dose and bivalent vaccine hesitancy in a longitudinal semi-structured interview-based qualitative study. Serial interviews were conducted between July 25th and September 1 st , 2022 (Phase I: univalent booster dose availability), and between November 21 st , 2022 and January 11 th , 2023 (Phase II: bivalent vaccine availability). Adults (≥18 years) in Canada who had received an initial primary series and had not received a COVID-19 booster dose were eligible for Phase I, and subsequently invited to participate in Phase II. Twenty-two of twenty-three (96%) participants completed interviews for both phases (45 interviews). Nearly half of participants identified as a woman ( n  = 11), the median age was 37 years (interquartile range: 32-48), and most participants were employed full-time ( n  = 12); no participant reported needing to vaccinate (with a primary series) for their workplace. No participant reported having received a COVID-19 booster dose at the time of their interview in Phase II. Three themes relating to the development of hesitancy toward continued vaccination against COVID-19 were identified: 1) effectiveness (frequency concerns; infection despite vaccination); 2) necessity (less threatening, low urgency, alternate protective measures); and 3) information (need for data, contradiction and confusion, lack of trust, decreased motivation). The data from interviews with individuals who had not received a COVID-19 booster dose or bivalent vaccine despite having received a primary series of COVID-19 vaccines highlights actionable targets to address vaccine hesitancy and improve public health literacy.

Background: Before the COVID-19 pandemic, it was already recognized that internet-based misinformation and disinformation could influence individuals to refuse or delay vaccination for themselves, their families, or their children. Reinformation, which refers to hyperpartisan and ideologically biased content, can propagate polarizing messages on vaccines, thereby contributing to vaccine hesitancy even if it is not outright disinformation., Objective: This study aimed to evaluate the impact of reinformation on vaccine hesitancy. Specifically, the goal was to investigate how misinformation presented in the style and layout of a news article could influence the perceived tentativeness (credibility) of COVID-19 vaccine information and confidence in COVID-19 vaccination., Methods: We conducted a web-based randomized controlled trial by recruiting English-speaking Canadians aged 18 years and older from across Canada through the Qualtrics (Silver Lake) paid opt-in panel system. Participants were randomly assigned to 1 of 4 distinct versions of a news article on COVID-19 vaccines, each featuring variations in writing style and presentation layout. After reading the news article, participants self-assessed the tentativeness of the information provided, their confidence in COVID-19 vaccines, and their attitude toward vaccination in general., Results: The survey included 537 participants, with 12 excluded for not meeting the task completion time. The final sample comprised 525 participants distributed about equally across the 4 news article versions. Chi-square analyses revealed a statistically significant association between general attitude toward vaccination and the perceived tentativeness of the information about COVID-19 vaccines included in the news article (χ 2 1 =37.8, P<.001). The effect size was small to moderate, with Cramer V=0.27. An interaction was found between vaccine attitude and writing style (χ 2 1 =6.2, P=.01), with a small effect size, Cramer V=0.11. In addition, a Pearson correlation revealed a significant moderate to strong correlation between perceived tentativeness and confidence in COVID-19 vaccination, r(523)=0.48, P<.001. The coefficient of determination (r 2 ) was 0.23, indicating that 23% of the variance in perceived tentativeness was explained by confidence in COVID-19 vaccines. In comparing participants exposed to a journalistic-style news article with those exposed to an ideologically biased article, Cohen d was calculated to be 0.38, indicating a small to medium effect size for the difference in the perceived tentativeness between these groups., Conclusions: Exposure to a news article conveying misinformation may not be sufficient to change an individual's level of vaccine hesitancy. The study reveals that the predominant factor in shaping individuals' perceptions of COVID-19 vaccines is their attitude toward vaccination in general. This attitude also moderates the influence of writing style on perceived tentativeness; the stronger one's opposition to vaccines, the less pronounced the impact of writing style on perceived tentativeness., International Registered Report Identifier (irrid): RR2-10.2196/41012., (©Benoît Béchard, Julie A Gramaccia, Dominique Gagnon, Elhadji Anassour Laouan-Sidi, Ève Dubé, Mathieu Ouimet, Delphine de Hemptinne, Sébastien Tremblay. Originally published in JMIR Formative Research (https://formative.jmir.org), 04.12.2024.)

Background: Vaccination prevents seasonal influenza and its complications, particularly among high-risk populations. The COVID-19 pandemic has been reported to impact healthcare behaviors and vaccination patterns. This study aims to assess influenza vaccination coverage and changes in vaccination settings among Canadian adults from the 2018-2019 to the 2023-2024 seasons., Method: We conducted a retrospective analysis of data from multiple cycles of the Seasonal Influenza Vaccination Coverage Survey (SIVCS). Vaccination coverage was examined across different seasons, stratified by population groups. Odds ratios (ORs) were calculated to compare vaccination likelihoods across seasons, with 2018-2019 serving as the reference. Chi-square tests were applied to determine whether there were significant differences in the place of vaccination since the pre-pandemic season., Results: When comparing vaccine uptake before, during and after the COVID-19 pandemic, we observed a temporary coverage decline in 2021-2022 season (OR = 0.882, 95% CI = 0.787-0.988) compared to the pre-pandemic season in 2018-2019. By the 2022-2023 and 2023-2024 seasons, vaccination coverage returned to pre-pandemic levels. Coverage among adults aged 18-64 without chronic medical condition consistently remained lower than in other groups. The places of vaccination shifted markedly, with pharmacies becoming the predominant site, increasing from 35.4% in 2018-2019 to 57.4% in 2023-2024, while doctor's offices saw a decline from 32.7 to 15.2% over the same period., Conclusion: Our findings highlight the transient effect of the pandemic on flu vaccine uptake in Canada. The increasing use of pharmacies for vaccinations underscores the importance of accessible and convenient vaccination sites. Future efforts should focus on maintaining and improving vaccination coverage through diverse and adaptable vaccination settings., Competing Interests: Declarations. Ethics approval and consent of participation: The Seasonal Influenza Vaccination Coverage Survey (SIVCS) was conducted in compliance with the Public Opinion Research Contract Regulations (SOR/2007 − 134), ensuring that all public opinion research followed proper guidelines, including transparency and data handling. It also adhered to the Privacy Act, guaranteeing the protection of personal information. Additionally, the Policy on Communications and Federal Identity was respected, ensuring that all communications were factual and accessible. All necessary confidentiality rules were applied to the data, and if required, data were suppressed to prevent the identification of respondents. Consent was implied through continued participation after a voluntary and confidentiality statement was read to respondents. The methodology was qualitatively tested, and the research protocols were approved in accordance with the respective privacy and data ethics standards. The data collected adhered to the legal obligations to ensure no personal data was released, and the information was processed as mandated by the Public Opinion Research Contract Regulations and Privacy Act, preventing any direct or residual disclosure of identifiable data. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. Crown.)

