Practice recommendations
- Recommend the flu shot and make it convenient to get vaccinated.
- Tell your patients that the flu is a serious illness and that they may be susceptible, even if they haven’t had it before. reinforce the idea that they should practice good hygiene, such as washing their hands regularly.
- Tell patients that the flu shot is safe; it will not give them the flu or interact with any of their medications.
- Give patients printed materials. excellent resources are available through the CDC (www.cdc.gov/flu) or the National Institute of Allergy and Infectious Disease (www3.niaid.nih.gov).
Abstract
Purpose Adults 65 and older are at greatest risk for complications and death from influenza, yet one third of those at risk do not receive the influenza vaccine; African American vaccination rates are even lower. This study explored older African Americans’ concerns about getting the flu vaccine and vaccine providers’ level of awareness of these concerns.
Methods Focus groups and in-depth interviews were conducted among African Americans who were 50 years of age and older, and vaccine providers.
Results Older African Americans’ fear of getting the flu from vaccination was widespread, as were concerns about vaccine interaction with medications and allergic reactions. older African Americans also doubted the vaccine’s effectiveness, and distrusted both the vaccine and the healthcare system. For their part, providers understood patients’ concerns and recognized that fear of illness caused by the shot was a major issue. They did not, however, recognize the importance of asking about, and discussing, patients’ fears of allergies and medication interactions when administering the vaccine.
Conclusions In order to improve vaccination rates among older African Americans, health care providers would be wise to take the time to discuss the vaccine and address vaccine efficacy, safety, side effects, and drug interactions.
Why are older African Americans less likely than whites to get a flu vaccination? Despite the existence of an effective flu vaccine, usage rates still remain low: 66% on average,1 and are even lower among minority groups.2 One survey found only 47% of older African Americans were vaccinated against the flu.3
These disparities are not easily explained. Even when controlling for increased risk, age distribution, perceived health status, family size and marital status, poverty level, education, and access to medical care and health insurance, African Americans are still less likely than whites to get vaccinated.3,4
In light of this disparity, we explored barriers to flu vaccination among this population, including concerns over safety and adverse events, and the role that health care providers can play in overcoming these issues.
What are the barriers?
Structural factors, such as having access to a location that provides vaccinations,5 and social factors, such as believing that others support vaccination,6 increase vaccination rates. Vaccination increases with age5,7 and is more likely in those who have previously been vaccinated.8
People who believe they aren’t susceptible to a disease are less likely to get vaccinated.9,10 Fear of side effects is also a significant barrier.2,6,7,11,12 Fear of illness from the vaccine is often cited by both white and African American Medicare patients, older adults, and most notably by older African Americans.2,5,12 African Americans and other minority groups are less likely to accept the vaccine as safe.13
A physician’s recommendation to get the flu vaccine appears to motivate patients in risk groups to get vaccinated,6,7,12 and is a significant determinant of vaccine acceptance in surveys of older Americans, high-risk patients, and older African Americans in particular.6,12
Methods
Focus groups and interviews
The study team conducted qualitative formative research with 2 pertinent audiences: African American adults (hereafter, “public participants”) and clinicians who administer the flu vaccine (hereafter, “providers”). The Saint Louis University Institutional Review Board approved the research.
We recruited older African American public participants through local community contacts, and screened to identify those ambivalent about getting a flu shot. A trained moderator then conducted focus groups and interviews with those who were ambivalent about the flu shot to assess their knowledge, beliefs, norms, and intentions related to vaccination.
We also recruited vaccine providers by calling local hospitals, doctors’ offices, health departments, and clinics that serve African Americans. To identify providers’ perceptions of patients’ concerns, we carried out interviews at the clinicians’ place of business or in a university conference room; a focus group was conducted at a community clinic.
All focus groups and interviews were audiotaped and transcribed. In pairs, research team members (all authors except for HJ) coded each of the transcripts independently, reviewed and discussed their codes, and then came to agreement on the final codes. Coded transcripts were entered into Atlas.ti (Atlas.ti GmbH, Berlin, Germany), a qualitative data analysis software program, and were analyzed with summary reports drafted for each focus group and interview. Findings were then synthesized across groups and interviews, and across segments.