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Journal of Community Health

, Volume 43, Issue 1, pp 201–206 | Cite as

Influenza Vaccination Beliefs and Practices in Elderly Primary Care Patients

  • Sharon Rikin
  • Vanessa Scott
  • Steven Shea
  • Philip LaRussa
  • Melissa S. StockwellEmail author
Original Paper

Abstract

The majority of influenza related deaths and hospitalizations occur among individuals ≥65 years, yet the national influenza vaccination rate for this group is 63% and is lower in the Hispanic population. Previous studies have described negative predictors of vaccination; however, there is a knowledge gap of how influenza vaccine-specific beliefs affect vaccination rates. We examined the relationship between influenza vaccine health beliefs and vaccination behaviors in a cross sectional sample of 200 primarily Hispanic patients aged ≥65 years in an academic general internal medicine clinic. Participants were asked about perceptions of influenza vaccine effectiveness and safety. Interview responses regarding influenza vaccine concerns were evaluated qualitatively with conventional content analysis. Logistic regression evaluated associations between beliefs and self-reported vaccination the previous year, adjusted for age, gender, and language. Of those approached to complete the questionnaire, 88% participated. Self-reported influenza vaccination rate during the study year was 75%. Only 46.5% endorsed the belief that influenza vaccine is very effective and 47% that it is very safe. Many stated specific concerns about flu vaccine including that it causes side effects/adverse outcomes, is not effective, vaccine components are harmful, and vaccination is not necessary. Belief that the flu shot causes the flu and concern for variability of the flu shot were associated with reduced odds of vaccination (aOR 0.19, 95% CI [0.05, 0.83] and 0.06 [0.006, 0.63] respectively). The patient-perceived distinction between cold, flu, and other symptoms warrants further exploration. This information can be used to develop targeted communication to promote vaccination.

Keywords

Geriatrics Health behavior Immunization Medical decision making Underserved populations 