Introduction: Human papillomavirus (HPV) vaccines have been offered in Quebec schools to 4th-grade (9-10 years old) girls since 2008 and boys since 2016. HPV vaccine coverage does not reach the 90 % target in many regions. This project evaluated the feasibility and the acceptability of interventions to improve HPV vaccine acceptability and coverage in school-based programs., Methods: The evaluation was conducted in 32 Quebec schools in 2019-2020. We tested a strategy of three interventions implemented in sequence (face-to-face information session, email reminder with an online decision support tool, and telephone reminder using motivational interviewing (MI) techniques). Parents and school staff completed online surveys. School nurses participated in individual interviews. Key stakeholders participated in a workshop to identify enabling conditions and barriers to implementing interventions across Quebec., Results: The strategy was generally well-received by school staff, nurses, and parents. Many parents found the 3 interventions helpful to support their vaccination decision. Most parents (92 %) suggested that the face-to-face information session and the decision support tool (82 %) be offered to all parents. Nevertheless, delivering classroom presentations was perceived by nurses as logistically challenging. Parents were generally satisfied with the telephone reminder, but only a limited number of nurses applied motivational interviewing techniques, as half (51 %) of unreturned consent forms were due to forgetfulness., Conclusion: Our strategy was accepted and deemed feasible by a majority of parents, school staff, and nurses. Collaboration between health authorities and schools is essential for implementing interventions to enhance vaccine acceptance in school-based programs., Competing Interests: Dre Chantal Sauvageau has research grants paid to the organization (Institut national de santé publique du Québec or CRCHU de Québec-Université Laval) for clinical trials and epidemiological studies funded by non-profit organizations: Ministère de la Santé et des Services sociaux du Québec, Bill & Melinda Gates Foundation and Michael Smith Foundation). Dre Sauvageau is an active member of the Comité sur l'immunization du Québec and the Groupe de travail sur la vaccination contre le VPH et le zona of the Comité consultatif national de l'immunization. Other authors have no conflicts of interest to disclose., (© 2024 The Authors. Published by Elsevier Inc.)

