SCIENTIFIC
Knowledge Gap as Barrier to Influenza Vaccination at a University Primary Care Clinic
AUTHORS :
Yi-Wen Chen , MD , MS Department of Internal Medicine , Palo Alto Medical Foundation
Ruchi Bhandari , PhD , MPA , MBA Department of Epidemiology and Biostatistics , School of Public Health , West Virginia University
Melanie Fisher , MD , FACP , MSc Section of Infectious Diseases , West Virginia University
INTRODUCTION
According to the Centers for Disease Control and Prevention , influenza-associated mortality has the potential to reach up to 56,000 annually in the United States ( US ). 1 Influenza is a preventable disease , and the vaccine is known to be a safe and effective modality for prevention . The 2009 H1N1 pandemic affected 200 million people and caused more than 17,000 deaths worldwide , 2 emphasizing the importance of prevention . During the 2015-2016 season , an estimated 5 million cases of influenza and 2.5 million medical visits were averted , and up to 112,000 hospitalizations were prevented by the vaccine in the US . 3 To address this preventable disease , the Healthy People 2020 initiative set goals to achieve a vaccination rate of 70 % by the year 2020 .
In West Virginia ( WV ), the influenza vaccination rate was 49.6 % during the 2016- 2017 influenza season . This rate was significantly below the goal of Healthy People 2020 and more than three percentage points lower than other neighboring states , including Pennsylvania and Maryland . 4 Studies have suggested potential barriers to vaccination , including lack of awareness , 5-9 fear of side effects , 5-10 and socioeconomic factors . 11 However , these factors might not be the same in different communities , so it is important to determine the barriers at the local level . Therefore , we aimed to elucidate patients ’ knowledge , attitudes , and perceptions of
ABSTRACT
INTRODUCTION Since the influenza vaccination rate in West Virginia has been low in comparison to the Healthy People 2020 Goal of 70 %, we sought to understand the barriers to vaccination .
METHODS A questionnaire was administered to adult patients 18 years and older who sought care between October 1 , 2017 , and February 28 , 2018 , at a university primary care clinic . The participants were divided into two groups : patients who received or intended to receive the influenza vaccine ( vaccinated group ) and those who declined it ( unvaccinated group ). The two groups were compared to assess differences in knowledge , attitudes , and perceptions .
influenza vaccination at a university primary care clinic in Morgantown , WV .
METHODS PARTICIPANTS
This study recruited new and returning patients who were 18 years or older and sought care between October 1 , 2017 , and February 28 , 2018 , at the West Virginia University ( WVU ) Medical Group Practice Clinic ( MGP ), a university clinic serving the city of Morgantown and neighboring regions . Participants were asked to complete a survey to assess their knowledge and attitudes of the influenza vaccine . A cover letter was included with the questionnaire to introduce participants to the research study and encourage participation . The survey was voluntary , anonymous and approved by the WVU Institutional Review Board . The clinic ’ s front desk staff distributed the survey to patients when they checked in for their appointments , and they were asked to complete it before leaving clinic . To avoid duplicate entries , the cover letter instructed patients who completed the questionnaire at a previous
RESULTS In total , 178 patients participated . The vaccinated group had increased knowledge of the vaccine ’ s effectiveness ( p value < 0.001 ), vaccine indications ( p = 0.044 ), and reduced disease severity after vaccination ( p < 0.001 ) compared to the unvaccinated group . In addition , the most common reasons for declining vaccination were lack of awareness ( 34 %), fear of side effects ( 31 %), and lack of perceived need or motivation ( 21 %).
CONCLUSION A significant knowledge disparity existed between patients who received or planned to receive the influenza vaccine and those who declined , suggesting this knowledge gap may explain the low vaccination rates and emphasizing the importance of counseling patients on the benefits and risks of the vaccine .
visit to not complete it again and return the blank survey to the front desk .
SURVEY
The questionnaire was designed to assess the participants ’ knowledge , perceptions , and attitudes of the influenza vaccine and was based on a similar survey developed to evaluate the barriers to hepatitis B vaccination in another study . 12 It contained questions about patient demographics , including age , gender , highest level of education , and knowledge of the influenza vaccine . Specifically , the knowledge section evaluated patients ’ understanding of vaccine effectiveness , influenza severity , vaccine indications , disease severity after vaccination , herd immunity , and vaccine side effects . The survey also included the patient ’ s vaccination status , whether he or she received or planned to receive the vaccine during the 2017-2018 influenza season , and the proportions of family and close friends who were vaccinated .
In addition , the questionnaire contained a free response section for patients to express
28 • www . wvsma . org