Background Healthcare workers (HCWs) and healthcare students display high levels of vaccine hesitancy with impact on healthcare provision, patient safety, and health promotion. The factors related to vaccine hesitancy have been reported in several systematic reviews. However, this evidence needs to be synthesised, as interventions to reduce vaccination hesitancy in this population are needed. Methods This Umbrella Review aimed to explore the barriers and facilitators of vaccine hesitancy toward the COVID-19 vaccine for HCWs and healthcare students. The review was performed and reported in accordance with Joanna Briggs Institutes guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A protocol was preregistered on PROSPERO (CRD42022327354). Eight databases were searched from November 2019 to 23rd May 2022 to identify any systematic reviews that explored factors associated with hesitancy towards the COVID-19 vaccine for HCWs or healthcare students. Results A total of 31 studies were included in the review. The majority of studies (71%) were appraised as strong or moderate quality and there was a slight degree of overlap (<5%) of primary studies between the reviews. Vaccine hesitancy was more common among HCWs and healthcare students in specific occupational roles (e.g. nurses) than others (e.g. physicians). Frequent reasons for hesitancy were related to sociodemographic factors (gender, age, ethnicity), occupational factors (COVID-19 exposure, perceived risk, mandatory vaccination), health factors (vaccination history), vaccine-related factors (concerns about safety, efficacy, side-effects, rapid development, testing, approval and distribution of the vaccine), social factors (social pressure, altruism and collective responsibility), distrust factors (key social actors, pandemic management), information factors (inadequate information and sources, exposure to misinformation). Conclusion The results from this Umbrella Review have wide-reaching implications for the research area, healthcare systems and institutions and governments worldwide. Designing tailored strategies for specific occupational groups is pivotal to increasing vaccine uptake and securing a safe healthcare provision worldwide.

Introduction Many adults hospitalised with COVID-19 have persistent symptoms such as fatigue, breathlessness and brain fog that limit day-to-day activities. These symptoms can last over 2 years. Whilst there is limited controlled studies on interventions that can support those with ongoing symptoms, there has been some promise in rehabilitation interventions in improving function and symptoms either using face-to-face or digital methods, but evidence remains limited and these studies often lack a control group. Methods and analysis This is a nested single-blind, parallel group, randomised control trial with embedded qualitative evaluation comparing rehabilitation (face-to-face or digital) to usual care and conducted within the PHOSP-COVID study. The aim of this study is to determine the effectiveness of rehabilitation interventions on exercise capacity, quality of life and symptoms such as breathlessness and fatigue. The primary outcome is the Incremental Shuttle Walking Test following the eight week intervention phase. Secondary outcomes include measures of function, strength and subjective assessment of symptoms. Blood inflammatory markers and muscle biopsies are an exploratory outcome. The interventions last eight weeks and combine symptom-titrated exercise therapy, symptom management and education delivered either in a face-to-face setting or through a digital platform (www.yourcovidrecovery.nhs.uk). The proposed sample size is 159 participants, and data will be intention-to-treat analyses comparing rehabilitation (face-to-face or digital) to usual care. Ethics and dissemination Ethical approval was gained as part of the PHOSP-COVID study by Yorkshire and the Humber Leeds West Research NHS Ethics Committee, and the study was prospectively registered on the ISRCTN trial registry (ISRCTN13293865). Results will be disseminated to stakeholders, including patients and members of the public, and published in appropriate journals. Article summary Strengths and limitations of this study • This protocol utilises two interventions to support those with ongoing symptoms of COVID-19 • This is a two-centre parallel-group randomised controlled trial • The protocol has been supported by patient and public involvement groups who identified treatments of symptoms and activity limitation as a top priority