Promoting vaccine acceptance and demand is an essential, yet often underrecognized component of ensuring that everyone has access to the full benefits of immunization. Convened by the Sabin Vaccine Institute, the Vaccination Acceptance Research Network (VARN) is a global network of multidisciplinary stakeholders driving strengthened vaccination acceptance, demand, and delivery. VARN works to advance and apply social and behavioral science insights, research, and expertise to the challenges and opportunities facing vaccination decision-makers. The second annual VARN conference, When Communities Lead, Global Immunization Succeeds, was held June 13-15, 2023, in Bangkok, Thailand. VARN2023 provided a space for the exploration and dissemination of a growing body of evidence, knowledge, and practice for driving action across the vaccination acceptance, demand, and delivery ecosystem. VARN2023 was co-convened by Sabin and UNICEF and co-sponsored by Gavi, the Vaccine Alliance. VARN2023 brought together 231 global, regional, national, sub-national, and community-level representatives from 47 countries. The conference provided a forum to share learnings and solutions from work conducted across 40+ countries. This article is a synthesis of evidence-based insights from the VARN2023 Conference within four key recommendations: (1) Make vaccine equity and inclusion central to programming to improve vaccine confidence, demand, and delivery; (2) Prioritize communities in immunization service delivery through people-centered approaches and tools that amplify community needs to policymakers, build trust, and combat misinformation; (3) Encourage innovative community-centric solutions for improved routine immunization coverage; and (4) Strengthen vaccination across the life course through building vaccine demand, service integration, and improving the immunization service experience. Insights from VARN can be applied to positively impact vaccination acceptance, demand, and uptake around the world., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Rupali Limaye reports a relationship with Sabin Vaccine Institute that includes: funding grants. Eve Dube reports a relationship with Sabin Vaccine Institute that includes: travel reimbursement. Holly Seale reports a relationship with Sabin Vaccine Institute that includes: travel reimbursement. Rubina Qasim reports a relationship with Sabin Vaccine Institute that includes: travel reimbursement. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Facebook is a prominent social medial platform frequently used for business marketing. Researchers are starting to recognize the utility of this platform for developing research awareness, information dissemination, and more recently participant recruitment., Purpose: This paper will provide an overview of methods used in Facebook recruitment through an exemplar study. It will highlight successes and challenges and provide insight into future opportunities for its' use., Methods: Two methods of Facebook recruitment are outlined in this paper: the use of Facebook groups and paid advertising. A step-by-step guide highlights how researchers can implement these specific methods of Facebook recruitment., Results: Facebook was successfully utilized to recruit participants in the exemplar study. Recruitment was completed over a period of 82 days with a total cost of $157.09 Canadian dollars., Conclusion: Facebook is a viable method of recruiting research participants. This method can be cost-effective, timely, and efficient in comparison to traditional research recruitment methods. However, one must balance the benefits and challenges of this type of recruitment., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Context: Vaccination coverage against human papillomavirus (HPV) in school-based programs in Quebec, Canada, is suboptimal despite more than a decade of introduction. Three interventions to improve HPV vaccine acceptability and coverage in school-based programs were developed, implemented as part of a multicomponent strategy and evaluated., Method: Sixty-four (64) schools were recruited, of which 32 received the interventions (pilot schools), and 32 received usual vaccination activities (control schools). Two approaches were used to assess the impact of the interventions. Pre-post questionnaires were completed by parents in both pilot and control schools. Quantitative analyses of vaccination coverage using the Quebec immunization registry were conducted., Results: Participating parents (n = 989 in the pre-intervention survey and n = 772 in the post-intervention one) were generally aware of HPV and HPV vaccination. Most parents were confident about vaccination, had little or no hesitation and had decided to have their child vaccinated. Parents in the pilot schools were less concerned about vaccine safety than those in the control schools after the interventions. Parents in the pilot schools were also more likely to have decided to have their child vaccinated. A statistically significant difference of 7.4 % in HPV vaccine coverage between pilot and control schools was observed (82.9 % vs 75.5 %, p <0.0001)., Conclusion: Although school-based programs offer equitable access to vaccination and minimize access barriers, it remains crucial to identify effective interventions to improve vaccine uptake further and reach the WHO cervical cancer elimination goal. Our multicomponent strategy appears to have positively impacted HPV vaccine acceptability and coverage and could be adapted to other contexts where vaccination is delivered in school-based programs., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dre Chantal Sauvageau has research grants paid to the organization (INSPQ or CRCHU de Québec-Université Laval) for clinical trials and epidemiological studies funded by non-profit organizations (MSSS, CIHR, Bill & Melinda Gates Foundation, and Michael Smith Foundation). Dre Sauvageau is an active member of the Comité sur l'immunisation du Québec and the National Advisory Committee on Immunization (NACI) HPV Working Group., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Parents make important vaccination decisions for their children and many variables affect parents' decisions to accept or decline vaccines. Parents are tasked with locating, understanding, and applying information to inform health decisions often using online resources; however, the digital health literacy levels of parents are unknown. The purpose of this study was to investigate parents' digital health literacy levels, their sources for vaccine information, and analyze how demographics, digital health literacy, health literacy, parental attitudes and vaccine beliefs, trust, and vaccine information sources predict vaccine acceptance. Quantitative findings of a mixed methods study that examined parental vaccine decision making across the continuum of vaccine hesitant to vaccine accepting is reported. An online survey of parents of young children living in Ontario, Canada was conducted in 2022. Multiple linear regression determined predictors of vaccine acceptance. 219 participants completed the survey and on average reported adequate digital health literacy skill. Healthcare providers were reported as the most commonly used source of vaccine information. Two models were retained that predicted vaccine acceptance, both models predicted about 50% of the variability in vaccine acceptance. Model A identified that trust predicted parent vaccine acceptance and model B identified that digital health literacy, and the vaccine information sources healthcare providers, family and friends, and alternate healthcare providers predicted vaccine acceptance. Family and friends and alternate healthcare providers negatively predicted vaccine acceptance. Most parents in our study had high levels of digital health literacy. Opportunities exist for further research and policy change focused on trust at a systemic public health level. While clinical level implications included the importance of healthcare providers as a vaccine information source and adequate digital health literacy to facilitate parental vaccine decision making. Continued efforts to develop awareness on the importance of digital health literacy among the public and healthcare providers is needed, including further research on the digital health literacy levels of Canadians., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Ashfield et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: Successful clinical conversations about vaccination in pregnancy (pertussis, COVID-19, and influenza) are key to improving low uptake rates of both vaccination in pregnancy and infancy. The purpose of this study was to understand Canadian perinatal care providers' knowledge, attitudes, and practices around vaccination in pregnancy., Methods: Qualitative interviews with 49 perinatal care providers (nurse practitioner, general practitioner, registered nurse, registered midwife, obstetrician-gynecologist, and family physicians) in 6 of 13 provinces and territories were deductively coded using directed content analysis [1] and analyzed according to key themes., Results: Participants detailed their professional training and experiences, patient community demographics, knowledge of vaccines, views and beliefs about vaccination in pregnancy, and attitudes about vaccine counselling. Providers generally described having a good range of information sources to keep vaccine knowledge up to date. Some providers lacked the necessary logistical setups to administer vaccines within their practice. Responses suggest diverging approaches to vaccine counselling. With merely hesitant patients, some opted to dig in and have more in-depth discussions, while others felt the likelihood of persuading an outright vaccine-refusing patient to vaccinate was too low to be worthwhile., Conclusion: Provider knowledge, attitudes, and practices around vaccination varied by professional background. To support perinatal providers' knowledge and practices, clinical guidelines should detail the importance of vaccination relative to other care priorities, emphasize the positive impact of engaging hesitant patients in vaccine counselling., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)

