Abstract
BACKGROUND: Pneumococcal disease is a leading cause of morbidity and mortality worldwide, with older adults aged 65 and above at particularly high risk for invasive pneumococcal infections. In Canada, pneumococcal vaccination has been recommended for this age group since 1989, yet coverage remains below national targets. Currently, only about 55% of older adults report being vaccinated, falling short of the 80% target. This study assessed knowledge, attitudes, willingness, and barriers to pneumococcal vaccination among unvaccinated older adults. METHODS: We used baseline data from a randomized controlled trial conducted as a cross-sectional survey among community-dwelling adults aged 65 years and older, residing in any of the ten Canadian provinces, and who self-identified as unvaccinated against pneumococcal disease. The survey was administered online using a tailored web-based electronic data capture system. Data were collected between June 20, 2024, and December 12, 2024, capturing data on participants’ knowledge, attitudes, and willingness to receive the vaccine, along with perceived barriers. Ordinal logistic regression was used to identify factors associated with willingness to be vaccinated, categorized as “willing”, “not willing”, and “I don’t know”. RESULTS: A total of 720 participants completed the baseline survey. Ninety percent of the respondents had moderate to good knowledge, and 47% reported positive attitudes toward the vaccine. 59% of respondents reported willingness to be vaccinated, 20% were unwilling, and 21% were unsure. We also found that positive attitudes were the strongest predictor of willingness to be vaccinated (aOR 14.8, 95% CI: 9.2-23.9), followed by good knowledge of pneumococcal vaccines and pneumococcal disease (aOR 2.6, 95% CI: 1.4-5.0). Regional differences emerged, with significantly higher willingness among those residing in the Prairies versus Ontario. Commonly reported barriers included affordability concerns and lack of awareness about where to get vaccinated. CONCLUSION: Our findings underscore the need to address attitudes alongside knowledge in public health efforts to improve pneumococcal vaccine uptake among older adults. Tailored interventions that reduce logistical and informational barriers may help close the coverage gap and support national immunization goals. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-025-26170-x.