Background Vaccination during pregnancy has been repeatedly demonstrated to be safe and effective in protecting against infection and associated harms for the mother, developing baby, and subsequent infant. However, maternal vaccination uptake remains low compared to the general population. Objectives An umbrella review to explore the barriers and facilitators to Influenza, Pertussis and COVID-19 vaccination during pregnancy and within 2 years after childbirth, and to inform interventions to encourage uptake (PROSPERO registration number: CRD42022327624). Methods Ten databases were searched for systematic reviews published between 2009 and April 2022 exploring the predictors of vaccination or effectiveness of interventions to improve vaccination for Pertussis, Influenza, or COVD-19. Both pregnant women and mothers of infants under two years were included. Barriers and facilitators were organised using the WHO model of determinants of vaccine hesitancy through narrative synthesis, the Joanna Briggs Institute checklist assessed review quality, and the degree of overlap of primary studies was calculated. Results 19 reviews were included. Considerable overlap was found especially for intervention reviews, and the quality of the included reviews and their primary studies varied. Sociodemographic factors were specifically researched in the context of COVID-19, exerting a small but consistent effect on vaccination. Concerns around the safety of vaccination particularly for the developing baby were a main barrier. While key facilitators included recommendation from a healthcare professional, previous vaccination, knowledge around vaccination, and communication with and support from social groups. Intervention reviews indicated multi-component interventions involving human interaction to be most effective. Conclusion The main barriers and facilitators for Influenza, Pertussis and COVID-19 vaccination have been identified and constitute the foundation for policy development at the international level. Ethnicity, socioeconomic status, concerns about vaccine safety and side effects, and lack of healthcare professionals’ recommendations, are the most relevant factors of vaccine hesitancy. Adapting educational interventions to specific populations, person-to-person interaction, healthcare professionals’ involvement, and interpersonal support are important strategies to improve uptake.

Pregnant women are particularly vulnerable to infection. Furthermore, infection from pertussis, influenza and COVID-19 increases the likelihood of adverse consequences to the mother and developing baby such as stillbirth, ICU admission, and pre-term caesarean birth. Increased rates of transmission and risk of adverse consequences from infection justifies the provision of national maternal vaccination programmes. Additionally, maternal vaccination helps protect the infant until they are able to receive their own vaccinations; a time when they are most at risk of mortality from influenza and pertussis. Vaccination during pregnancy has been repeatedly demonstrated as safe and effective in reducing harm, although rates of uptake remain low compared to the general population. The current protocol describes the methodology for an umbrella review aiming to explore the barriers and facilitators of vaccination during pregnancy for pertussis, influenza, and COVID-19. Systematic reviews that investigate the barriers and facilitators of at least one of either pertussis, influenza, or COVID-19 will be included in this review. Multiple databases will be searched, and included reviews assessed for quality (using the Joanna Briggs Institute (JBI) quality assessment for systematic reviews) and degree of overlap of included primary studies. Included reviews will be analysed according to the WHO SAGE model of determinants of vaccine hesitancy and separated by whether these explore influenza and pertussis, or COVID-19. The outcomes of this review will help inform the development of interventions to increase uptake of vaccination during pregnancy, and on whether interventions need to be tailored depending on the infectious disease. The key findings will identify the specific barriers and facilitators of vaccination hesitancy by considering contextual influences (e.g. sociodemographic variables), individual/social group influences (e.g. trust in the institutions), and vaccine-specific issues (e.g. safety and recommendations).

Volunteering provides unique benefits to organisations, recipients, and potentially the volunteers themselves. This umbrella review examined the benefits of volunteering and their potential moderators. Eleven databases were searched for systematic reviews on the social, mental, physical, or general health benefits of volunteering, published up to July 2022. AMSTAR 2 was used to assess quality and overlap of included primary studies was calculated. Twenty-eight reviews were included; participants were mainly older adults based in the USA. Although overlap between reviews was low, quality was generally poor. Benefits were found in all three domains, with reduced mortality and increased functioning exerting the largest effects. Older age, reflection, religious volunteering, and altruistic motivations increased benefits most consistently. Referral of social prescribing clients to volunteering is recommended. Limitations include the need to align results to research conducted after the COVID-19 pandemic. (PROSPERO registration number: CRD42022349703).