Background: The Biobanque québécoise de la COVID-19 (Quebec Biobank for COVID-19, or BQC19) is a provincial initiative that aims to manage the longitudinal collection, storage, and sharing of biological samples and clinical data related to COVID-19. During the study, BQC19 investigators reported a high loss-to-follow-up rate. The current study aimed to explore motivational and attrition factors from the perspective of BQC19 participants and health care and research professionals., Methods: This was an inductive exploratory qualitative study. Using a theoretical sampling approach, a sample of BQC19 participants and professionals were invited to participate via semi-structured interviews. Topics included motivations to participate; participants' fears, doubts, and barriers to participation; and professionals' experiences with biobanking during the COVID-19 pandemic., Results: Interviews were conducted with BQC19 participants (n = 23) and professionals (n = 17) from 8 clinical data collection sites. Motivations included the contribution to science and society in crisis, self-worth, and interactions with medical professionals. Reasons for attrition included logistical barriers, negative attitudes about public health measures or genomic studies, fear of clinical settings, and a desire to move on from COVID-19. Motivations and barriers seemed to evolve over time and with COVID-19 trends and surges. Certain situations were associated with attrition, such as when patients experienced indirect verbal consent during hospitalization. Barriers related to human and material resources and containment/prevention measures limited the ability of research teams to recruit and retain participants, especially in the ever-evolving context of crisis., Conclusion: The pandemic setting impacted participation and attrition, either by influencing participants' motivations and barriers or by affecting research teams' ability to recruit and retain participants. Longitudinal and/or biobanking studies in a public health crisis setting should consider these factors to limit attrition., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to declare., (Crown Copyright © 2024. Published by Elsevier Ltd. All rights reserved.)

Background: Little is known about how intersecting social privilege and disadvantage contribute to inequities in COVID-19 information use and vaccine access. This study explored how social inequities intersect to shape access to and use of COVID-19 information and vaccines among parents in Canada., Methods: We conducted semi-structured interviews on COVID-19 vaccination information use with ethnically diverse parents of children ages 11 to 18 years from April to August 2022. We purposefully invited parents from respondents to a national online survey to ensure representation across diverse intersecting social identities. Five researchers coded transcripts in NVivo using a discourse analysis approach informed by intersectionality. Our analysis focused on use of vaccine information and intersecting privileges and oppressions, including identifying with equity-denied group(s)., Results: Interview participants (N = 48) identified as ethnically diverse non-Indigenous (n = 40) and Indigenous (n = 8) Peoples from seven Canadian provinces. Racialized minority or Indigenous participants reflected on historical and contemporary events of racism from government and medical institutions as barriers to trust and access to COVID-19 information, vaccines, and the Canadian healthcare system. Participants with privileged social locations showed greater comfort in resisting public health measures. Despite the urgency to receive COVID-19 vaccines, information gaps and transportation barriers delayed vaccination among some participants living with chronic medical conditions., Conclusion: Historicization of colonialism and ongoing events of racism are a major barrier to trusting public health information. Fostering partnerships with trusted leaders and/or healthcare workers from racialized communities may help rebuild trust. Healthcare systems need to continuously implement strategies to restore trust with Indigenous and racialized populations., (© 2024. The Author(s).)

Objective: COVID-19 transmission, emergence of variants of concern, and weakened immunity have led to recommended vaccine booster doses for COVID-19. Vaccine hesitancy challenges broad immunization coverage. We deployed a cross-national survey to investigate knowledge, beliefs, and behaviours toward continued COVID-19 vaccination., Methods: We administered a national, cross-sectional online survey among adults in Canada between March 16 and March 26, 2022. We utilized descriptive statistics to summarize our sample, and tested for demographic differences, perceptions of vaccine effectiveness, recommended doses, and trust in decisions, using the Rao-Scott correction for weighted chi-squared tests. Multivariable logistic regression was adjusted for relevant covariates to identify sociodemographic factors and beliefs associated with vaccine hesitancy., Results: We collected 2202 completed questionnaires. Lower education status (high school: odds ratio (OR) 1.90, 95% confidence interval (CI) 1.29, 2.81) and having children (OR 1.89, CI 1.39, 2.57) were associated with increased odds of experiencing hesitancy toward a booster dose, while higher income ($100,000-$149,999: OR 0.60, CI 0.39, 0.91; $150,000 or more: OR 0.49, CI 0.29, 0.82) was associated with decreased odds. Disbelief in vaccine effectiveness (against infection: OR 3.69, CI 1.98, 6.90; serious illness: OR 3.15, CI 1.69, 5.86), disagreeing with government decision-making (somewhat disagree: OR 2.70, CI 1.38, 5.29; strongly disagree: OR 4.62, CI 2.20, 9.7), and beliefs in over-vaccinating (OR 2.07, CI 1.53, 2.80) were found associated with booster dose hesitancy., Conclusion: COVID-19 vaccine hesitancy may develop or increase regarding subsequent vaccines. Our findings indicate factors to consider when targeting vaccine-hesitant populations., (© 2023. The Author(s).)

