How can you improve vaccination rates among older African Americans?
Patients want you to address their fear of drug interactions and allergic reactions.
Providers noted the importance of: promoting informed decision making, one-on-one communication, using a matriarchal figure to promote vaccination and using the media to promote vaccination. “You would have to have a mother, or a grandmother, or aunt figure because that is usually who is responsible, who takes care of the family.” Providers also pointed out that patients often voice concerns about not having enough information to make informed decisions, and that patients rely on convenience and doctors’ recommendations when deciding about vaccination.
Patients may distrust the system, but they trust their doctor
Our study’s findings from both providers and older African Americans suggest that physicians are the most influential source of information when patients are deciding about flu vaccination. This is true despite the fact that the public makes no secret of its distrust of the medical system and the safety of the vaccine. The African American participants also suggested that physicians do not adequately address patient concerns through discussion and the information they provide.
Providers were concerned that many people do not believe the flu is a severe illness or that they are susceptible. Although the African Americans in the study recognized some high-risk groups, they tended not to consider themselves part of any of those groups.
Doctors didn’t realize that patients fear drug interactions
One of the interesting findings of this study was that armed with the knowledge that the flu shot does not guarantee flu prevention, African American adults were willing to forego the vaccine. This absence of a guarantee also reinforced their beliefs that other prevention methods, such as handwashing and avoidance, are more effective.
Not surprisingly, of course, was the finding that patients continue to avoid the flu shot for fear of getting the flu.2,6 What was a bit surprising was that providers did not recognize that fear of medication reactions (drug interactions and allergic reactions) was also a barrier to flu vaccination. Providers also missed out on an educational opportunity, since many of the African American participants wanted to discuss the possibility of interactions with them.
Limitations of the study
External validity is limited because the findings cannot be generalized to every African American population in the US. The participants made up a non-random convenience sample of older African Americans in a Midwestern city, although the community-based recruitment strategy succeeded in reaching members of a lower income urban population. This study included only those who were ambivalent about the vaccine and who were open to both the pros and cons of vaccination. Project staff minimized possible interviewer bias by using experienced moderators, ensuring the consistent use of moderator guides, and using consensus coding procedures.
Funding
This research was funded by grant #6465 from the National Immunization Program at the Centers for Disease Control and Prevention, via Special Interest Project 11, to the Prevention research Center at the Saint louis University School of Public Health.
Acknowledgments
We thank Katie Duggan at the School of Public Health and edith Gary and Pascale Wortley at the CDC for their support. This article is dedicated to the memory of Joe D. Wray, MD, who suggested it.
Correspondence
Ricardo J. Wray, PhD, Community Health, Saint Louis University School of Public Health, 3545 Lafayette Avenue, St. Louis, MO 63104; wray@slu.edu
