Influenza Vaccine Preference, Uptake in Older People Reviewed

Laurie Barclay, MD

October 20, 2010

October 20, 2010 — A review of influenza vaccine preference and uptake among older people in 9 countries may help guide strategies for better vaccine access and compliance in older people, according to a report published in the October issue of the Journal of Advanced Nursing.

"This paper is a report of a study delineating factors that influence older people's preferences and uptake of the influenza vaccine in nine countries," write Enid Wai-yung Kwong, PhD, RN, from the School of Nursing, Hong Kong Polytechnic University, and colleagues. "Vaccination uptake for the aging population in many countries still remains below the World Health Organization recommended rate. Older people who perceive higher susceptibility to and severity of influenza, and more benefits from vaccination and action cues prompting vaccination, tend to accept the vaccine, but those with more perceived barriers to vaccination are less likely to accept it."

The study goal was to determine why so many of these countries were failing to meet the 75% annual influenza vaccination rate recommended by the World Health Organization, particularly as annual influenza epidemics result in up to half a million deaths every year, with most deaths in industrialized countries occurring in people older than 65 years.

In 2007, the investigators recruited 208 older people from 9 countries with different healthcare systems: China, Indonesia, Turkey, Korea, Greece, Canada, the United Kingdom, Brazil, and Nigeria. Participants were enrolled in 14 vaccinated and 12 unvaccinated focus groups, where they discussed their experiences regarding influenza, vaccination against influenza, and promotion of influenza vaccination.

To facilitate an in-depth understanding of vaccination behavior among older people, the investigators identified 5 themes and generated a hypothetical framework connecting these themes. Behavioral beliefs in vaccination affected participants' vaccine preferences. These beliefs were based on participants' estimation of how susceptible they were to vaccination, of the severity of influenza, and of the efficacy of the vaccine, as well as their utility calculation of vaccine, healthcare, and social costs.

"Action cues prompting vaccination and vaccine access further affected the vaccine uptake of participants with vaccine preferences," the study authors write. "Vaccination coverage was likely to be higher in the countries where normative beliefs in favour of vaccination had formed. The hypothetical framework can be used to guide healthcare providers in developing strategies to foster normative beliefs of older people in vaccination, provide effective action cues and promote vaccine access."

Compared with participants who were vaccinated, those who chose not to be vaccinated were more likely to rely on indigenous or traditional health practices, as well as good general health and hand hygiene. For example, some of the traditional health practices favored by those who were not vaccinated were eating steamed pears, having a soothing massage, or being rubbed with a coin.

"Our framework is more comprehensive than the health belief model in explaining the vaccination behaviour of older people across countries with different healthcare financing systems and dominant cultures," the study authors conclude. "It can contribute to future research investigating vaccination behaviour and also to the development of interventions to increase the vaccination coverage of older people.... We thus recommend the development of a vaccination programme in future studies, based on our framework, to motivate older people's acceptance of these vaccines and to test the effect of the programme."

The International Council of Nurses supported this study. The study authors have disclosed no relevant financial relationships.

J Advanced Nursing. 2010;66:2297-2308.

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