The aim of this study was to explore the sociodemographic and individual-level factors associated with vaccine hesitancy in general, including political affiliation and beliefs in vaccine conspiracy theories, in a diverse group of Canadian adults within the context of the COVID-19 pandemic. 641 responses were included in the analysis, with those self-identifying as Indigenous, Black Canadian, and low-income (household income <$40,000) being sampled to yield data from historically marginalized populations. Demographic variables and responses to questions on vaccine hesitancy, and beliefs in vaccine conspiracy theories were used to explore explanatory variables of vaccine hesitancy. General linear regression models were fit using the method of least squares via PROC GLM and used to examine sociodemographic and individual explanatory variables of vaccine hesitancy. Age, ethnicity, political affiliation, and beliefs in vaccine conspiracies were associated with vaccine hesitancy. Findings are discussed in relation to the critical role of distrust and misinformation in hesitancy. Our data provide insight into how Canadian provincial governments may promote uptake of vaccines in ways that target diverse groups that may differ from those developed in a pre-pandemic context., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: HPV vaccination prevents cancers, including 90% of cervical cancer. Since 2008, a school-based HPV vaccination program has been implemented in Quebec, but vaccine coverage is suboptimal. The COVID-19 pandemic disrupted school-based vaccination programs. This study aimed to assess variation in HPV vaccination coverage in the school-based program between 2015 and 2022 in Quebec and to identify sociodemographic characteristics associated with non-vaccination., Methods: HPV vaccine coverage data were extracted from the Quebec Immunization Registry for students in Grade 4 and matched to the 2016 Canadian census sociodemographic data. Descriptive analysis was conducted to explore individual-level vaccine coverage according to sociodemographic data. A Generalized Estimating Equations model assessed the independent association between non-vaccination and students' sociodemographic characteristics., Results: HPV vaccine coverage (at least one dose) was 84% in 2018-2019 and 85% in 2019-2020. A decrease was observed during the pandemic. In 2020-2021, the HPV vaccine coverage (at least one dose) was 52% (at the end of the school year) and rose to 84% with intense catch-up activities. In 2021-2022, the coverage was slightly lower than before the pandemic (81%). Factors in the dissemination area were statistically significantly associated with non-vaccination: material (p-value = 0.0001) and social deprivation index (p-value = 0.0048), the proportion of immigration (p-value < 0.0001), and the language spoken at home (English (p-value = 0.0318), other than French or English (p-value = 0.0001)., Conclusion: School-based vaccination programs offer equitable access to vaccination, and our analysis showed that some groups have consistently lower vaccine acceptance and uptake. Strategies to improve HPV vaccine coverage should target children living in areas with a higher proportion of immigrants, non-French speakers, and people from underprivileged backgrounds. Although it is too early to assess the full impact of COVID-19 on school-based programs in Quebec, it remains important to ensure that catch-up strategies are implemented for missed doses., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: CS has research grants paid to the organization (INSPQ or CRCHU de Québec-Université Laval) for clinical trials and epidemiological studies funded by non-profit organizations: MSSS, Bill & Melinda Gates Foundation and Michael Smith Foundation). CS is an active Comité sur l’immunisation du Québec member and the National Advisory Committee on Immunization HPV Vaccination and Herpes Zoster Vaccination Working Group., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: With the advent of the COVID-19 pandemic, in-person social interactions and opportunities for accessing resources that sustain health and well-being have drastically reduced. We therefore designed the pan-Canadian prospective COVID-19: HEalth and Social Inequities across Neighbourhoods (COHESION) cohort to provide a deeper understanding of how the COVID-19 pandemic context affects mental health and well-being, key determinants of health, and health inequities., Methods: This paper presents the design of the two-phase COHESION Study, and descriptive results from the first phase conducted between May 2020 and September 2021. During that period, the COHESION research platform collected monthly data linked to COVID-19 such as infection and vaccination status, perceptions and attitudes regarding pandemic-related measures, and information on participants' physical and mental health, well-being, sleep, loneliness, resilience, substances use, living conditions, social interactions, activities, and mobility., Results: The 1,268 people enrolled in the Phase 1 COHESION Study are for the most part from Ontario (47%) and Quebec (33%), aged 48 ± 16 years [mean ± standard deviation (SD)], and mainly women (78%), White (85%), with a university degree (63%), and living in large urban centers (70%). According to the 298 ± 68 (mean ± SD) prospective questionnaires completed each month on average, the first year of follow-up reveals significant temporal variations in standardized indexes of well-being, loneliness, anxiety, depression, and psychological distress., Conclusions: The COHESION Study will allow identifying trajectories of mental health and well-being while investigating their determinants and how these may vary by subgroup, over time, and across different provinces in Canada, in varying context including the pandemic recovery period. Our findings will contribute valuable insights to the urban health field and inform future public health interventions., (© 2023. Crown.)

Background: Racial and ethnic disparities in COVID-19 vaccination coverage have been observed in Canada and in other countries. We aimed to compare vaccination coverage for at least 1 dose of a COVID-19 vaccine between First Nations people living off reserve and Métis, Black, Arab, Chinese, South Asian and White people., Methods: We used data collected between June 2021 and June 2022 by Statistics Canada's Canadian Community Health Survey, a large, nationally representative cross-sectional study. The analysis included 64 722 participants aged 18 years or older from the 10 provinces. We used a multiple logistic regression model to determine associations between vaccination status and race, controlling for collection period, region of residence, age, gender and education., Results: Nonvaccination against COVID-19 was more frequent in off-reserve First Nations people (adjusted odds ratio [OR] 1.8, 95% confidence interval [CI] 1.2-2.7) and Black people (adjusted OR 1.7, 95% CI 1.1-2.6), and less frequent among South Asian people (adjusted OR 0.3, 95% CI 0.1-0.7) compared to White people., Interpretation: This analysis showed significant inequalities in COVID-19 vaccine uptake between racial/ethnic populations in Canada. Further research is needed to understand the sociocultural, structural and systemic facilitators of and barriers to vaccination across racial groups, and to identify strategies that may improve vaccination uptake among First Nations and Black people., Competing Interests: Competing interests: None declared., (© 2023 CMA Impact Inc. or its licensors.)

