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Huseth-Zosel AL, Fuller H, Carson PJ. Vaccination Motivators and Deterrents Among Undervaccinated Older Adults in North Dakota. J Community Health 2024; 49:848-856. [PMID: 38615100 DOI: 10.1007/s10900-024-01351-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 04/15/2024]
Abstract
Despite increased risk of morbidity and mortality among older adults due to preventable infectious diseases such as influenza, shingles, pneumonia, and COVID-19, many forego receiving some, if not all, of these vaccinations. This study examines vaccination motivators and deterrents for undervaccinated older adults in North Dakota (ND). Adults aged 65+ in ND were mailed a survey (n = 901) with questions gauging vaccination behaviors and perceptions, with 132 of these indicating not receiving certain vaccinations. Further questions assessed reasons they have not been vaccinated against the following diseases: influenza, shingles, pneumonia, and COVID-19 (e.g., "Concerned about side effects", "Vaccines are dangerous", "I'm healthy and I do not need it") and what would make it more likely to get a vaccine (e.g., "More information", "Doctor recommendation", "Easy access to vaccines"). Reasons for remaining unvaccinated varied by vaccine. For influenza and pneumococcal vaccines, respondents were more likely to indicate they are healthy and do not need the vaccine. For shingles and COVID-19, respondents were more likely to indicate concerns about side effects. Factors reported to motivate increasing the likelihood of getting a vaccine were receiving a doctor recommendation, receiving more information, and having a vaccine provided at no cost. These results contribute to our understanding of vaccination behaviors among older adults and underscore specific issues around which to frame interventions tailored to increase vaccine uptake for this population.
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Affiliation(s)
- Andrea L Huseth-Zosel
- Department of Public Health, North Dakota State University, Dept. 2662, PO Box 6050, Fargo, ND, 58108-6050, USA.
| | - Heather Fuller
- Department of Human Development and Family Science, North Dakota State University, Fargo, ND, USA
| | - Paul J Carson
- Department of Public Health, North Dakota State University, Dept. 2662, PO Box 6050, Fargo, ND, 58108-6050, USA
- Department of Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
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2
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Zhang WX, Zhang Y, Du J, Shi W, Zhang SS, Yuan M, Zhou Y, Wang L, Zhao TS, Ma Q, Cai X, Zhang S, Yang H, Zhang X, Wang M, Huang N, Zeng J, Liu Y, Wu J, Cui F, Lu QB. Effectiveness of momentary intervention on influenza vaccination among the elderly in China: From willingness to action. Vaccine 2024; 42:125984. [PMID: 38777696 DOI: 10.1016/j.vaccine.2024.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/27/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To evaluate the impact of momentary intervention on the willingness and actual uptake of influenza vaccination among the elderly in China. METHODS A cross-sectional study assessed the willingness of the elderly to receive influenza vaccination, and an momentary intervention aimed to increase vaccination willingness among those initially unwilling. The elderly reporting a willingness were offered free influenza vaccination through a community intervention program. RESULTS A total of 3138 participants were recruited in this study, and 61.3 % (95 % CI 59.6 %-63.0 %) were willing to receive influenza vaccination at baseline. The willingness rate of influenza vaccination increased to 79.8 % (95 % CI 78.4 %-81.2 %), with an increase of 18.5 % (95 % CI 16.3 %-20.7 %) after momentary intervention. The influenza vaccination rate was 40.4 % (95 % CI 38.5 %-42.3 %) before and 53.9 % (95 % CI 52.0 %-55.8 %) after momentary intervention with an increase of 13.5 % (95 % CI 10.9 %-16.2 %). There was no significant difference in influenza vaccination rates between the initially willing people and those who changed to be willing to receive influenza vaccination after momentary intervention (vaccination rates: 78.0 % vs. 81.3 %). CONCLUSION Momentary intervention has been shown to effectively enhance the willingness of the elderly to receive influenza vaccination, thereby facilitating the translation of this intention into actual behavior.