Notes

Acknowledgements

S. Rikin and V. Scott were supported by Health Resources and Services Administration (HRSA), Grant Number T0BHP293020100. We thank our research assistant, Angela Barrett.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Thompson, W. W., Shay, D. K., Weintraub, E., Brammer, L., Cox, N., Anderson, L. J., et al. (2003). Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA, 289(2), 179–186.CrossRefPubMedGoogle Scholar
  2. 2.
    Thompson, W. W., Shay, D. K., Weintraub, E., Brammer, L., Bridges, C. B., Cox, N. J., et al. (2004). Influenza-associated hospitalizations in the United States. JAMA, 292(11), 1333–1340.CrossRefPubMedGoogle Scholar
  3. 3.
    Nichol, K. L., Nordin, J. D., Nelson, D. B., Mullooly, J. P., & Hak, E. (2007). Effectiveness of influenza vaccine in the community-dwelling elderly. The New England Journal of Medicine, 357(14), 1373–1381.CrossRefPubMedGoogle Scholar
  4. 4.
    Beyer, W. E., McElhaney, J., Smith, D. J., Monto, A. S., Nguyen-Van-Tam, J. S., & Osterhaus, A. D. (2013). Cochrane re-arranged: support for policies to vaccinate elderly people against influenza. Vaccine, 31(50), 6030–6033.CrossRefPubMedGoogle Scholar
  5. 5.
    National Center for Quality Assurance. (2017) Flu Vaccinations. http://www.ncqa.org/report-cards/health-plans/state-of-health-care-quality/2016-table-of-contents/flu-vaccinations. Accessed 11 May 2017.
  6. 6.
    Grohskopf, L. A., Sokolow, L. Z., Broder, K. R., et al. (2016). Prevention and Control of Seasonal Influenza with Vaccines. MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports/Centers for Disease Control, 65(5), 1–54.CrossRefGoogle Scholar
  7. 7.
    Santibanez T, Kahn K, Zhai Y, et al. (2016). Flu vaccination coverage, United States, 2015-2016 influenza season. https://www.cdc.gov/flu/fluvaxview/coverage-1516estimates.htm. Accessed 27 Mar 2017.
  8. 8.
    Zimmerman, R. K., Santibanez, T. A., Janosky, J. E., Fine, M. J., Raymund, M., Wilson, S. A., et al. (2003). What affects influenza vaccination rates among older patients? An analysis from inner-city, suburban, rural, and veterans affairs practices. The American Journal of Medicine, 114(1), 31–38.CrossRefPubMedGoogle Scholar
  9. 9.
    Nowalk, M. P., Zimmerman, R. K., Shen, S., Jewell, IK, & Raymund, M. (2004). Barriers to pneumococcal and influenza vaccination in older community-dwelling adults (2000–2001). Journal of the American Geriatrics Society, 52(1), 25–30.CrossRefPubMedGoogle Scholar
  10. 10.
    Nichol, K. L., Mac Donald, R., & Hauge, M. (1996). Factors associated with influenza and pneumococcal vaccination behavior among high-risk adults. Journal of General Internal Medicine, 11(11), 673–677.CrossRefPubMedGoogle Scholar
  11. 11.
    Hebert, P. L., Frick, K. D., Kane, R. L., & McBean, A. M. (2005). The causes of racial and ethnic differences in influenza vaccination rates among elderly Medicare beneficiaries. Health Services Research, 40(2), 517–537.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Salmon, D. A., Dudley, M. Z., Glanz, J. M., Omer, S. B. (2015). Vaccine hesitancy: Causes, consequences, and a call to action. Vaccine, 33(Supplement 4):D66–D71.CrossRefPubMedGoogle Scholar
  13. 13.
    Schmid, P., Rauber, D., Betsch, C., Lidolt, G., & Denker, M. L. (2017). Barriers of Influenza vaccination intention and behavior—A systematic review of influenza vaccine hesitancy, 2005–2016. PLoS ONE, 12(1), e0170550.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Jacobson, R. M., St. Sauver JL, & Finney Rutten, L. J. (2015). Vaccine hesitancy. Mayo Clinic Proceedings. Mayo Clinic, 90(11), 1562–1568.CrossRefGoogle Scholar
  15. 15.
    Siddiqui, M., Salmon, D. A., & Omer, S. B. (2013). Epidemiology of vaccine hesitancy in the United States. Human Vaccines & Immunotherapeutics, 9(12), 2643–2648.CrossRefGoogle Scholar
  16. 16.
    Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288.CrossRefPubMedGoogle Scholar
  17. 17.
    Nichol, K. L., Lofgren, R. P., & Gapinski, J. (1992). Influenza vaccination. Knowledge, attitudes, and behavior among high-risk outpatients. Archives of Internal Medicine, 152(1), 106–110.CrossRefPubMedGoogle Scholar
  18. 18.
    Zimmerman, R. K., Santibanez, T. A., Fine, M. J., et al. (2003). Barriers and facilitators of pneumococcal vaccination among the elderly. Vaccine, 21(13–14), 1510–1517.CrossRefPubMedGoogle Scholar
  19. 19.
    Zimmerman, R. K., Mieczkowski, T. A., & Wilson, S. A. (2002). Immunization rates and beliefs among elderly patients of inner city neighborhood health centers. Health Promotion Practice, 3(2), 197–206.CrossRefGoogle Scholar
  20. 20.
    Nowak, G. J., Sheedy, K., Bursey, K., Smith, T. M., & Basket, M. (2015). Promoting influenza vaccination: insights from a qualitative meta-analysis of 14 years of influenza-related communications research by U.S. Centers for Disease Control and Prevention (CDC). Vaccine, 33(24), 2741–2756.CrossRefPubMedGoogle Scholar
  21. 21.
    Gust, D. A., Darling, N., Kennedy, A., & Schwartz, B. (2008). Parents with doubts about vaccines: Which vaccines and reasons why. Pediatrics, 122(4), 718–725.CrossRefPubMedGoogle Scholar
  22. 22.
    Opel, D. J., Taylor, J. A., Mangione-Smith, R., et al. (2011). Validity and reliability of a survey to identify vaccine-hesitant parents. Vaccine, 29(38), 6598–6605.CrossRefPubMedGoogle Scholar
  23. 23.
    Jefferson, T., Di Pietrantonj, C., Al-Ansary, L. A., Ferroni, E., Thorning, S., & Thomas, R. E. (2010). Vaccines for preventing influenza in the elderly. Cochrane Database of Systematic Reviews. doi: 10.1002/14651858.CD004876.Google Scholar
  24. 24.
    Maibach, E. W., & Parrott, R. (1995). Designing health messages: Approaches from communication theory and public health practice. Newcastle upon Tyne: Sage.Google Scholar
  25. 25.
    Jacobson, R. M., Van Etta, L., Bahta, L. (2013). The C.A.S.E. approach: Guidance for talking to vaccine-hesitant parents. Minnesota Medicine, 96(4), 49–50.PubMedGoogle Scholar
  26. 26.
    Briss, P. A., Rodewald, L. E., Hinman, A. R., Shefer, A. M., Strikas, R. A., Bernier, R. R., et al. (2000) Reviews of evidence regarding interventions to improve vaccination coverage in children, adolescents, and adults. American Journal of Preventive Medicine, 18(1):97–140.CrossRefPubMedGoogle Scholar
  27. 27.
    Ndiaye, S. M., Hopkins, D. P., Shefer, A. M., Hinman, A. R., Briss, P. A., Rodewald, L., et al. (2005). Interventions to improve influenza, pneumococcal polysaccharide, and hepatitis B vaccination coverage among high-risk adults: A systematic review. American Journal of Preventive Medicine, 28(5), 248–279.CrossRefPubMedGoogle Scholar
  28. 28.
    Mac Donald, R., Baken, L., Nelson, A., & Nichol, K. L. (1999). Validation of self-report of influenza and pneumococcal vaccination status in elderly outpatients. American Journal of Preventive Medicine, 16(3), 173–177.CrossRefPubMedGoogle Scholar
  29. 29.
    Irving, S. A., Donahue, J. G., Shay, D. K., Ellis-Coyle, T. L., & Belongia, E. A. (2009). Evaluation of self-reported and registry-based influenza vaccination status in a Wisconsin cohort. Vaccine, 27(47), 6546–6549.CrossRefPubMedGoogle Scholar
  30. 30.
    Skull, S. A., Andrews, R. M., Byrnes, G. B., et al. (2007). Validity of self-reported influenza and pneumococcal vaccination status among a cohort of hospitalized elderly inpatients. Vaccine, 25(25), 4775–4783.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Sharon Rikin
    • 1
    • 2
  • Vanessa Scott
    • 2
    • 3
  • Steven Shea
    • 1
    • 2
    • 4
  • Philip LaRussa
    • 3
  • Melissa S. Stockwell
    • 2
    • 3
    • 5
    • 6
    Email author
  1. 1.Department of MedicineColumbia University Medical CenterNew YorkUSA
  2. 2.NewYork-Presbyterian HospitalNew YorkUSA
  3. 3.Department of PediatricsColumbia University Medical CenterNew YorkUSA
  4. 4.Department of EpidemiologyColumbia University Medical CenterNew YorkUSA
  5. 5.Department of Population and Family HealthColumbia University Medical CenterNew YorkUSA
  6. 6.Division of Child and Adolescent HealthColumbia UniversityNew YorkUSA

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