In Switzerland, the Federal Office of Public Health develops and publishes a national vaccination plan together with the Federal Commission for Immunization. HCPs are meant to contribute to the implementation of the vaccination plan by informing parents/patients about vaccination recommendations. As vaccinations are voluntary, parents/patients are not required to adhere to official recommendations.

In Switzerland, vaccination rates are relatively high overall (27), but they vary widely, with measles and human papilloma viruses (HPV) vaccination rates being higher in French-and Italian-speaking regions than in German-speaking regions of Switzerland. Moreover, HPV vaccination rates are higher where the vaccine is offered through schools (24, 29, 30).

We developed an online survey to assess interest in training regarding vaccination knowledge and communication needs among HCPs across Switzerland. In a first step, we assembled potentially relevant questions and divided them into appropriate categories (16–18). In discussions among our multidisciplinary team (including biomedicine, CM, sociology, anthropology, epidemiology, public health, social marketing, and communication sciences) we condensed the survey, with the goal of making it concise and appropriate for the different health professions. Qualtrics software (Qualtrics XM, Provo, Utah, US) was used as the online platform. The survey was translated from English into three Swiss national languages (German, French, and Italian) by bilingual research team members. The surveys were then administered in these four languages, with respondents choosing their preference at the beginning of the survey. We piloted the survey in all national languages with four participants from each target group (physicians, pharmacists, nurses, and midwives), and then discussed and adjusted the survey wording accordingly in each language. We display study results in English.

The survey contained questions addressed to each HCP group, with common items and branching logic for specific items tailored to the type of provider: 29 (physicians), 28 (pharmacists, nurses), and 25 (midwives), respectively. Hospital pharmacists were excluded from the survey due to their infrequent contact with clients around the topic of vaccination. Medical practice assistants and medical students were excluded from the survey because they only administer vaccinations at the direction of the supervising physician. The survey included questions about the following topics (1): interest in obtaining additional training related to vaccination knowledge and counseling, particularly in relation to the Swiss vaccination schedule (2); vaccination counseling frequency and practices (3); experience with vaccination counseling and administration (4); level of comfort when dealing with VH patients/clients (5); perspectives on VH, vaccine delays and refusals. We included demographic and background questions (age, gender, profession, location of work, type of work, position, additional designation, and year of graduation), questions regarding interest in preferred training modalities (in-person workshops, online interactive workshops, online lectures, written material), and desired training content (vaccine safety, efficacy, side effects, vaccine-preventable diseases, vaccine components, immunology, communication with VH individuals, shared decision making and details of the Swiss vaccination schedule) (Supplementary File). Not all survey questions were asked to each HCP group, due to the fact that some HCP groups are rarely exposed to certain topics, e.g., the question about their recommendation for HPV vaccine was not asked to midwives.

To assess participant vaccination recommendation behavior a 5-point Likert scale (1: “do not encourage vaccination at all” to 5: “encourage vaccination completely”) was used. We asked participants if they encouraged patients/clients to follow the official recommendations regarding childhood vaccinations and HPV vaccine for adolescents. We also asked about personal experiences with vaccination counseling and administration. HCPs chose from a list of statements and indicated how often they counsel VH patients/clients and how often they answer questions about vaccination in their friend/acquaintance networks.

The survey was available online from 1 November 2020 to 31 March 2021 and most participants completed it in 5–8 min. We invited physicians, pharmacists in private pharmacies, nurses, and midwives through mailing lists of key professional societies. Membership in these societies is not compulsory in Switzerland, but our team’s professional experience suggests membership is nearly universal. The professional societies invited their members to participate through email (nurses, midwives), through their monthly newsletter (pharmacists) or society journals (physicians). Participating societies included Kinderärzte Schweiz (31), Swiss Society of Pediatrics (pédiatrie suisse) (32), Swiss Society of General and Internal Medicine (33), the Swiss Pharmacists Association (pharmaSuisse) (34), Swiss Association of Nurses (35), and Swiss Association of Midwives (36). We asked professional societies to send out one email reminder to their members 3–4 weeks after the first invitation. Participation in the survey was voluntary and anonymous. The study was approved by the local ethics committee (Ethikkommission Nordwest- und Zentralschweiz), and participants provided informed consent (project-ID: 2017-00725).