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Affiliation(s)
- Wan-Xue Zhang
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
| | - Yuanshan Zhang
- Department of Infectious Diseases Control, Lingcheng Center for Diseases Control and Prevention, Dezhou, China
| | - Juan Du
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Wanna Shi
- Department of Infectious Diseases Control, Lingcheng Center for Diseases Control and Prevention, Dezhou, China
| | - Shan-Shan Zhang
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
| | | | - Yiguo Zhou
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China; Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Lili Wang
- Department of Immunization Program, Lingcheng Center for Diseases Control and Prevention, Dezhou, China
| | - Tian-Shuo Zhao
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
| | - Qinyi Ma
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
| | - Xianming Cai
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
| | - Sihui Zhang
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
| | - Han Yang
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
| | - Xiyu Zhang
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
| | - Mingting Wang
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
| | - Ninghua Huang
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Jing Zeng
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Yaqiong Liu
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China
| | - Jian Wu
- Department of Infectious Diseases Control, Lingcheng Center for Diseases Control and Prevention, Dezhou, China.
| | - Fuqiang Cui
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China; Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China.
| | - Qing-Bin Lu
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China; Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China.
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Liang X, Li J, Fang Y, Zhang Q, Wong MCS, Yu FY, Ye D, Chan PSF, Kawuki J, Chen S, Mo PKH, Wang Z. Associations between COVID-19 Vaccination and Behavioural Intention to Receive Seasonal Influenza Vaccination among Chinese Older Adults: A Population-Based Random Telephone Survey. Vaccines (Basel) 2023; 11:1213. [PMID: 37515029 PMCID: PMC10385482 DOI: 10.3390/vaccines11071213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/23/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
During the Coronavirus Disease 2019 (COVID-19) pandemic, seasonal influenza remained a significant health threat for older adults. Seasonal influenza vaccination (SIV) is highly effective and safe for older adults. This study investigated the associations of COVID-19 vaccination, perceptions related to COVID-19 and SIV, with the behavioural intention to receive SIV among older adults in Hong Kong, China. A random telephone survey was conducted among 440 community-dwelling Hong Kong residents aged 65 years or above, between November 2021 and January 2022. Among the participants, 55.7% intended to receive SIV in the next year. After adjustment for significant background characteristics, concern about whether SIV and COVID-19 vaccination would negatively affect each other was associated with a lower intention to receive SIV, while a perceived higher risk of co-infection with COVID-19 and seasonal influenza was positively associated with the dependent variable. In addition, the perceived severe consequences of seasonal influenza, perceived benefits of SIV, received cues to action from doctors and participants' family members or friends, and the perception that more older people would receive SIV was associated with a higher behavioural intention. Future programmes promoting SIV among older adults should modify perceptions related to COVID-19 vaccination and SIV at the same time.
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Affiliation(s)
- Xue Liang
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Jiming Li
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yuan Fang
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, China
| | - Qingpeng Zhang
- Musketeers Foundation Institute of Data Science, The University of Hong Kong, Hong Kong, China
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Martin C S Wong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Fuk-Yuen Yu
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Danhua Ye
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Paul Shing-Fong Chan
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Joseph Kawuki
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Siyu Chen
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Phoenix K H Mo
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Zixin Wang
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Chia SC, Lu F, Sun Y. Tracking the Influence of Misinformation on Elderly People's Perceptions and Intention to Accept COVID-19 Vaccines. HEALTH COMMUNICATION 2023; 38:855-865. [PMID: 34555979 DOI: 10.1080/10410236.2021.1980251] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In this study, we surveyed low-income elderly people in Hong Kong and their family or friends to test a dual-path model with which we identified how misinformation in the media reached elderly people and how the elderly people's perception and acceptance of coronavirus disease 2019 (COVID-19) vaccines were influenced. The findings suggest that elderly people's own exposure to erroneous information regarding vaccines and COVID-19 in the media was positively associated with their misperceptions. In addition, their family or friends, who also received misinformation from the media, were found to relay the misleading or erroneous information to the elderly people, indicating a two-step flow of media influence. While previous studies have predominantly focused on the direct influence of misinformation in the media, our study suggests that social influence can also mediate the influence of misinformation in the media and negatively impacts elderly people's perceptions of COVID-19 vaccines.
