Voices from the Frontline: Understanding the Barriers and Enablers to Vaccination in Aged Care Facilities in Sydney, Australia

Background/Objectives: Vaccination is a critical public health measure for older adults in residential aged care facilities (RACFs). In Australia, COVID-19, influenza, pneumococcal, and shingles vaccines are recommended and funded for this group. However, vaccination coverage remains suboptimal, with limited understanding of the underlying causes. Methods: A mixed-methods design explored the enablers and barriers to vaccination from the perspectives of frontline providers, RACF staff, residents and family members. Descriptive statistics were used to quantify the prevalence of perceived enablers and barriers within stakeholder groups. Qualitative data—collected through open-ended questions—were analysed using manual, deductive-iterative coding to identify key themes. Key quotes illustrate the findings. Results: Input was gathered from seven in-reach geriatric staff, 40 general practitioners (GPs), 90 RACF staff, 17 RACF residents, and 84 family members of residents. Results were grouped under four key themes: operational, communication, coordination, and financial. RACF staff identified limited access to vaccination histories as the most significant barrier and relied on external providers to upload data to the Australian Immunisation Register (AIR). On-site clinics were essential, but organisational policies prevented nurse-led vaccination of residents. Most RACFs stored only influenza vaccines and depended on external providers for others. Simplified, translated information was called for. Healthcare provider and RACF endorsement was valued, but RACF staff felt ill-equipped to handle conversations around vaccine hesitancy. Consent processes were burdensome, and responsibility for tracking vaccination schedules was unclear with calls for streamlined processes. Low provider remuneration was also noted, with calls for increased government support. Conclusions: This work identifies key enablers and barriers to resident vaccination in RACFs. Improving delivery requires organisational policy change, staff support, digital access, and continued advocacy. Analysis of targeted interventions and coverage will be reported separately. The approach is replicable for other vulnerable groups.