Background: HPV vaccination has been offered in school programs for over a decade in Quebec, Canada, but the vaccine coverages are not reaching the target coverage in several regions. This qualitative study aimed to describe barriers and enabling conditions of HPV vaccination as perceived by parents and school nurses and identify potential solutions to improve HPV vaccine uptake rates and acceptance in school-based programs., Methods: Three focus group discussions were conducted with parents of children in Grades 2 or 3 who were unsure or unwilling to vaccinate. Individual interviews were conducted with 24 school nurses. A thematic content analysis was performed using N'Vivo., Results: The main parental questions and concerns regarding the HPV vaccination were the children's young age, the possible side effects, the rationale behind boys' vaccination and the possible interaction with COVID-19 vaccination. Except for interaction with COVID-19 vaccination, these concerns remain similar to those identified before the pandemic. Interviews highlighted that the information on HPV vaccination provided by the public was not well understood by parents. Parents suggested different tools to access information tailored to their concerns and situation. From the nurses' perspective, HPV vaccination promotion tools such as decision-aids and social media communication campaigns were needed and could reduce their work., Conclusion: COVID-19 may have disrupted the acceptance of the vaccines. While strategies to catch up on missed doses and reduce access barriers to vaccines are urgently needed, our findings highlight that a shift in attitudes toward routine vaccines may pose further challenges even if HPV vaccine coverage appears to have returned to pre-pandemic levels., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: CS has research grants paid to the organization (INSPQ or CRCHU de Québec-Université Laval) for clinical trials and epidemiological studies funded by non-profit organizations: MSSS, Bill & Melinda Gates Foundation and Michael Smith Foundation). CS is an active member of the Comité sur l’immunisation du Québec and the National Advisory Committee on Immunization HPV Vaccination and Herpes Zoster Vaccination Working Group., (Copyright © 2023. Published by Elsevier Ltd.)

Background: In Canada, all provinces implemented vaccine passports in 2021 to reduce SARS-CoV-2 transmission in non-essential indoor spaces and increase vaccine uptake (policies active September 2021-March 2022 in Quebec and Ontario). We sought to evaluate the impact of vaccine passport policies on first-dose SARS-CoV-2 vaccination coverage by age, and area-level income and proportion of racialized residents., Methods: We performed interrupted time series analyses using data from Quebec's and Ontario's vaccine registries linked to census information (population of 20.5 million people aged ≥ 12 yr; unit of analysis: dissemination area). We fit negative binomial regressions to first-dose vaccinations, using natural splines adjusting for baseline vaccination coverage (start: July 2021; end: October 2021 for Quebec, November 2021 for Ontario). We obtained counterfactual vaccination rates and coverage, and estimated the absolute and relative impacts of vaccine passports., Results: In both provinces, first-dose vaccination coverage before the announcement of vaccine passports was 82% (age ≥ 12 yr). The announcement resulted in estimated increases in coverage of 0.9 percentage points (95% confidence interval [CI] 0.4-1.2) in Quebec and 0.7 percentage points (95% CI 0.5-0.8) in Ontario. This corresponds to 23% (95% CI 10%-36%) and 19% (95% CI 15%-22%) more vaccinations over 11 weeks. The impact was larger among people aged 12-39 years. Despite lower coverage in lower-income and more-racialized areas, there was little variability in the absolute impact by area-level income or proportion racialized in either province., Interpretation: In the context of high vaccine coverage across 2 provinces, the announcement of vaccine passports had a small impact on first-dose coverage, with little impact on reducing economic and racial inequities in vaccine coverage. Findings suggest that other policies are needed to improve vaccination coverage among lower-income and racialized neighbourhoods and communities., Competing Interests: Competing interests: David Buckeridge reports past contractual agreements with Institut national d’excellence en santé et en services sociaux. Marc Brisson reports grants from Canadian Institutes of Health Research; Medical Research Council, UK; the Bill and Melinda Gates Foundation; the Centers for Disease Control and Prevention; Fonds de Recherche du Québec - Santé/Fonds pour la formation des chercheurs et l’aide à la recherche; the World Health Organization (WHO); the Public Health Agency of Canada; the Québec Ministry of Health and Social Services, and the Institut national de santé publique du Québec (INSPQ). Michael Hillmer reports grants from Public Health Agency of Canada and Canadian Institutes of Health Research, and is a board member for Canada Health Infoway and Canadian Institute for Health Information. Caroline Wagner reports funding through the Natural Sciences and Engineering Research Council of Canada Emerging Infectious Diseases Modelling Initiative for studying COVID-19 epidemiology in Quebec (co-applicant on the grant CANMOD). Dr. Wagner presented to WHO Strategic Advisory Group of Experts on Immunization twice about aspects related to SARS-CoV-2 vaccination. Stefan Baral is on a data safety monitoring board for a National Institutes of Health–funded study focused on suicide prevention among LGBT youth, which includes payments for meetings. Mathieu Maheu-Giroux reports a research grant from Gilead Sciences, contractual agreements with the WHO and the Joint United Nations Programme on HIV/AIDS, and past contractual agreements with Institut national d’excellence en santé et services sociaux and INSPQ., (© 2023 CMA Impact Inc. or its licensors.)

