Flu vaccination among patients with diabetes: motives, perceptions, trust, and risk culture - a qualitative survey

Abstract

BackgroundVaccination against seasonal influenza (SIV) is recommended for patients with diabetes, but their vaccination coverage is unsatisfactory in France and elsewhere. This qualitative survey of people with diabetes sought to explore 1) the extent to which SIV-related behaviour is more or less automatic; 2) reasons they choose/reject SIV; 3) their trust/distrust in authorities, science, and medicine.MethodsWe conducted semi-structured in-depth interviews of 19 adults with diabetes in 2014. We recruited them through physicians or patient associations and implemented an analysis of thematic content.ResultsEight patients were vaccinated against flu in the preceding flu season and 11 were not. SIV uptake and refusal were stable over time and justified by multiple arguments. Coupons for free vaccines and regular doctor visits contributed to the habit of vaccination. Vaccination decisions were frequently anchored in past experiences of influenza and its vaccine. Patients often justified non-vaccination with attitudes of trivialisation/relativisation of influenza-associated risks and the perception that these can be controlled by means other than vaccination (e.g., through the avoidance of exposure). Some misbeliefs (e.g., SIV causes influenza) and doubts about SIV effectiveness and safety also existed. Several patients reported increased mistrust of SIV since the A/H1N1 pandemic in 2009. Patients trusted their doctors strongly regardless of their SIV behaviour, but unvaccinated patients had little trust in the government and pharmaceutical companies. Some discordances were found between perceptions and behaviour (e.g., remaining vaccinated despite doubts about SIV effectiveness or remaining unvaccinated despite feelings of vulnerability towards influenza complication), suggesting the existence of some vaccine hesitancy among patients.ConclusionThis study among patients with diabetes suggest that SIV uptake is stable, thanks to a favourable environment. Nonetheless, SIV refusal is also stable over time. Unvaccinated patients used multiple arguments to justify SIV refusal, including compensatory health beliefs. Physicians should take every opportunity to recommend SIV. The necessary individualised patient education regarding SIV requires better physician training in patients priorities. While almost all patients strongly trust their doctors, unvaccinated patients distrust distal stakeholders: it is absolutely essential to restore trust in them and to develop new more effective influenza vaccines.

Seasonal influenza vaccination among people with diabetes: influence of patients’ characteristics and healthcare use on behavioral changes

“…Our results demonstrate, consistently with previous findings, that people with diabetes have mainly stable SIV behaviors. 6,7,14 The finding that the probability of remaining vaccinated (0.91) was significantly higher than that of remaining unvaccinated (0.83) is somewhat encouraging, even though the order of magnitude of these probabilities did not differ notably. Nonetheless, the probabilities of behavioral shifts were non-negligible in each group and higher for starting to vaccinate than for stopping it.…”

“…These findings confirm the key role of doctors in promoting SIV among at-risk patients. 6,12,21 Previous studies have shown that patients trust their physicians strongly 7 and that these professionals can play an important role in improving patients' knowledge and decision-making process about SIV. 22,23 The absence of any similar effect for endocrinologists and cardiologists, however, suggests that these specialists might be missing some opportunities to promote SIV.…”

“…These events may increase patients' perception of their own vulnerability toward influenza or of the severity of the diseaseboth strong facilitators of the adoption of SIV. 7 Moreover, they provide a good practical opportunity to meet caregivers involved in therapeutic education programs, provided that these include education about SIV.…”

“…The SIV rate in this population is nonetheless far below WHO's target of 75% in most Western countries, 4 including France (about 30% among those <65 years and 60% among those ≥ 65 years). 5,6 Vaccine hesitancy among people with diabetes may contribute significantly to suboptimal vaccination coverage, 7 as observed in other population groups, such as parents. [8][9][10][11] The complexity of the vaccination pathway in Francedespite efforts to simplify itmay also contribute to this situation.…”

Vaccine hesitancy in the French population in 2016, and its association with vaccine uptake and perceived vaccine risk–benefit balance

“…As in previous studies [ 18 ], we also found that mothers were more often vaccine hesitant than fathers, perhaps because they are often more involved in the medical follow-up of their children. Finally, in EP, health concerns and chronic disease have already been described as motives for attributing a low priority to or refusing influenza vaccination [ 19 , 20 ].…”