“I need vaccines – without them I would be dead by now.” Vaccination intention among homeless men

Background

Achieving health equity requires prioritizing marginalized groups, such as people experiencing homelessness (PEH), who face health disparities and adverse health outcomes. Harsh living conditions increase their risk of infectious diseases, including vaccine-preventable diseases, yet vaccine hesitancy leads to suboptimal vaccine uptake. As understanding population-specific concerns is crucial for developing tailored interventions, this study aims to examine vaccination intentions among PEH and the factors influencing them.

Methods

A cross-sectional survey was conducted (2024-2025) among male PEH using a structured questionnaire with open-ended questions. Multiple logistic regression analysis was performed to examine the relationship between individual characteristics and intention to vaccinate.

Results

215 male participants, with a mean age of 51.2 (SD:12.7), were surveyed. Based on FEANTSA categories, 135 (62.8%) were classified as Roofless, 80 (37.2%) as Houseless. 142 participants (66%) exhibited intention to vaccinate. Significant predictors of intention to be vaccinated were homelessness lasting ≥21 years (OR = 4.451 [1.189–16.657], p = 0.027), belief in the personal health benefits of vaccination (OR = 2.359 [1.026-5.420], p = 0.043), belief that physician-recommended vaccines are beneficial (OR = 3.686 [1.557-8.728], p = 0.003), and willingness to follow healthcare provider recommendations (OR = 6.421 [2.611-15.788], p < 0.001). None of the socio-demographic characteristics (age, education, marital status) or health-related PEH variables (self-rated health, healthcare utilization) were significantly associated with vaccination intention.

Conclusions

Vaccination intention among male PEH is driven by trust and perceived vaccine necessity, rather than by demographic or health-related factors. Interventions targeting vaccination uptake should utilize healthcare professionals’ authority through low-barrier care, addressing vaccine necessity and common concerns.

Key messages

• Results of our study show that vaccination intention among male PEH is driven by trust and perceived vaccine necessity, rather than by demographic or health-related factors.

• To increase vaccination uptake and acceptance among PEH, interventions should utilize healthcare professionals’ authority through low-barrier care, addressing vaccine necessity and common concerns.