“You need to be an advocate for yourself”: Factors associated with decision-making regarding influenza and pneumococcal vaccine use among US older adults from within a large metropolitan health system

Abstract

In the United States, influenza and pneumonia account significantly to emergency room use and hospitalization of adults >65 y. The Centers for Disease Control and Prevention recommends use of the annual influenza vaccine and 2 pneumococcal vaccines for older adults to decrease risks of morbidity and mortality. However, actual vaccine up-take is estimated at 61.3% for pneumococcal vaccines and 65% for influenza vaccine in the 2013-2014 season. Vaccine up-take is affected by multiple socio-cultural and economic factors including general healthcare access and utilization, social networks and norms, communication with health providers and health information sources, as well as perceptions related to vaccines and targeted diseases. In this study, 8 focus group discussions (total N = 48) were conducted with adults 65+ years living in urban and suburban communities in the Detroit Metropolitan Area. The research objective was to increase understanding of barriers and facilitators to vaccine up-take in this age cohort within the context of general healthcare availability and accessibility, social networks, information sources, and personal perceptions of diseases and vaccines. The data suggest the need to integrate broader health care service experiences, concepts of knowledge of one's own well-being and vulnerabilities, and self-advocacy as factors associated with older adults' vaccine-use decisions. These data also support recognition of multiple levels of vaccine acceptance which can be disease specific. Implications include potential for increasing vaccine up-take through general improvement in health care delivery and services, as well as specific vaccine-focused patient and provider education programs.

The role of health determinants in the influenza vaccination uptake among older adults (65+): a scope review

“…Additional factors in uencing in uenza vaccination uptake by older citizens found in this analysis range from in uence of family/friend [22,26,32,42] to household arrangements/children [10,18,19,21,22,28,30,31,33,37,38,42,47,48], previous vaccinations [9, 15, 17-20, 22, 29, 30, 32, 35, 38, 42, 51] and other health parameter [9, 15-21, 25, 27, 28, 31, 35, 39]. This implies that the psychosocial environment, like in children, impacts VU.…”

“…The study designs are divided into 34 cross-sectional studies of which 13 studies were developed by means of a secondary analysis of already existing data [11, 12, 14, 15, 19-21, 28-30, 38, 39, 41] and two cross-sectional studies following a qualitative study design [26,32], four randomized controlled trials [43][44][45][46], two systematic reviews [47,48], two cohort studies [49,50] and two theoretical reviews [51,52].…”

“…Methods used to evaluate vaccination uptake in the cross-sectional and cohort studies and in the systematic reviews were: questionnaires and surveys [13-15, 19, 21, 22, 25, 28, 34-36]; telephone interviews [20,23,27,29,30,33,39,41]; data retrieved from national/regional authorities and health care institutions [12,38,40,49,50]; data retrieved from medical records or vaccination registries [9,10,31,37]; combined methods [11,17,18,24]; focus group discussions [26,32]; face-to-face interviews [42]; database search [47,48].…”

“…The number of participants older than 65 years of study samples ranges from 11% to 100% of all initially included study participants (n= 19.604.711) from across the globe in countries from four continents and in following care settings: Community-dwelling or non-institutionalized citizens [9, 15, 21, 23, 27-31, 33, 36, 39, 42, 48, 50], nursing homes [12,38], combined settings [32,37], outpatient clinics [44], hospitals [18,22], primary care centres/clinics or practices [24,26,43,45], home-based primary care settings [10] and data bases such as the Medicare registry, national vaccine industry or settings of health services/insurance authorities [13,40,46]. In 12 studies, details about the care setting of the participants were not indicated [11,14,16,17,19,20,25,34,35,41,47,49].…”

“…Moreover, Godoy et al [24] highlighted that patients whose physicians were vaccinated had a higher VU than those whose physicians were not. An important result gathered in the review is the impact of social inclusion into family or informal social networks, which has been shown to positively affect VU [21,22,26,33,50]. Only a few publications were found reporting results of interventions on system level, one study found out that countries with good monitoring systems regarding VU rates exhibit higher vaccination coverage on average [13].…”