Background: Poor demand for vaccines has long been recognized as a threat to the realization of public and global health objectives. Consequently, over time a range of interventions have been researched, proposed, and implemented in an attempt to improve the acceptability of vaccines and overcome vaccine resistance. However, much of the contemporary research concentrates disproportionately on individual-level determinants as viable targets for interventions. This disparate focus on individual-level factors has seemingly been at the expense of research into fundamental contextual influences. As a result, the primary aim of this thesis is to explore and develop a greater understanding of the contextual determinants of vaccine acceptability and their evolution over time and across different global contexts. Furthermore, emerging themes will be analyzed in an effort to explore how different contextual determinants work together or separately to influence vaccine acceptability. Methodology: The methodological approach adopted for this thesis concentrated on enabling and conducting an in-depth literature review of the contextual determinants of vaccine acceptability. To begin, a concept analysis was conducted to inform the design, focus, and implementation of a literature review. Subsequently, an in-depth literature review of research derived from the Global Health database was conducted using relevant papers published between 1910 and 2022. Data related to publication and content characteristics were extracted to support the analysis process and discussion. Ultimately themes related to the seven contextual determinants categories were identified, extracted, and analyzed. Results: Through the final analysis, 32, often interrelated themes were identified across the seven contextual determinant categories. The determinant category of Politics & Policy was found to be relevant in 70.5% (n=98) of articles included in this literature review. Religious, Social & Cultural determinants were relevant in 53.24% (n=74) of articles, followed by Communication & Media Environment at 43.16% (n=60), Influential Leaders at 41.37% (n=58), History & Historical Factors at 38.13% (n=53), Pharmaceutical Influences at 24.46% (n=34), and Geographic Influences at 18.7% (n=26). Conclusion: The acceptability of vaccines is undoubtedly influenced by the broader factors that shape the contexts in which vaccines are delivered. Additionally, these contextual determinants are likely to interact with, or influence the many commonly referenced putative individual-level determinants of vaccine acceptability. As a result, the complex nature of any relevant contextual determinants should be considered in the design of efforts aimed at promoting or improving demand for vaccines. / Thesis / Master of Science (MSc) / The contextual determinants of vaccine acceptability have been seemingly under- researched relative to other individual-level factors. As a result, this thesis aims to explore and develop a greater understanding of the contextual determinants of vaccine acceptability and their evolution over time and across different global contexts. To achieve this objective, an in-depth literature review of 139 identified articles was conducted in an effort to explore and identify themes related to the contextual determinant of vaccine acceptability. Ultimately, through this review 32 themes across the seven contextual determinant categories were identified and discussed. These findings helped elucidate the complex and fundamental role that contextual determinants have in shaping demand for vaccines.

HIV in Karnataka, south India disproportionately burdens female sex workers (FSWs) and men who have sex with men (MSM). The best long-term strategy for managing the global HIV epidemic might involve a preventive vaccine; however, vaccine availability cannot guarantee its acceptability. An exploratory, cross-sectional study was conducted among frontline health service providers (HSPs) working with MSM/FSWs in relation to HIV-related health services in Karnataka. Face-to-face structured interviews were performed to better understand potential barriers/facilitators to acceptability/uptake of a future HIV vaccine among MSM/FSW communities. Descriptive analyses explored HSPs’ perceptions of vaccine acceptability/uptake and likelihood to recommend an HIV vaccine. Although HSPs mentioned numerous potential barriers to future HIV vaccine acceptability/uptake, most believed that MSM/FSWs would be willing to receive the vaccine to protect their health and avoid HIV. HSPs reported being very likely to recommend the vaccine, however young age of potential vaccine recipients negatively affected likelihood to recommend.

HIV in Karnataka, south India disproportionately burdens female sex workers (FSWs) and men who have sex with men (MSM). The best long-term strategy for managing the global HIV epidemic might involve a preventive vaccine; however, vaccine availability cannot guarantee its acceptability. An exploratory, cross-sectional study was conducted among frontline health service providers (HSPs) working with MSM/FSWs in relation to HIV-related health services in Karnataka. Face-to-face structured interviews were performed to better understand potential barriers/facilitators to acceptability/uptake of a future HIV vaccine among MSM/FSW communities. Descriptive analyses explored HSPs’ perceptions of vaccine acceptability/uptake and likelihood to recommend an HIV vaccine. Although HSPs mentioned numerous potential barriers to future HIV vaccine acceptability/uptake, most believed that MSM/FSWs would be willing to receive the vaccine to protect their health and avoid HIV. HSPs reported being very likely to recommend the vaccine, however young age of potential vaccine recipients negatively affected likelihood to recommend.

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Human papillomavirus (HPV) is widespread in the population and an important concern for public health. HPV-associated benign and cancerous disease is vaccine preventable yet vaccine uptake has been suboptimal. Adolescents are the primary target for vaccination yet their perspective has been inadequately examined. Ontario provides population-based preventive HPV vaccination to adolescent girls yet in the program’s first 2 years only approximately half of eligible girls received it. Effective strategies to improve vaccine uptake are needed. This thesis proposes a theory and ethics-based model to guide health promotion planning for HPV vaccination. Adopting an adolescent perspective, the model is applied and comprises: 1) a systematic review to identify barriers and facilitators to HPV vaccination from the viewpoint of young females; 2) GIS uses for communicating geospatial health information regarding vaccination; and 3) a roadmap for the future including recommendations for guiding principles, research, intervention development, and health policy.

Human papillomavirus (HPV) is widespread in the population and an important concern for public health. HPV-associated benign and cancerous disease is vaccine preventable yet vaccine uptake has been suboptimal. Adolescents are the primary target for vaccination yet their perspective has been inadequately examined. Ontario provides population-based preventive HPV vaccination to adolescent girls yet in the program’s first 2 years only approximately half of eligible girls received it. Effective strategies to improve vaccine uptake are needed. This thesis proposes a theory and ethics-based model to guide health promotion planning for HPV vaccination. Adopting an adolescent perspective, the model is applied and comprises: 1) a systematic review to identify barriers and facilitators to HPV vaccination from the viewpoint of young females; 2) GIS uses for communicating geospatial health information regarding vaccination; and 3) a roadmap for the future including recommendations for guiding principles, research, intervention development, and health policy.

Human papillomavirus (HPV) is widespread in the population and an important concern for public health. HPV-associated benign and cancerous disease is vaccine preventable yet vaccine uptake has been suboptimal. Adolescents are the primary target for vaccination yet their perspective has been inadequately examined. Ontario provides population-based preventive HPV vaccination to adolescent girls yet in the program’s first 2 years only approximately half of eligible girls received it. Effective strategies to improve vaccine uptake are needed. This thesis proposes a theory and ethics-based model to guide health promotion planning for HPV vaccination. Adopting an adolescent perspective, the model is applied and comprises: 1) a systematic review to identify barriers and facilitators to HPV vaccination from the viewpoint of young females; 2) GIS uses for communicating geospatial health information regarding vaccination; and 3) a roadmap for the future including recommendations for guiding principles, research, intervention development, and health policy.