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Affiliation(s)
- Stella C Chia
- Department of Media and Communication, City University of Hong Kong
| | - Fangcao Lu
- Department of Media and Communication, City University of Hong Kong
| | - Yanqing Sun
- Department of Media and Communication, City University of Hong Kong
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Kharroubi G, Cherif I, Bouabid L, Gharbi A, Boukthir A, Ben Alaya N, Ben Salah A, Bettaieb J. Influenza vaccination knowledge, attitudes, and practices among Tunisian elderly with chronic diseases. BMC Geriatr 2021; 21:700. [PMID: 34911475 PMCID: PMC8672335 DOI: 10.1186/s12877-021-02667-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 11/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Generally, seasonal influenza does not cause severe infection in healthy adults, but for the elderly, an infection can pose a serious health concern. Although several measures can help prevent influenza, vaccination is considered the most effective. This study aimed to assess influenza vaccine uptake among elderly with chronic diseases in Tunisia during the 2018-2019 influenza season, and to identify knowledge, attitudes and barriers associated with influenza vaccine uptake. METHODS During influenza season of 2018-2019, we conducted a national cross-sectional study among elderly with chronic disease who were attending primary and secondary health care facilities in Tunisia. We collected data regarding practices, general knowledge and attitudes related to influenza and influenza vaccine, using a standardized questionnaire. A multivariate analysis by logistic regression was performed to assess the factors influencing willingness to receive influenza vaccine. RESULTS Among the 1191 surveyed elderly, 19.4% (95%CI 14.1-21.9) were vaccinated during the 2018-2019 influenza season and 64.7% (61.9-67.3) expressed willingness to be vaccinated in the next season regardless of vaccination status in the 2018-2019 season. Previous vaccination in the 2018-2019 influenza season was the most significantly associated factor with willingness to receive influenza vaccine (adjusted OR = 16.5 [3.7-72.4]). Significant associations were also observed between knowledge of influenza severity for the elderly as well as for those with chronic diseases and willingness to be vaccinated (p < 0.01). Likewise, participants who were convinced by flu vaccine effectiveness and those who were not concerned about vaccine side effects were more likely to be vaccinated (p < 0.001). The main reason that may lead to vaccine acceptance was a doctor's recommendation (41.1%), while the two main reasons that may lead to vaccine refusal were concerns about side effects (71.5%) and a belief that vaccine was ineffective in averting influenza illness (33.9%). Doctors were the most trusted source for information about influenza vaccine (91.5%). CONCLUSION Our study revealed low influenza vaccination coverage among Tunisian elderly with chronic diseases believed to be at higher risk for severe acute respiratory infections and death if infected with influenza. Treating physicians' role in promoting influenza vaccination in this high-risk group seems to be crucial.
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Affiliation(s)
- Ghassen Kharroubi
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, 1002, Belvédère, Tunis, Tunisia.,Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, Tunis, Tunisia
| | - Ines Cherif
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, 1002, Belvédère, Tunis, Tunisia.,Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, Tunis, Tunisia
| | - Leila Bouabid
- National Observatory of New and Emerging Diseases, Tunis, Tunisia
| | - Adel Gharbi
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, 1002, Belvédère, Tunis, Tunisia.,Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, Tunis, Tunisia
| | - Aicha Boukthir
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, 1002, Belvédère, Tunis, Tunisia.,Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, Tunis, Tunisia
| | - Nissaf Ben Alaya
- National Observatory of New and Emerging Diseases, Tunis, Tunisia
| | - Afif Ben Salah
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, 1002, Belvédère, Tunis, Tunisia.,Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, Tunis, Tunisia.,Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Jihene Bettaieb
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, 1002, Belvédère, Tunis, Tunisia. .,Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, Tunis, Tunisia.
