Drivers and barriers to influenza vaccination in the post–COVID-19 era in the Federation of Bosnia and Herzegovina: A qualitative study using focus groups with risk groups and in-depth interviews with physicians

Seasonal influenza is a significant public health issue, especially for older adults and those with chronic conditions. This qualitative study examined the factors influencing vaccination decisions among these high-risk groups in the Federation of Bosnia and Herzegovina (FBiH), supplemented by insights from primary health care providers. The study recruited 15 focus groups comprising 131 participants and conducted interviews with 18 physicians to investigate the barriers and drivers influencing influenza vaccination uptake. Participants referred to reliable information, proactive health system engagement, and increased access to influenza vaccines as essential factors promoting acceptance. Physicians identified organizational support and ongoing communication strategies as critical components for enhancing vaccination coverage. Findings indicate that healthcare worker recommendations significantly impact patient decisions, but limited time and resources restrict their ability to actively promote vaccination. Misinformation increased during the COVID-19 pandemic, affecting vaccination confidence. These insights provide decision-makers with context-specific, evidence-based interventions to improve influenza vaccination uptake and inform a comprehensive prevention and control plan for FBiH.