To calculate approximate response rates among the four professional groups, we divided the number of participants by the number of members of each professional society indicated on their respective websites (31–36). We tabulated and analyzed the data using IBM SPSS for Mac statistical package version 27. We report the observations as percentages and used chi-square test to test for associations between each pair of categorical variables. The expected frequencies of each category of each variable have resulted to be greater than five. For this reason, the results have statistical power, i.e., it is likely that the test may detect a genuine effect. We tested for significant differences across the four professions (physicians, pharmacists, nurses, and midwives).

Specifically, we checked for associations between level of comfort in counseling VH patients/clients and

(1) whether or not the HCP has additional training in CM.

We also checked for associations between whether the HCP has additional training in CM and

(1) HCPs reporting patients/clients stop coming to them due to a disagreement about vaccination

We calculated the years of professional experience by subtracting the year of graduation from the year of the survey. We conducted one-way analysis of variance (ANOVA) to determine if there were significant differences between the means of the three different groups for level of comfort when dealing with VH patients/clients (comfortable, neither comfortable nor uncomfortable, uncomfortable). Subsequently, we ran a post hoc test procedure (Hochberg’s GT2, checking with the Games–Howell procedure) to find out which groups differ.

1,933 participants responded to the survey, including 496 physicians, 226 pharmacists, 607 nurses, and 604 midwives. The response rate was 4.4% (1,933 respondents among 44,290 society members). The response rate was 496/9,390 (5.3%) among physicians, 226/6,700 (3.4%) among pharmacists, 607/25,000 (2.4%) among nurses, and 604/3,200 (19%) among midwives.

Participant characteristics are shown in Table 1. Respondents were located in all 3 main language regions of Switzerland: German (n = 1,627, 86%), French (n = 232, 12%), and Italian (n = 42, 2%). The majority of participants were in the 41–60-year age category. There were more female than male participants, particularly among nurses and midwives. Among physicians, 75% worked in pediatrics and most had obtained a specialist degree. The majority of nurses worked in adult medicine, with ∼66% working in the hospital and with direct patient contact. The majority of midwives were self-employed freelancers. Between 10% (physicians) and 45% (midwives) of participants had additional training in CM.

Most participants were interested in obtaining additional training related to vaccination: 96% of physicians, 98% of pharmacists, 85% of nurses and 91% of midwives. Regarding the preferred training modality for additional vaccination training (Figure 1), HCPs mentioned in-person workshops, online interactive workshops, and online lectures with similar frequency, except for pharmacists who indicated a slight preference for online lectures. All vaccination topics offered in the survey were of interest to a large majority of HCPs (Figure 2), with limited differences between topics and between HCP groups. The topics for which >80% of respondents from each HCP group expressed additional training interest were vaccine safety, efficacy, and side effects.

0% of physicians, 3% of pharmacists, 17% of nurses and 6% of midwives were unfamiliar with the Swiss vaccination plan for children. 88% of physicians, 68% of pharmacists, 37% of nurses, and 14% of midwives encouraged patients/clients to follow the official childhood vaccination recommendations (Table 2). For HPV-vaccine, 74% of physicians, 44% of pharmacists, and 23% of nurses encouraged patients/clients to follow vaccination recommendations (Table 2). 3% of physicians, 16% of pharmacists and 37% of nurses were unfamiliar with the HPV vaccination schedule. 79% of physicians and 56% of pharmacists were somewhat or completely satisfied with how the health authorities communicate about the official vaccination schedule. Only 34% of nurses and 27% of midwives shared this view (Table 2).

Table 2 provides details about vaccine counseling and administration. There was a significant association between professional group and each of the questions asked in Table 2. 59% of physicians reported that they answer questions about vaccines from patients/clients on a daily basis, whereas other HCP groups reported doing so less frequently. 28% of nurses answered questions about vaccines from friends/acquaintances at least once a week, whereas the other HCPs did so less frequently.

The majority of physicians (97%), pharmacists (76%), and nurses (58%) reported that they administer vaccines, but only 23% of midwives did so (Table 2). Physicians and pharmacists were more likely to encourage patients to follow the official childhood and HPV vaccination schedule than nurses (and midwives regarding childhood vaccines).