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Bhanu C, Gopal DP, Walters K, Chaudhry UAR. Vaccination uptake amongst older adults from minority ethnic backgrounds: A systematic review. PLoS Med 2021; 18:e1003826. [PMID: 34735440 PMCID: PMC8568150 DOI: 10.1371/journal.pmed.1003826] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 09/28/2021] [Indexed: 11/19/2022] Open
Abstract
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. 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. 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.
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Affiliation(s)
- Cini Bhanu
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Dipesh P. Gopal
- Institute of Population Health Sciences, Queen Mary University of London, London, United Kingdom
| | - Kate Walters
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Umar A. R. Chaudhry
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
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Roller-Wirnsberger R, Lindner S, Kolosovski L, Platzer E, Dovjak P, Flick H, Tziraki C, Illario M. The role of health determinants in the influenza vaccination uptake among older adults (65+): a scope review. Aging Clin Exp Res 2021; 33:2123-2132. [PMID: 33587270 PMCID: PMC7882864 DOI: 10.1007/s40520-021-01793-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/11/2021] [Indexed: 02/06/2023]
Abstract
Background Although the burden of influenza infection is the highest in older adults, vaccination coverage remains low, despite this age group being more vulnerable than others. Aims Given the current pandemic of SARS-CoV-2, it was the aim of this scope review to update knowledge on factors affecting seasonal influenza vaccine uptake among older adults to strengthen prevention approaches in the context of an overall burden of infectious diseases. Methods We searched bibliographic databases from 2012 to 2019. All studies reviewed one or more social determinant of health listed by WHO, or factors affecting the decision-making process whether to accept influenza vaccine or not. Results Overall, 44 studies were included, 41 determinants were extracted and summarized into six categories. Older age and constitutional factors including multiple chronic diseases as well as preventive lifestyle and frequent routine healthcare utilization positively affected vaccination uptake (VU). Living and working conditions are also researched determinants of influenza vaccine uptake. A small number of studies explored the role of social inclusion and system-based interventions. Discussion and conclusions This scope review provides a comprehensive overview on factors affecting seasonal influenza vaccination uptake among older citizens. The review also clearly shows gaps for evidence on system-based level or political strategies to improve vaccination uptake. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-021-01793-3.
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Kajikawa N, Kataoka Y, Goto R, Maeno T, Yokoya S, Umeyama S, Takahashi S, Maeno T. Factors associated with influenza vaccination in Japanese elderly outpatients. Infect Dis Health 2019; 24:212-221. [PMID: 31402297 DOI: 10.1016/j.idh.2019.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/12/2019] [Accepted: 07/15/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Elderly patients benefit from influenza vaccination, but the number of Japanese elderly patients who are vaccinated is insufficient. Several factors are associated with influenza vaccination acceptance, but little is known about Japanese elderly outpatients. The purpose of this study was to examine factors associated with influenza vaccination in elderly outpatients in Japan. METHODS During the 2017-2018 influenza season, outpatients from one hospital and one clinic in Kitaibaraki City, Ibaraki, Japan, participated in this study. Patients answered a self-report questionnaire exploring factors such as their vaccination status during the 2017-2018 season, past influenza vaccination, perceived susceptibility to influenza and adverse events of the vaccine, perceived vaccine efficacy, physician recommendations. Multivariable logistic regression analyses were conducted to identify factors associated with vaccination. RESULTS Of 377 patients, 316 (83.8%) responded, and the vaccination rate was 57%. Eighty-three patients (27.0%) reported that their physician recommended the influenza vaccine. In multivariate analysis, influenza vaccination was associated with higher age (odds ratio (OR) 1.09, 95% confidence interval (CI) 1.03-1.14), physician recommendations (OR 2.49, 95% CI 1.18-5.25), low perceived susceptibility to vaccine-related adverse events (OR 0.33, 95% CI 0.15-0.74), and belief in vaccine efficacy (OR 4.73, 95% CI 2.08-10.8). CONCLUSIONS Influenza vaccination was associated with belief in vaccine efficacy, perceived susceptibility to vaccine-related adverse events, physician recommendations, and older age. Increasing the frequency of physician recommendations may lead to increased vaccination coverage.
