Factors influencing vaccine uptake in people from culturally and linguistically diverse communities in Australia: An integrative review

BACKGROUND: Vaccination is an important means of reducing morbidity and mortality caused by vaccine-preventable diseases. However, vaccination uptake among culturally and linguistically diverse (CALD) communities in Australia remains lower than the national average. Understanding the determinants of vaccine uptake is essential to inform culturally responsive and equity-focused immunisation strategies. The aim of this integrative review is to explore the factors influencing vaccination uptake among people from CALD backgrounds in Australia.

METHODS: A systematic integrative review was conducted following Whittemore and Knafl's framework and reported in accordance with PRISMA guidelines. A comprehensive search strategy explored the electronic databases CINAHL, MEDLINE, Web of Science, PsycINFO, Scopus and google scholar for primary peer-reviewed studies (qualitative, quantitative, mixed methods) examining factors influencing vaccination uptake in people from CALD backgrounds in Australia. Study quality was appraised using the Mixed Methods Appraisal Tool (MMAT). The extracted data were analysed using a narrative synthesis approach.

RESULTS: From an initial search result of 1028 papers, 28 papers were included in this review - including qualitative (17), quantitative (9), and mixed methods (2). 4617 participants are represented across the included papers including participants from CALD communities (n = 3941) and participants working with people from CALD communities (n = 676). Five overarching themes and eleven sub-themes were identified, highlighting multi-level influences on vaccination uptake including: knowledge, beliefs and risk perception; trust and confidence in systems and providers; access to information; healthcare system and providers; and socioeconomic and access factors.

CONCLUSIONS: Vaccination uptake among CALD populations in Australia is shaped by intersecting community and system-level factors. Co-designed, culturally tailored communication delivered through trusted community channels, alongside coordinated policy, strengthened digital infrastructure, and adequate resourcing of providers, is critical to improving vaccination equity and sustaining population-level protection.