Open Access Open Badges Research article

Are healthcare workers’ intentions to vaccinate related to their knowledge, beliefs and attitudes? a systematic review

Raúl Herzog1, Mª José Álvarez-Pasquin12*, Camino Díaz1, José Luis Del Barrio3, José Manuel Estrada4 and Ángel Gil3

Author affiliations

1 Primary Healthcare Service, Madrid Health Service, Santa Hortensia 14, Madrid, Spain

2 Spanish Association of Vaccinology, Madrid, Spain

3 Department of Preventive Medicine, Public Health, Medical Immunology and Microbiology, Rey Juan Carlos University, Avenida de Atenas s/n, Alcorcón, Spain

4 Virtual Library, Lain Entralgo Agency, Gran Vía 27, Madrid, Spain

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Citation and License

BMC Public Health 2013, 13:154  doi:10.1186/1471-2458-13-154

Published: 19 February 2013



The Summit of Independent European Vaccination Experts (SIEVE) recommended in 2007 that efforts be made to improve healthcare workers’ knowledge and beliefs about vaccines, and their attitudes towards them, to increase vaccination coverage. The aim of the study was to compile and analyze the areas of disagreement in the existing evidence about the relationship between healthcare workers’ knowledge, beliefs and attitudes about vaccines and their intentions to vaccinate the populations they serve.


We conducted a systematic search in four electronic databases for studies published in any of seven different languages between February 1998 and June 2009. We included studies conducted in developed countries that used statistical methods to relate or associate the variables included in our research question. Two independent reviewers verified that the studies met the inclusion criteria, assessed the quality of the studies and extracted their relevant characteristics. The data were descriptively analyzed.


Of the 2354 references identified in the initial search, 15 studies met the inclusion criteria. The diversity in the study designs and in the methods used to measure the variables made it impossible to integrate the results, and each study had to be assessed individually. All the studies found an association in the direction postulated by the SIEVE experts: among healthcare workers, higher awareness, beliefs that are more aligned with scientific evidence and more favorable attitudes toward vaccination were associated with greater intentions to vaccinate. All the studies included were cross-sectional; thus, no causal relationship between the variables was established.


The results suggest that interventions aimed at improving healthcare workers’ knowledge, beliefs and attitudes about vaccines should be encouraged, and their impact on vaccination coverage should be assessed.

Immunization; Vaccination; Knowledge; Belief; Attitude; Healthcare worker; Coverage; Intentions