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Affiliation(s)
- Natsuki Kajikawa
- Department of Primary Care and Medical Education, Graduate School of Comprehensive Human Science, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan; Kitaibaraki Center for Family Medicine, 844-5 Nakago-cho, Kitaibaraki, Ibaraki, 319-1559, Japan.
| | - Yoshihiro Kataoka
- Department of Primary Care and Medical Education, Graduate School of Comprehensive Human Science, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan; Department of Family Medicine, General Practice and Community Health, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Ryohei Goto
- Department of Primary Care and Medical Education, Graduate School of Comprehensive Human Science, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan; Department of Family Medicine, General Practice and Community Health, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Takami Maeno
- Department of Primary Care and Medical Education, Graduate School of Comprehensive Human Science, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Shoji Yokoya
- Kitaibaraki Center for Family Medicine, 844-5 Nakago-cho, Kitaibaraki, Ibaraki, 319-1559, Japan; Department of Family Medicine, General Practice and Community Health, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Shohei Umeyama
- School of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Satoko Takahashi
- Kitaibaraki Center for Family Medicine, 844-5 Nakago-cho, Kitaibaraki, Ibaraki, 319-1559, Japan.
| | - Tetsuhiro Maeno
- Department of Primary Care and Medical Education, Graduate School of Comprehensive Human Science, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan.
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Sheldenkar A, Lim F, Yung CF, Lwin MO. Acceptance and uptake of influenza vaccines in Asia: A systematic review. Vaccine 2019; 37:4896-4905. [PMID: 31301918 DOI: 10.1016/j.vaccine.2019.07.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 06/04/2019] [Accepted: 07/02/2019] [Indexed: 12/17/2022]
Abstract
In Asia, the public health burden of influenza is significant despite the existence of efficacious influenza vaccines. Annual seasonal influenza vaccination can reduce the incidence of influenza significantly, yet influenza vaccination coverage remains low in this part of the world. As a densely populated region with varying climatic zones and a larger proportion of developing countries compared to the West, Asia is at increased risk of influenza. To provide a more comprehensive and nuanced understanding of the Asian region, the key objective of this systematic review is to examine the determinants of vaccination uptake in Asia, beyond that of existing studies that have largely been western-centric. We carried out a systematic review of peer-reviewed scientific research, examining the key determinants, acceptance and uptake of influenza vaccinations across Asia. A comprehensive search strategy was defined to capture studies that met the inclusion criteria of articles published in English, from 2008 to 2018, focusing on adult populations within Asia. A total of 83 relevant studies were appraised in this review. Analyses of the extant data confirmed that vaccination rates within Asia are low, and that most countries lack scientific research on vaccination behaviours. Studies were categorised into four different population groups: healthcare workers, high risk groups, general population and uniform groups. The motivators and deterrents for vaccine uptake varied according to population groups and characteristics. Both general populations and healthcare workers were concerned with vaccine safety and efficacy, and recommendations from health authorities were influential in vaccine uptake within the other populations. The findings suggest that further research is needed within a broader range of Asian countries to garner greater in-depth knowledge of vaccination behaviours in the region. In particular, influenza vaccination programs within Asia should focus on improving engagement more effectively, through greater relatability and transparency of data when educating the public.
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Affiliation(s)
- Anita Sheldenkar
- Wee Kim Wee School of Communication and Information, Nanyang Technological University (NTU), Singapore.
