Exploring racial influences on flu vaccine attitudes and behavior: Results of a national survey of White and African American adults

Abstract

Introduction Racial disparities in adult flu vaccination rates persist with African Americans falling below Whites in vaccine acceptance. Although the literature has examined traditional variables including barriers, access, attitudes, among others, there has been virtually no examination of the extent to which racial factors including racial consciousness, fairness, and discrimination may affect vaccine attitudes and behaviors. Methods We contracted with GfK to conduct an online, nationally representative survey with 819 African American and 838 White respondents. Measures included risk perception, trust, vaccine attitudes, hesitancy and confidence, novel measures on racial factors, and vaccine behavior. Results There were significant racial differences in vaccine attitudes, risk perception, trust, hesitancy and confidence. For both groups, racial fairness had stronger direct effects on the vaccine-related variables with more positive coefficients associated with more positive vaccine attitudes. Racial consciousness in a health care setting emerged as a more powerful influence on attitudes and beliefs, particularly for African Americans, with higher scores on racial consciousness associated with lower trust in the vaccine and the vaccine process, higher perceived vaccine risk, less knowledge of flu vaccine, greater vaccine hesitancy, and less confidence in the flu vaccine. The effect of racial fairness on vaccine behavior was mediated by trust in the flu vaccine for African Americans only (i.e., higher racial fairness increased trust in the vaccine process and thus the probability of getting a flu vaccine). The effect of racial consciousness and discrimination for African Americans on vaccine uptake was mediated by perceived vaccine risk and flu vaccine knowledge. Conclusions Racial factors can be a useful new tool for understanding and addressing attitudes toward the flu vaccine and actual vaccine behavior. These new concepts can facilitate more effective tailored and targeted vaccine communications.

African American adults and seasonal influenza vaccination: Changing our approach can move the needle

“…We explored this area in our 2015 survey, examining racial factors including 1) racial fairness, defined as perceptions of whether treatment, either by government or within a health care setting, is fair to one's race; 2) racial consciousness defined as the awareness of oneself as a racial being in a health care setting; 3) experience with discrimination in health care, and 4) the impact of that discrimination on the ability to get health care. 15 We found that higher perceived racial fairness was associated with key factors such as higher trust in the vaccine, higher confidence in the vaccine, and lower perceived risk of vaccine side effects. 15 Racial consciousness explored the extent to which an individual thought their race affected their experiences with health care.…”

“…However, when African Americans also perceived a high risk of influenza itself, the perceived risk of side effects did not affect vaccine uptake. [15][16] In our qualitative research, we found when African Americans thought about vaccine risk, they often discussed very severe side effects, which are highly unusual. 17 For example, one African American man reported, "I hear people, I hear tall tales, someone will say, 'It will paralyze you.…”

“…17 We also found that African Americans had lower knowledge about the flu vaccine, less trust in the vaccine, and perceived greater barriers to getting a vaccine. 15 We know that social norms can influence behavior, so our finding that African Americans were less likely to believe that people close to them wanted them to get the flu vaccine is troubling. In Table 1, we present the data from two survey items, administered as part of our larger cross-sectional survey with GfK's Knowledge Panel in 2015.…”

“…Since 2012, my research team has used mixed methods research including two cross sectional surveys with nationally representative samples and extensive qualitative research including focus groups and individual interviews to explore cultural and other psychosocial factors associated with flu vaccine disparities. [15][16][17] Looking specifically at our African American participants across our studies, we have found some important factors that we believe can improve vaccine uptake. For example, in our nationally representative survey of 819 African Americans, we found they were more likely to perceive higher risk of side effects from the vaccine itself, and specifically, women, younger adults and those with lower education level were more likely to have higher perceived risk of vaccine side effects.…”

Determinants of trust in the flu vaccine for African Americans and Whites

“…The second, from the American Academy of Arts and Science (AAAS), calls for research on the role of trust in vaccine decisions, particularly within “at-risk communities” where social norms may contribute to lower vaccine trust and greater vaccine hesitancy (AAAS, 2014). Reflecting upon both calls, we recognized the need for research on trust as it relates to vaccine disparities, as growing evidence indicates African Americans experience greater distrust and vaccine hesitancy when compared to their White peers (Quinn et al, 2017). In this manuscript, we utilize national survey data to explore the determinants of trust in both influenza vaccines and trust in the entities and agencies responsible for vaccine development, manufacture, and administration in a representative sample of White and African American adults.…”