Background Older adults from minority ethnic backgrounds are at increased risk of contracting COVID-19 and developing severe infection and have increased risk of mortality. Whilst an age-based vaccination approach prioritising older groups is being implemented worldwide, vaccine hesitancy is high amongst minority ethnic groups.</p> Methods and findings We conducted a systematic review and convergent synthesis to systematically examine perceptions of vaccinations amongst older adults from minority ethnic backgrounds. We included studies that reported on perceptions, beliefs, and attitudes towards vaccinations in older adults aged >= 65 years from a minority ethnic background. We excluded studies of vaccinations in investigation or development, studies focused on specific medical conditions, studies where ethnic background or age group was unidentifiable, systematic reviews, editorials, and conference abstracts. We searched MEDLINE, Embase, Virtual Health Library, Web of Science, Cochrane Library, medRxiv, and PROSPERO databases from inception to 15 July 2021. Risk of bias for studies was assessed using the Mixed Methods Appraisal Tool. The quality of evidence of collective outcomes was estimated using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) framework. A total of 28 eligible studies conducted between 1997 and 2020 were included in the final analysis (17 quantitative surveys, 8 focus group or interview studies, 2 mixed methods studies, and 1 case-control study). The majority were US studies in English or Spanish, except for 6 studies set in Hong Kong, 2 studies in Japan, 1 study in Brazil, and 1 multi-centre study (including China, Indonesia, Turkey, South Korea, Greece, UK, Brazil, and Nigeria). In total, 28,262 individuals with an estimated mean age of 69.8 years were included, 63.2% of whom were female. We summarised the common concepts and themes across studies and populations using a convergent synthesis analysis. Thirteen themes categorised as barriers or facilitators were identified and grouped into structural factors-healthcare provider and system related, patient related, and policy and operational-and were analysed by minority ethnic group. The main limitation of the study was the predominance of studies from the US and East Asia.</p> Conclusions In this systematic review, we found that factors influencing vaccination uptake involve healthcare provider and system, patient-related, and governance-level factors that are specific to the older ethnic minority community being served. The evidence included in this review is supported by high or moderate certainty and can be translated to practice and policy. A tailored, multi-level approach combining increased education, access, and culturally competent discussions with trusted healthcare professionals to address health beliefs can maximise the potential impact of widespread vaccination policies.</p> Author summary Why was this study done? Older adults from minority ethnic backgrounds are at increased risk of contracting COVID-19 and developing severe infection and are at increased risk of mortality.</p> Vaccine hesitancy is high amongst individuals from minority ethnic backgrounds, yet no studies to our knowledge have systematically reviewed the factors influencing vaccination uptake amongst older adults from minority ethnic backgrounds, who are high priority on current COVID-19 vaccination schedules.</p> What did the researchers do and find? We conducted a systematic review identifying studies examining attitudes towards vaccination uptake amongst older adults (>= 65 years) from minority ethnic backgrounds.</p> We identified and summarised 13 themes categorised as barriers to and facilitators of vaccination uptake amongst older adults from minority ethnic backgrounds. These are related to healthcare provider and system factors, patient factors, and policy and operational factors.</p> What do these findings mean? The factors influencing vaccination uptake amongst older adults from minority ethnic backgrounds identified in this review will help healthcare providers, clinicians, and policy makers tailor vaccination delivery to ensure adequate impact in this high-risk group, essential to the current COVID-19 pandemic and in future vaccination schedules.</p> A tailored, multi-level approach combining increased education, access, and culturally competent discussions with trusted healthcare professionals to address health beliefs can maximise the potential impact, equity, and success of widespread vaccination policies.</p>