Background: Vaccine hesitancy exists on a continuum ranging between complete adherence and complete refusal due to doubts or concerns within a heterogeneous group of individuals. Despite widespread acknowledgement of the contextual factors influencing attitudes and beliefs shaping COVID-19 vaccine hesitancy, qualitative research with equity-deserving groups, accounting for unique lived experiences, remains a gap in the literature. We aim to identify and begin to understand and document the unique contextual factors shaping hesitancy by equity-deserving groups as it relates to relationships with government and health authorities., Methods: Participants were recruited and interviewed between Aug-Dec 2021. Semi-structured interviews using a convergent interviewing technique were conducted with individuals from the general population, as well as individuals who identify as First Nations, Métis, or Inuit, members of the LGBT2SQ + community, low-income Canadians, Black Canadians, and newcomers. Interviews were audio recorded and transcribed by a team of researchers. Memos were written following interviews and used to complement the thematic analysis of the interview data. Themes are presented in the results section., Results: The rationale for hesitancy among equity-deserving groups is consistent with literature documenting hesitancy in the general population. Contextual factors surrounding equity-deserving groups' attitudes and beliefs, however, are unique and relate to a history of oppression, discrimination, and genocide. We identified factors unique to subgroups; for example, religious or fatalistic beliefs among participant who identify as FNMI, fear associated with lack of testing and speed of vaccines' production among participants who identify as FNMI, Black, and LGBT2SQ + , distrust of the healthcare system for LGBT2SQ + and Black Canadians, and distrust of the government and opposition to vaccine mandates for participating who identify as LGBT2SQ + , low-income, FNMI, or Black Canadian. Newcomers stood out as very trusting of the government and accepting of COVID-19 vaccination., Conclusions: While our data on vaccine hesitancy largely mirror concerns reported in the vast body of literature citing rationale for COVID-19 hesitancy in high-income countries, the contextual factors identified in our work point to the need for wider systemic change. Our results may be used to support efforts, beyond tailored promotion campaigns, to support the confident acceptance of vaccines for COVID-19 and the acceptance of novel vaccines as future infectious diseases emerge., (© 2023. BioMed Central Ltd., part of Springer Nature.)

The first conference of the Vaccination Acceptance Research Network, VARN2022: Shaping Global Vaccine Acceptance with Localized Knowledge, was held virtually, from March 1 st to 3 rd 2022. This inaugural event brought together a global representation of experts to discuss key priorities and opportunities emerging across the ecosystem of vaccine acceptance and demand, from policies to programs and practice. Convened by the Sabin Vaccine Institute, VARN aims to support dialogue among multidisciplinary stakeholders to enhance the uptake of social and behavioral science-based solutions for vaccination decision-makers and implementers. The conference centered around four key themes: 1) Understanding vaccine acceptance and its drivers; 2) One size does not fit all: community- and context-specific approaches to increase vaccine acceptance and demand; 3) Fighting the infodemic and harnessing social media for good; and 4) Frameworks, data integrity and evaluation of best practices. Across the conference, presenters and participants considered the drivers of and strategies to increase vaccine acceptance and demand relating to COVID-19 vaccination and other vaccines across the life-course and across low-, middle- and high-income settings. VARN2022 provided a wealth of evidence from around the world, highlighting the need for human-centered, multi-sectoral and transdisciplinary approaches to improve vaccine acceptance and demand. This report summarizes insights from the diverse presentations and discussions held at VARN2022, which will form a roadmap for future research, policy making, and interventions to improve vaccine acceptance and demand globally., (© 2023. The Author(s).)

The ability of governments and nations to handle crises and protect the lives of citizens is heavily dependent on the public's trust in their governments and related social institutions. The aim of the present research was to understand public trust in government during a time of crisis, drawing on interview data (N = 56) collected during the COVID-19 pandemic (2021). In addition to the general public (n = 11), participants were sampled to obtain diversity as it relates to identifying as First Nations, Métis, and Inuit (n = 7), LGBT2SQ+ (n = 5), low-income (n = 8), Black Canadians (n = 7), young adult (n = 8), and newcomers to Canada (n = 10). Data were coded in consideration of social theories of trust, and specifically the nature of trust between individuals and institutions working with government in pandemic management. Canadians' trust in government was shaped by perceptions of pandemic communication, as well as decision-making and implementation of countermeasures. Data suggest that although participants did not trust government, they were accepting of measures and messages as presented through government channels, pointing to the importance of (re)building trust in government. Perhaps more importantly however, data indicate that resources should be invested in monitoring and evaluating public perception of individuals and institutions generating the evidence-base used to guide government communication and decision-making to ensure trust is maintained. Theoretically, our work adds to our understanding of the nature of trust as it relates to the association between interpersonal and institutional trust, and also the nature of trust across institutions., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Herati et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: Disparities in youth COVID-19 vaccine acceptance and uptake have been documented in several countries, yet few studies have explored the attitudes and perceptions underlying vaccine-related decision-making among adolescent populations with unique sociocultural, environmental, and/or structural contexts that may influence vaccine uptake., Methods: This study used data from surveys and semistructured interviews collected between January and March 2022 as part of an ongoing community-based research project in two ethnoculturally diverse, lower income neighborhoods of Montreal, Canada. Youth researchers designed and conducted interviews with unvaccinated adolescents, and thematic analysis was employed to explore attitudes and perceptions underlying vaccine-related decisions and opinions about vaccine passports. Survey data were used to describe sociodemographic and psychological determinants of COVID-19 vaccination., Results: Among 315 survey participants aged 14-17 years, most (74%) were fully vaccinated against COVID-19. Prevalence ranged from 57% among Black adolescents to 91% among South and/or Southeast Asian adolescents (34% difference, 95% confidence interval: 20-49). Qualitative and quantitative findings highlighted several misconceptions about the safety, effectiveness, and necessity of COVID-19 vaccines and adolescents' desire for trusted sources of information to address their concerns. Vaccine passports likely increased uptake, yet adolescents were strongly resistant to the policy, and for some, it may have fueled distrust of government and scientific institutions., Discussion: Strategies that increase the trustworthiness of institutions and foster genuine partnership with underserved youth may improve vaccine confidence and help ensure an effective, proequity recovery from COVID-19., (Copyright © 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

