# Factors influencing vaccination decisions in patients with inflammatory rheumatic and musculoskeletal disease: a qualitative approach

## TL;DR

This study explores why patients with inflammatory rheumatic diseases in Germany are not getting enough vaccinations, focusing on patient and doctor perspectives.

## Contribution

The study identifies novel insights into vaccination decision-making barriers and facilitators from the perspectives of patients and healthcare providers in Germany.

## Key findings

- Trust in doctors and clear communication increase vaccination willingness.
- Uncertainties about immunosuppressants and unclear responsibilities hinder vaccination uptake.
- Physicians emphasize the need for interprofessional coordination and structured information flow.

## Abstract

Patients with inflammatory rheumatic and musculoskeletal diseases (iRMD) have an increased risk of infections due to immunosuppression and autoimmune disease. While vaccinations are an important preventive strategy, vaccination coverage remains insufficient in Germany. The study aimed to identify barriers and facilitators for vaccination uptake from the perspective of iRMD patients, general practitioners (GPs), and rheumatologists.

We conducted semi-structured, qualitative interviews with German iRMD patients (n = 15), GPs (n = 10), and rheumatologists (n = 5). Data were analyzed using Kuckartz’s structured content analysis. The analysis focused on attitudes towards vaccination, information needs, decision-making, and perceived role distribution in care.

A trust-based doctor-patient relationship and consistent, comprehensible information promoted willingness to vaccinate. Barriers included uncertainties regarding immunosuppressants, unclear responsibilities between GPs and rheumatologists, and inconsistent or conflicting medical recommendations. Patients desired a proactive approach from physicians and clearly assigned responsibilities. Physicians emphasized interprofessional exchange but stated time and structural challenges.

The results underline the importance of coordinated communication and clear responsibilities in the vaccination process for iRMD patients. To increase vaccination rates among patients with iRMD, the focus should be on targeted information services, improved allocation of tasks between GPs and rheumatologists, timely scheduling of vaccinations (ideally before initiating immunosuppressive therapy), clear responsibilities for initiating and coordination of vaccination, and a structured, transparent flow of evidence-based information between specialists. The results provide a basis for the development of practical intervention strategies to increase vaccination uptake in this high-risk group.

The study was registered at the German Register of Clinical Studies (DRKS): https://drks.de/search/de/trial/DRKS00031559 (Registration Date: 28.08.2023).

The online version contains supplementary material available at 10.1186/s41927-025-00608-6.