| | - Fann Lim
- Wee Kim Wee School of Communication and Information, Nanyang Technological University (NTU), Singapore
| | - Chee Fu Yung
- KK Women's and Children's Hospital (KKH), Singapore; Duke-NUS Graduate Medical School, Singapore
| | - May O Lwin
- Wee Kim Wee School of Communication and Information, Nanyang Technological University (NTU), Singapore
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Feng W, Cui J, Li H. Determinants of Willingness of Patients with Type 2 Diabetes Mellitus to Receive the Seasonal Influenza Vaccine in Southeast China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16122203. [PMID: 31234404 PMCID: PMC6617503 DOI: 10.3390/ijerph16122203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 11/16/2022]
Abstract
Willingness of patients with Type 2 diabetes mellitus (T2DM) to receive the seasonal influenza vaccine is low in China. A cross-sectional study on a representative sample of T2DM patients was conducted in Ningbo, a city in southeast China, to assess T2DM patients' willingness to be vaccinated against influenza and identify the influence factors of this willingness. Data regarding the participant's history of influenza, the knowledge, willingness and uptake of the influenza vaccine, demographic characteristics, reasons for willingness or unwillingness to be vaccinated was collected. Only 19.55% of a total of 1749 participants reported a willingness to be vaccinated. Factors positively associated with willingness to be vaccinated were perceived susceptibility to influenza (OR = 1.9, 95% CI: 1.5-2.5), awareness of the vaccine (OR = 1.7, 95% CI: 1.3-2.3) and previous history of influenza vaccination (OR = 4.4, 95% CI: 3.0-6.4). Patients with T2DM who were farmers (OR = 0.6, 95% CI: 0.4-0.8) and those managed by contracted family doctors (OR = 0.8, 95% CI: 0.6-1.0) expressed less willingness to be vaccinated. Targeted interventions such as enhancing health education and strengthening medical staff training should be conducted to increase T2DM patients' willingness to be vaccinated and enhance influenza vaccine uptake among this population.
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Affiliation(s)
- Wei Feng
- Department of Chronic Diseases and Community Health, Fenghua District Center for Disease Control and Prevention, Ningbo 315000, Zhejiang, China.
| | - Jun Cui
- Department of Chronic Disease Prevention, Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315000, Zhejiang, China.
| | - Hui Li
- Department of Chronic Disease Prevention, Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315000, Zhejiang, China.
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Gazibara T, Kovacevic N, Kisic-Tepavcevic D, Nurkovic S, Kurtagic I, Gazibara T, Pekmezovic T. Flu vaccination among older persons: study of knowledge and practices. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2019; 38:2. [PMID: 30606257 PMCID: PMC6318864 DOI: 10.1186/s41043-018-0159-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 12/03/2015] [Indexed: 06/09/2023]
Abstract
BACKGROUND Surveys of older adults' knowledge relative to flu immunization have highlighted its relevance in the improvement of vaccination coverage. The purpose of this study was to estimate the proportion of older persons who have ever been immunized against seasonal flu in the municipality of Vračar (Belgrade, Serbia), assess their knowledge related to flu and flu vaccination, and to determine factors associated with flu immunization. METHODS In the period November 2012-January 2013, 480 persons aged above 65 years were recruited at the Community Health Center, of which 354 persons were finally included in the study. Data were collected using a questionnaire. To assess the level of knowledge, correct answers were awarded 1 point. The total knowledge score ranged from 0 to 17 and was divided into three levels: poor (0-4 points), moderate (5-8 points), good (9-13 points), and excellent (14-17 points). RESULTS The proportion of ever vaccinated older persons was 47.7%. Of those, one third (29.1%) had been immunized regularly. Most seniors (61.9%) demonstrated good, whereas one third (29.8%) demonstrated excellent level of knowledge. In terms of reasons for non-compliance, the highest proportion of older persons declined vaccination because "they were in good health" (33.5%) and because "they did not believe that vaccine protects from flu" (31.5%). Independent predictors of being ever immunized against seasonal flu were having higher level of education, being more knowledgeable relative to flu vaccination, and taking more medications. CONCLUSIONS Our results indicate that health care sector requires well-coordinated promotion campaigns to enhance acceptance of flu vaccination. Organized immunization counseling could provide accurate, evidence-based information in order to transform misbeliefs, prejudice, and negative attitude towards vaccination.
