Determinants of Tetanus, Pneumococcal and Influenza Vaccination in the Elderly

A Representative Cross-Sectional Study on Knowledge, Attitude and Practice (KAP)

Carolina J. Klett-Tammen; Gérard Krause; Linda Seefeld; Jördis J. Ott


BMC Public Health. 2016;16(121) 

In This Article


Descriptive Results (Bivariate Analysis)

The sample consisted of 4483 German adults (16 to 85 years) of which 1223 individuals were in the upper age class (60 to 85 years, mean: 69.2 years, SD: 0.6) and were included in the analyses. The majority of participants was female (57.8 %) and had an educational level of secondary education or higher (66.7 %). 12.5 % had a migration background (Table 1).

Half of the respondents rated their health status as "good" or "very good", although 40.5 % indicated having a chronic condition of any kind. Vaccination, independent of the type of vaccine, had been recommended by a physician to 28.2 % of the participants. 72.0 % of the participants indicated they were vaccinated during the last 5 years whereas uptake varied by vaccine type ranging from 11.5 % for pneumococcal vaccination to 50 % for annual influenza and 56.3 % for tetanus vaccination (Table 2).

50.2 % of respondents rated pneumococcal vaccination as important. Pneumococcal, tetanus and influenza vaccine recommendations were known to 28.2, 72.9, and 78.9 % of participants, respectively. Almost 2/3 of the participants had a positive general attitude towards vaccination and 55 % trusted the official vaccine recommendations. More than 90 % perceived physicians to be an appropriate source of information regarding vaccinations (Additional file 3

Individual Predictors of Vaccination (Multivariate Logistic Regression)

  1. Any vaccination
    Results from the multivariate analysis revealed that practice-related variables such as the intention to get vaccinated against influenza (OR = 6.9, CI = 4.0–12.0) and the possession of a vaccination record (OR = 4.5, CI = 2.7–7.4) was strongly associated with vaccine uptake in general (Table 3).

  2. Tetanus vaccination
    Participants who considered it as important to be vaccinated against tetanus were 18 times more likely to be vaccinated. Being vaccinated due to media information (OR = 3.9, 95 % CI = 2.9–5.3) and occupational exposure (OR = 3.3, 95 % CI = 2.2–5.1) also increased the chance of having a tetanus vaccination. The perceived level of information available to an individual was a sex-dependent predictor for the uptake of the tetanus vaccination with men being more likely to be vaccinated against tetanus, if feeling well informed. Most predictors for the tetanus vaccination were attitude-related while none was knowledge-related (Table 3).

  3. Influenza vaccination
    Similar to the tetanus vaccination, the most important predictor for being vaccinated against influenza was the perceived importance of the influenza vaccination, with a 23 times higher likelihood for being vaccinated. For influenza vaccine specifically, uptake was mostly associated with attitude-related variables whereas socio-demographic factors showed no impact. Regarding the practice of vaccine uptake by an individual, the recommendation by a physician significantly increased the likelihood of being vaccinated (OR = 1.7, CI = 1.1–2.7). A low rated own health status was positively correlated with influenza vaccine uptake compared to a good subjective health status (OR = 2.9, CI = 1.1–3.3) (Table 3).

  4. Pneumococcal vaccination
    Knowledge-related variables such as being aware of the vaccine recommendation were strongly associated with pneumococcal vaccine uptake. Similar to influenza and tetanus vaccination but to a lesser degree, the high perceived importance of the vaccine was related to a higher chance to be vaccinated (six times as high for pneumococcal vaccine, 23 and 14 times as high for influenza and tetanus vaccine, respectively).

Among the socio-demographic variables, place of residence (Eastern versus Western Germany) influenced uptake of the pneumococcal vaccination: Participants living in the Eastern part of Germany were 80 % more likely (OR = 1.8, CI = 1.1–3.1) to be vaccinated against pneumococci (Table 3).

Scores as Predictors for Vaccination (Multivariate Score Analysis)

Factor analyses resulted in three scores which consisted of two (knowledge-score) or five factors (attitude- and practice-score). All Cronbach's alphas were at above 0.70. Details on score generation are available from Additional file 4 and Additional file 5

The multivariate score analysis aggregated individual KAP-variables. The result for "any vaccination" revealed that respondents with a higher practice-score, i.e., those who indicated to perform more vaccination-related practices like having a vaccination record or consulting vaccination advice, had an almost four times higher likelihood for receipt of a vaccination compared to those with a lower practice-score. The knowledge- and attitude-score were not significantly associated with uptake of "any vaccination" (Table 4). Similar results were observed for tetanus vaccine uptake. For influenza vaccine, all three scores determined the chance of being vaccinated: participants with a higher knowledge-score were 30 % more likely to get vaccinated compared to those with a lower score. A higher practice-score indicated a 40 % higher likelihood to receive pneumococcal vaccine (Table 4).

Comparison of Individual Variables and Score Analysis for Predicting Vaccine Uptake

Regarding "any vaccination", the comparison of the variables-based and the score-based analysis revealed the same result, i.e., that the general vaccination practice is the most important predictor for vaccine uptake.

Results for score-based and variable-based analysis differed when looking at specific vaccines. For influenza, attitude served as a predictor on both, the variable- and score-level, while the scores "knowledge" and "practice" additionally determined influenza vaccine receipt. Tetanus vaccination was mostly related to attitudes as reflected by the individual attitude-related determinants. Controversially, in the score-based analysis the strongest association with the uptake of the tetanus vaccination was shown for the practice-score. The comparison of the individual variable- and the score-analysis for pneumococcal vaccination revealed that knowledge and practice are predictors on both, the individual variable and score level (Table 5).