TABLE 1 : Sample Characteristics by Vaccination Status Vaccination Status
Yes ( N = 149 ) No ( N = 29 )
Mean SEM Mean SEM P value Age 45.14 1.43 48.44 3.72 0.376
Gender
Education
N % N % Male 49 33 9 31 0.982 Female 88 59 16 55 High School 53 36 15 52 0.443 Associate 9 6 2 7 College 54 36 7 24 Graduate 29 19 5 17
Independent Sample T-Test , χ ², or Fisher ’ s Exact Test
Patient characteristics by vaccination status with independent sample t-test , chi square , or Fisher ’ s exact test showing no statistical differences between the vaccinated and unvaccinated groups by age , gender , and education .
N = number of participants in the denoted category ; % = percentage of patients in each category ; χ ² = chi square ; SEM = standard error of mean .
their reasons for declining vaccination and their recommendations to improve vaccination rates . Before the survey was administered , it had been revised to ensure the questions were unbiased , non-judgmental , and easy-to-read , based on feedback from the faculty in the Department of Internal Medicine and the Section of Infectious Diseases at WVU .
DATA ANALYSIS AND STATISTICS
The participants were divided into two groups : patients who received or intended to receive the vaccine during the 2017- 2018 influenza season ( vaccinated group ) and those who declined ( unvaccinated group ). The two groups were compared in terms of patient age , gender , and highest level of education to determine if significant differences existed between them . Frequencies and percentages for all variables were calculated , and we conducted independent sample t-test , chi-square test of independence , or Fisher ’ s exact test depending on the type of variable and number of data points in each category . A p-value of less than 0.05 is considered statistically significant . The analysis was conducted with IBM SPSS Statistics for Windows ( Version 26.0 . Armonk , NY : IBM Corp ).
For each knowledge category , we conducted independent sample t-test , chi square , or
Fisher ’ s exact test , depending on the variable type and data count in each category to compare the two groups .
In addition to the knowledge assessment , participants were asked to report the proportions of family and close friends who were vaccinated during the same season . The answer choices were as follows : less than half , about half , and more than half , and they were coded as 1 , 2 , and 3 , respectively . Chi square analysis was used to determine if a difference between the vaccinated and unvaccinated groups existed in terms of the proportions of family and friends who received the vaccine .
Furthermore , the survey included free response questions , including reasons for declining the influenza vaccine and recommendations from participants to improve vaccination rates . The responses were categorized , and frequency tables were constructed .
RESULTS PATIENT CHARACTERISTICS
A total of 5,004 unique patients sought care from WVU MGP during the five-month study period , and 179 completed the survey for a response rate of 3.6 %. One survey was excluded due to unknown vaccination status , resulting in a total of 178 entries for analysis . The mean age of the participants who were vaccinated during the influenza season was 45 years old , and those who declined vaccination , 48 years old . No statistically significant differences existed between the two groups by age ( p = 0.376 ) or gender ( p = 0.982 ). We also examined their highest level of education , including high school , associate , college , and graduate levels and did not find a statistical difference between the groups ( p = 0.443 ) ( Table 1 ).
KNOWLEDGE OF THE INFLUENZA VACCINE
The vaccinated group scored higher on three out of the six knowledge-based categories . When the two groups were compared with respect to each knowledge category , the understanding of the vaccine ’ s effective ness , indications for vaccination , and influenza severity after vaccination was statistically significant ( Table 2 ). In addition , the vaccinated group was more likely to have family and close friends who also received the vaccine ( p = 0.001 ).
REASONS FOR DECLINING VACCINATION
A total of 29 participants declined the vaccine . The most common reasons were lack of awareness ( 34 %), fear of side effects ( 31 %), and lack of perceived need or motivation ( 21 %). Another less common reason was the lack of reminders from healthcare professionals .
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