In Canada, the first COVID-19 vaccine was approved for use in December 2020, marking the beginning of a large vaccination campaign. The campaign was not only unprecedented in terms of reach, but also with regards to the amount of information about vaccines that circulated in traditional and social media. This study's aim was to describe COVID-19 vaccine related discourses in Canada through an analysis of editorial cartoons. We collected 2172 cartoons about COVID-19 published between January 2020 and August 2022 in Canadian newspapers. These cartoons were downloaded and a first thematic analysis was conducted using the WHO-EPIWIN taxonomy (cause, illness, treatment, interventions, and information). From this, 389 cartoons related to COVID-19 vaccines were identified under the treatment category. These were subjected to a second thematic analysis to assess main themes (e.g., vaccine development, campaign progress, etc.), characters featured (e.g., politicians, public figures, public) and position with respect to vaccine (favorable, unfavorable, neutral). Six main themes emerged: Research and development of vaccines; Management of the vaccination campaign; Perceptions of and experiences with vaccination services; Measures and incentives to increase COVID-19 vaccine uptake; Criticism of the unvaccinated; and Effectiveness of vaccination. Our analysis revealed a shift in attitudes toward COVID-19 vaccination from high hopes to disenchantment, which may reflect some vaccine fatigue. In the future, public health authorities could face some challenges in maintaining confidence and high COVID-19 vaccine uptake., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: In Canada, vaccination that protects against pertussis and influenza is recommended in every pregnancy, but uptake remains low. Communicating the risks and benefits of vaccination is key to clinical conversations about vaccination, which may influence the uptake of pregnancy and subsequent infant vaccines. Canadian midwives use an informed choice model of care, which is distinct from informed consent and prioritizes client autonomy in decision-making., Methods: Using institutional ethnography, which treats lived experience as expertise, we aimed to understand how Canadian midwives, governed by intersecting professional standards and regulations, navigate vaccine discussions with their clients. We conducted interviews with individuals involved in midwifery training, regulation, and continuing education, as well as key public health professionals with expertise in immunization training. Following the phases of thematic analysis outlined by Braun and Clarke, data were analyzed holistically, emergent themes identified, and coding categories developed., Results: Two types of confidence emerged as important to midwives' ability to conduct a thoroughly informed choice discussion about vaccines: confidence in vaccination itself (vaccine confidence), and confidence in vaccine knowledge and counseling skills (vaccine counseling confidence). A deferred or shortened vaccine discussion could be the result of either vaccine hesitancy or counseling hesitancy., Discussion: Currently, available clinical communication tools and recommended techniques for addressing vaccine hesitancy do not always adapt well to the needs of midwives working to support clients' informed choice decisions. Our findings suggest that Canadian midwives require more and clearer resources on both the risks and benefits of vaccination in pregnancy., (© 2022 The Authors. Birth published by Wiley Periodicals LLC.)

Newcomers to Canada have been disproportionally affected by COVID-19, with higher rates of infection and severity of illness. Determinants of higher rates may relate to social and structural inequities that impact newcomers' capacity to follow countermeasures. Our aim was to describe and document factors shaping newcomers' acceptance of COVID-19 countermeasures. Semi-structured qualitative interviews were conducted with individuals living in Canada for <5 years. Participants were asked to discuss their pandemic experiences, and perceptions and acceptance of measures. Five themes were identified: (i) belief in the necessity and efficacy of countermeasures; (ii) negative impact of measures on health/wellbeing; (iii) existing barriers to newcomer settlement exacerbated by pandemic measures; (iv) countermeasure adherence related to immigration status and (v) past experiences shaping countermeasure acceptance. Government should continue to provide messaging regarding the importance of measures for individual and population heath and continue to demonstrate a commitment to the interests of citizens. Importantly, newcomer trust in government should not be taken for granted, as this trust is critical for the acceptance of government interventions now and moving forward. It will be important to ensure that newcomers are given support to overcome challenges to settlement that were intensified during the pandemic., (© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

COVID-19 vaccine-induced immunity wanes over time, and with the emergence of new variants, additional "booster" doses have been recommended in Canada. However, booster vaccination uptake has remained low, particularly amongst younger adults aged 18-39. A previous study by our research team found that an altruism-eliciting video increased COVID-19 vaccination intentions. Using qualitative methods, the present study aims to: (1) identify the factors that influence vaccine decision-making in Canadian younger adults; (2) understand younger adults' perceptions of an altruism-eliciting video designed to increase COVID-19 vaccine intentions; and (3) explore how the video can be improved and adapted to the current pandemic context. We conducted three focus groups online with participants who: (1) received at least one booster vaccine, (2) received the primary series without any boosters, or (3) were unvaccinated. We used deductive and inductive approaches to analyze data. Deductively, informed by the realist evaluation framework, we synthesized data around three main themes: context, mechanism, and intervention-specific suggestions. Within each main theme, we deductively created subthemes based on the health belief model (HBM). For quotes that could not be captured by these subthemes, additional themes were created inductively. We found multiple factors that could be important considerations in future messaging to increase vaccine acceptance, such as feeling empowered, fostering confidence in government and institutions, providing diverse (such as both altruism and individualism) messaging, and including concrete data (such as the prevalence of vulnerable individuals). These findings suggest targeted messaging tailored to these themes would be helpful to increase COVID-19 booster vaccination amongst younger adults.