10% of physicians reported having previously refused care to parents/patients who refused vaccines or who asked for a vaccine to be administrated later than officially recommended (Table 2). 29% of physicians and 1 pharmacist (0.5%) reported that patients/clients sometimes stopped coming to them because of a disagreement around vaccination recommendations (Table 2). In contrast, 41% of physicians and 10% of pharmacists reported that patients/clients sometimes came to see them specifically due to a disagreement around vaccination with another HCP (Table 2).

16% of the HCP with additional CM training indicated that patients sometimes stopped coming to them due to a disagreement about vaccination with them, compared to the 27% of the non-CM trained HCPs (p = 0.038). Conversely, 50% of CM-trained providers indicated that patients sometimes came to them due to a disagreement about vaccination with another HCP, compared to the 42% of the non-CM providers (p = 0.038). Less than 5% of HCPs across all professions agreed with the statement that it shows a lack of respect when patients/clients disagree with their recommendations (Table 2).

42% of physicians encountered VH patients/clients at least once a week. In contrast, more than 85% of pharmacists, nurses and midwives encountered VH patients/clients once a month or less often. 43% of physicians, 31% of pharmacists, 15% of nurses and 23% of midwives felt comfortable counseling VH patients/clients (Table 3). 2% or less of all HCP groups reported they preferred to no longer see VH patients/clients.

HCPs with CM training felt more comfortable in counseling VH patients/clients, compared to HCPs without CM training (Table 4). Along the same lines, more non-CM providers felt uncomfortable compared to the CM providers. With increasing age, HCPs reported feeling more comfortable counseling VH patients/clients, and along these lines, with increasing age fewer HCPs reported feeling uncomfortable (Table 4). In addition to age, HCPs feeling comfortable counseling VH parents/patients had more mean years of professional experience (23.9 +/− 11.3 years) compared to HCPs who felt neither comfortable nor uncomfortable (20.6 +/− 11.6 years) or uncomfortable (15.5 years +/− 11.3 years). There was a significant effect of years of experience on levels of comfort in counseling VH patients/clients, F (2, 1662) = 49.046.12, p < 0.001. The post hoc test procedure showed that there is a significant effect for each category. Additionally, there was an association between the frequency with which HCPs encounter VH patients/clients, and their indication of feeling comfortable in counseling them (Table 4). And with decreasing encounter frequency, HCP indicated feeling less comfortable in counseling VH patients/clients.

A major strength of our study is the large sample size of a diverse group of HCP respondents across the country (N = 1,933). We provide novel insights into HCPs’ interest in additional training on vaccination knowledge and communication. This is an area that has received little previous research attention in Switzerland. The response rate is a limitation. The sample is not statistically representative, and response rates were lower in French- and Italian-speaking Switzerland. There was also likely selection bias, since HCPs interested in vaccination topics may have been more likely to participate (52). As with all survey methods, there was potential for participants to have recall bias in their response.

Although the questionnaire was piloted for content and clarity with a panel of experts representing each HCP group and four additional participants from each HCP group, the questionnaire was not validated with any statistical tests. Some questions left room for interpretation regarding the directionality of vaccination perspectives (i.e., favorable or unfavorable toward vaccination). For example, questions about disagreement (“Have any parents/patients stopped coming to you for consultations due to a disagreement with you about vaccination?”) do not specify if disagreements were around favorable or unfavorable vaccine attitudes. Future studies should address this by specifying the directionality of vaccination attitudes and by including rigorous validation of survey constructs.

Because the survey was administered during the COVID-19 pandemic, this likely influenced the interest and time availability of HCPs. The approval of coronavirus vaccinations during the survey period possibly influenced study results, but we are unable to determine what that influence may be with the data available.

Our results indicate a high level of interest among HCPs in Switzerland for additional training on a variety of vaccination topics. In addition to knowledge-based vaccine education, training should include the development of communication skills. Knowledge and communication training for HCPs are essential for maintaining high vaccination coverage and for helping HCPs to feel more confident in counseling patients about vaccination.