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Affiliation(s)
- Tatjana Gazibara
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Visegradska 26A, Belgrade, 11000 Serbia
| | - Nikolina Kovacevic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Visegradska 26A, Belgrade, 11000 Serbia
| | - Darija Kisic-Tepavcevic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Visegradska 26A, Belgrade, 11000 Serbia
| | - Selmina Nurkovic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Visegradska 26A, Belgrade, 11000 Serbia
| | - Ilma Kurtagic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Visegradska 26A, Belgrade, 11000 Serbia
| | - Teodora Gazibara
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Visegradska 26A, Belgrade, 11000 Serbia
| | - Tatjana Pekmezovic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Visegradska 26A, Belgrade, 11000 Serbia
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Chong HJ, Kim HK, Lee MH, Lee S. Influenza vaccine acceptance and health beliefs among Korean kidney transplant patients. PSYCHOL HEALTH MED 2018; 23:1113-1124. [DOI: 10.1080/13548506.2018.1467023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Hye Jin Chong
- Organ Transplant Center, Chonbuk National University Hospital, Jeonju-si, South Korea
| | - Hyun Kyung Kim
- College of Nursing, Research Institute of Nursing Science, Chonbuk National University, Jeonju-si, South Korea
| | - Myung Ha Lee
- College of Nursing, Research Institute of Nursing Science, Chonbuk National University, Jeonju-si, South Korea
| | - Sik Lee
- Division of Nephrology, Department of Internal Medicine, Chonbuk National University Hospital, Jeonju-si, South Korea
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Kan T, Zhang J. Factors influencing seasonal influenza vaccination behaviour among elderly people: a systematic review. Public Health 2018; 156:67-78. [PMID: 29408191 PMCID: PMC7111770 DOI: 10.1016/j.puhe.2017.12.007] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/24/2017] [Accepted: 12/11/2017] [Indexed: 10/29/2022]
Abstract
OBJECTIVES To explore the behaviour-related factors influencing influenza vaccination among elderly people using a framework derived from the Health Belief Model (HBM) and the Theory of Reasoned Action (TRA). STUDY DESIGN Systematic review. METHODS Five databases were searched using predetermined strategies in March 2016, and 1927 citations were identified. Articles were selected according to inclusion and exclusion criteria. Key information was extracted from selected studies using a predesigned sheet. Both authors assessed study quality using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) or Critical Appraisal Skills Programme (CASP) checklist. RESULTS Thirty-six articles were selected. A new framework was proposed that contributes to shared understanding of factors influencing health behaviour. Possible determinants of influenza vaccination among elderly people were knowledge, health promotion factors, all constructs of the HBM, and some concepts of the TRA. Key factors were threat perception, behavioural beliefs, subjective norms, recommendations, past behaviour and perceived barriers. CONCLUSIONS This is the first systematic review to analyse the factors influencing influenza vaccination behaviour of elderly people using a framework integrating the HBM and the TRA. The framework identified key factors of influenza vaccination and presented the inter-relation of behaviour-related variables. However, further well-designed studies are required to explore the inter-relationships accurately and comprehensively.
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Affiliation(s)
- T Kan
- School of Nursing, Second Military Medical University, Shanghai, China
| | - J Zhang
- School of Nursing, Second Military Medical University, Shanghai, China.
