Maternal and Child Health Journal

, Volume 17, Issue 5, pp 852–861 | Cite as

Knowledge, Attitudes, and Behaviors of Low-Income Women Considered High Priority for Receiving the Novel Influenza A (H1N1) Vaccine

  • Catherine A. Boyd
  • Julie A. Gazmararian
  • Winifred Wilkins Thompson
Article

Abstract

The primary purpose of this qualitative study was to explore the knowledge, attitudes, and behaviors of low-income women considered high priority for receiving the novel influenza A (H1N1) vaccine to improve communication in emergency preparedness and response. Researchers sought to identify the factors that affect this high priority population’s ability to successfully comply with vaccination recommendations. By utilizing an existing communication framework through the special supplemental nutrition program for women, infants, and children (WIC) they were able to document the systems and infrastructure needed to foster constructive responses in a sustainable manner in the future. Six focus group discussions with WIC clients (n = 56) and 10 individual interviews with staff members were conducted at two WIC clinics in Georgia (1 urban and 1 rural). Data were collected after the 2009–2010 influenza season and analyzed using thematic analysis. Knowledge and attitudes regarding H1N1 differed among participants with regard to perceived severity and perceived risk of influenza illness. Participants identified several barriers and motivators to receiving the vaccination, as well as information needs, sources, and information-seeking behaviors. Similarities emerged among both WIC clients and staff members regarding impressions of H1N1 and the vaccine’s use, suggesting that while the information may be provided, it is not effectively understood or accepted. Comprehensive education, policy and planning development regarding pandemic influenza and vaccine acceptance among low-income women is necessary, including improvements in risk communication messages and identifying effective methods to disseminate trusted information to these high priority groups.

Keywords

H1N1 influenza vaccine Immunization Health beliefs and attitudes Health behaviors Preparedness and emergency response Risk communication 

