Aim: To review and investigate the negative perceptions influencing the refusal of flu vaccination in the older adult population age older than 60-yearold. Methods: This literature review focus on the qualitative studies or qualitative data from the mix-design research. A structural search of databases was performed for qualitative studies or mix-design research containing qualitative methods which were published in English between 2011 and 2021. There are eight studies selected in total, including 6 pure qualitative studies and 2 mixed-design studies with qualitative research methods. Only the qualitative data would be analyzed during this literature review. Results: Five descriptive themes emerged: "Insufficient promotion for influenza vaccination by healthcare professionals", "Anti-vaccination influence", "Insufficient local policies for encouraging influenza vaccination in elders", "The negative personal experience of influenza vaccination" and "The negative perception of influenza vaccination from social network". And one analytical theme was developed: "The cultural influence of influenza vaccination". "Anti-vaccination influence" was the most significant theme out of the others, as this theme contained the greatest number of correlations to the other themes. Discussion: The six themes synthesized from the reviewed studies have correlations between them. The theme of anti-vaccine influence was the most significant theme with the evidence of the greatest number of correlations with the other theme. Both intrinsic and extrinsic factors strengthen the effect of anti-vaccine perception in older adults, leading to refusal of influenza vaccination in older people population. Conclusion: The government should design new strategies for promoting influenza vaccination among older adults and acknowl-How to cite this paper: Yu, W.K. and Puffett, E.
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