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14
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Leung KC, Mui C, Chiu WY, Ng YY, Chen MHY, Ho PH, Kwok CP, Lam SSM, Wong CY, Wong KY, Pang HH. Impact of patient education on influenza vaccine uptake among community-dwelling elderly: a randomized controlled trial. HEALTH EDUCATION RESEARCH 2017; 32:455-464. [PMID: 28931164 DOI: 10.1093/her/cyx053] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 07/18/2017] [Indexed: 06/07/2023]
Abstract
This randomized controlled trial aimed to test the effectiveness of brief face-to-face patient education in increasing influenza vaccination rate among elderly in the community. Recruitment and intervention were conducted at two general outpatient clinics in Hong Kong. 529 eligible patients were randomly assigned to intervention or control group with 1:1 allocation ratio. Patients in the intervention group received 3-min one-on-one verbal education by medical students and a pamphlet regarding influenza vaccination. Neither verbal health education nor pamphlet was given to the control group. Intention-to-treat analysis showed significantly higher vaccination rate in the intervention group compared with the control group (33.6 versus 25.0%) and the adjusted relative risk was 1.34 (95% CI 1.04-1.72; P = 0.021). Hence, brief face-to-face patient education was effective in increasing influenza vaccine uptake rate of community-dwelling elderly patients. Participants who were undecided whether to receive vaccination seemed to demonstrate larger beneficial effect (RR = 7.84; 95% CI 1.06-57.76) compared with patients who were certain of either receiving (RR = 1.16; 95% CI 0.90-1.48) or not receiving (RR = 2.18; 95% CI 0.68-6.99) the vaccine. The study also revealed that patients' intention for vaccination may not translate into action, reasons for which should be explored in future research.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Herbert H Pang
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
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Cheung KW, Mak YW. Association between Psychological Flexibility and Health Beliefs in the Uptake of Influenza Vaccination among People with Chronic Respiratory Diseases in Hong Kong. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:155. [PMID: 26805870 PMCID: PMC4772175 DOI: 10.3390/ijerph13020155] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 01/18/2016] [Accepted: 01/18/2016] [Indexed: 11/16/2022]
Abstract
It is common for elderly people and those with such chronic disorders as respiratory diseases to suffer severe complications from influenza, a viral infection. The voluntary uptake of vaccination is vital to the effectiveness of influenza prevention efforts. The Health Belief Model (HBM) is the most commonly used framework in the field of vaccination behavior to explain the decision that people make to accept or refuse vaccination. In addition, psychological flexibility is considered helpful in causing people to be open to adopting new practices that are consistent with their values. This study examined the role of psychological flexibility and health beliefs in predicting the uptake of influenza vaccination among people in Hong Kong. Eligible participants were Hong Kong permanent residents aged 18 years or above with a history of chronic respiratory diseases (CRD). A convenience sample of 255 patients was recruited to participate in a cross-sectional survey in which HBM components and factors of psychological flexibility were assessed. The following variables were found to be significant predictors of vaccination: age, smoking status, comorbidity, previous hospitalization, perceived susceptibility, perceived severity, and psychological flexibility. Enhancing psychological flexibility might be a potential new direction for motivating people to accept influenza vaccination.
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Affiliation(s)
- Kin Wai Cheung
- Ruttonjee Hospital, 266 Queen's Road East, Wan Chai, Hong Kong, SAR, China.
| | - Yim Wah Mak
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, SAR, China.
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Kim OS, Yoon SW. [Current state of influenza vaccination and factors affecting vaccination rate among pregnant women]. J Korean Acad Nurs 2015; 44:534-41. [PMID: 25381784 DOI: 10.4040/jkan.2014.44.5.534] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE This study was done to examine the actual state of influenza vaccination among pregnant women and factors affecting vaccination rate. METHODS Data were collected using self-report questionnaires. Participants were pregnant women who participated in a prenatal education program at an acute care hospital in 2013. Data collected from 218 pregnant women were analyzed using the SPSS 18.0 Program. RESULTS Only 48.6% of the pregnant women had received vaccination when the influenza was prevalent. Statistically significant factors affecting the influenza vaccination rate among pregnant women were vaccination experience in the previous year, knowledge and attitude about vaccination, and gestation period. CONCLUSION Results indicate that the influenza vaccination rate among pregnant women is lower than that of elders, healthcare workers, and patients with chronic diseases, who have been considered to be the mandatory vaccination recipients. Therefore, it is necessary to develop programs and policies which provide information including safety of vaccines for pregnant women and to induce positive attitudes towards vaccination for these women, in order to ultimately improve the vaccination rate.
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Affiliation(s)
- Og Son Kim
- Department of Nursing Science, Sangji University, Wonju, Korea
| | - Sung Won Yoon
- Department of Nursing, Chungwoon University, Hongseong, Korea.
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