References

  1. 1.
    CDC. (2009). Swine influenza A (H1N1) infection in two children—Southern California, March–April 2009. MMWR. Morbidity and Mortality Weekly Report, 58(15), 400–402.Google Scholar
  2. 2.
    Garten, R. J., Davis, C. T., Russell, C. A., et al. (2009). Antigenic and genetic characteristics of swine-origin 2009 A(H1N1) influenza viruses circulating in humans. Science, 325(5937), 197–201.PubMedCrossRefGoogle Scholar
  3. 3.
    CDC. (2009). Update: Novel influenza A (H1N1) virus infections—worldwide, May 6, 2009. MMWR. Morbidity and Mortality Weekly Report, 58(17), 453–458.Google Scholar
  4. 4.
    WHO. (2009). New influenza A (H1N1) virus: Global epidemiological situation, June 2009. Weekly Epidemiological Record, 84(25), 249–257.Google Scholar
  5. 5.
    CDC. (2010). Interim results: Influenza A (H1N1) 2009 monovalent vaccination coverage—United States, October–December 2009. MMWR. Morbidity and Mortality Weekly Report, 59(2), 44–48.Google Scholar
  6. 6.
    CDC. (2009). Use of influenza A (H1N1) 2009 monovalent vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. Morbidity and mortality weekly report. Recommendations and reports, 58(RR-10), 1–8.Google Scholar
  7. 7.
    Blendon, R. J., Steelfisher, G. K., Benson, J. M., et al. (2009). Public views of the H1N1 vaccine: Topline results, September 2009, 12–20.Google Scholar
  8. 8.
    Sword, W., & Watt, S. (2005). Learning needs in postpartum women: Does socioeconomic status matter? Birth, 32, 86–92.PubMedCrossRefGoogle Scholar
  9. 9.
    Ramanadhan, S., & Viswanath, K. (2006). Health and information non-seeker: A profile. Health Communication, 30, 131–139.CrossRefGoogle Scholar
  10. 10.
    U.S. Department of Health and Human Services. (2000). Healthy people 2010. Washington, DC: U.S. Government printing office. Originally developed for Ratzan SC, Parker RM. 2000. Introduction. In National library of medicine current bibliographies in medicine: Health literacy. Selden CR, Zorn M, Ratzan SC, Parker RM, Editors. NLM Pub. No. CBM 2000-1. Bethesda, MD: National institutes of health, U.S. Department of Health and Human Services.Google Scholar
  11. 11.
    Shieh, C., Mays, R., McDaniel, A., et al. (2009). Health literacy and its association with the use of information sources and with barriers to information seeking in clinic-based pregnant women. Health Care for Women International, 30(11), 971–988.PubMedCrossRefGoogle Scholar
  12. 12.
    Birkhead, G. S., Cicirello, H. G., & Talarico, J. (1996). The impact of WIC and AFDC in screening and delivering childhood immunizations. Journal of Public Health Management & Practice, 2(1), 26–33.Google Scholar
  13. 13.
    Birkhead, G. S., LeBaron, C. W., Parsons, P., et al. (1995). The immunization of children enrolled in the special supplemental food program for women, infants, and children (WIC). The impact of different strategies. JAMA, 274(4), 312–316.Google Scholar
  14. 14.
    Hoekstra, E. J., LeBaron, C. W., Megaloeconomou, Y., et al. (1998). Impact of a large-scale immunization initiative in the special supplemental nutrition program for women, infants, and children (WIC). JAMA, 280(13), 1143–1147.PubMedCrossRefGoogle Scholar
  15. 15.
    Hutchins, S. S., Rosenthal, J., Eason, P., et al. (1999). Effectiveness and cost-effectiveness of linking the special supplemental program for women, infants, and children (WIC) and immunization activities. Journal of Public Health Policy, 20(4), 408–426.PubMedCrossRefGoogle Scholar
  16. 16.
    Shefer, A. M., Fritchley, J., Stevenson, J., et al. (2002). Linking WIC and immunization services to improve preventive health care among low-income children in WIC. Journal of Public Health Management and Practice, 8(2), 56–65.PubMedGoogle Scholar
  17. 17.
    Chew, L. D., Griffin, J. M., Partin, M. R., et al. (2008). Validation of screening questions for limited health literacy. Journal of General Internal Medicine, 23(5), 561–566.PubMedCrossRefGoogle Scholar
  18. 18.
    Fridman, D., Steinberg, E., Azhar, E., et al. (2011). Predictors of H1N1 vaccination in pregnancy. American Journal of Obstetrics and Gynecology, 204(6 Suppl 1), S124–S127.PubMedCrossRefGoogle Scholar
  19. 19.
    Goldfarb, I., Panda, B., Wylie, B., et al. (2011). Uptake of influenza vaccine in pregnant women during the 2009 H1N1 influenza pandemic. American Journal of Obstetrics and Gynecology, 204(6 Suppl 1), S112–S115.PubMedCrossRefGoogle Scholar
  20. 20.
    SteelFisher, G. K., Blendon, R. J., Bekheit, M. M., et al. (2011). Novel pandemic A (H1N1) influenza vaccination among pregnant women: motivators and barriers. American Journal of Obstetrics and Gynecology, 204(6 Suppl 1), S116–S123.PubMedCrossRefGoogle Scholar
  21. 21.
    Ding, H., Santibanez, T. A., Jamieson, D. J., et al. (2011). Influenza vaccination coverage among pregnant women—national 2009 H1N1 flu survey (NHFS). American Journal of Obstetrics and Gynecology, 204(6 Suppl 1), S96–S106.PubMedCrossRefGoogle Scholar
  22. 22.
    Fisher, B. M., Scott, J., Hart, J., et al. (2011). Behaviors and perceptions regarding seasonal and H1N1 influenza vaccination during pregnancy. American Journal of Obstetrics and Gynecology, 204(6 Suppl 1), S107–S111.PubMedCrossRefGoogle Scholar
  23. 23.
    CDC. (2011). Influenza vaccination coverage among pregnant women—United States, 2011 influenza season. MMWR. Morbidity, Mortality Weekly Report, 60(32), 1078–1082.Google Scholar
  24. 24.
    Gidengil, C. A., Parker, A. M., & Zikmund-Fisher, B. J. (2012). Trends in risk perception and vaccination intentions: A longitudinal study of the first year of the H1N1 pandemic. American Journal of Public Health, 102(4), 672–679.PubMedCrossRefGoogle Scholar
  25. 25.
    CDC. (2010). Interim results: State-specific influenza A (H1N1) 2009 monovalent vaccination coverage—United States, October 2009–January 2010. MMWR, Morbidity, Mortality Weekly Report, 59(12), 363–368.Google Scholar
  26. 26.
    CDC. (2010). Interim results: Influenza A (H1N1) monovalent and seasonal influenza vaccination coverage among health-care personnel—United States, August 2009–January 2010. MMWR. Morbidity, Mortality Weekly Report, 59(12), 357–362.Google Scholar
  27. 27.
    Tong, A., Biringer, A., Ofner-Agostini, M., Upshur, R., & McGeer, A. (2008). A cross-sectional study of maternity care providers’ and women’s knowledge, attitudes, and behaviours towards influenza vaccination during pregnancy. Journal of Obstetrics and Gynecology Canada, 30, 404–410.Google Scholar
  28. 28.
    Silverman, N. S., & Greif, A. (2001). Influenza vaccination during pregnancy: Patients’ and physicians’ attitudes. Journal of Reproductive Medicine, 46(11), 989–994.PubMedGoogle Scholar
  29. 29.
    Meharry, P.M., Colson, E.R., Grizas, A.P., et al. (2012). Reasons why women accept or reject the trivalent inactivated influenza vaccine (TIV) during pregnancy. Maternal Child Health Journal, E-pub February, 25Google Scholar
  30. 30.
    Morgan, D. L. (1998). The focus group guide book. Thousand Oaks: Sage.Google Scholar
  31. 31.
    Wilkinson, S. (1998). Focus groups in feminist research: Power, interaction, and the co-construction of meaning. Women’s Studies International Forum, 21, 111–125.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Catherine A. Boyd
    • 1
  • Julie A. Gazmararian
    • 2
  • Winifred Wilkins Thompson
    • 1
    • 3
  1. 1.Department of Behavioral Sciences and Health Education, Rollins School of Public HealthEmory UniversityAtlantaUSA
  2. 2.Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaUSA
  3. 3.Robert W. Woodruff Health Sciences CenterWinship Cancer Institute at Grady Health System, Emory University School of Medicine AtlantaUSA

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