An Assessment of Adult Perceptions of Flu Illness and Vaccine Knowledge

Jonna S. LloydOral Capstone Defense Multimedia PresentationWestern Governors University

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Personal Introduction• Diploma in nursing, Graduated 1993• 8 years in public health, 5 years as a PHN, 3 years as a

WHNP (1 year certificate program via Emory University, 1997-1998)

• 13 years in secondary Health Science Education▫ A&P, Intro to Health Sciences, Rehab Therapies, Diagnostic

Medicine, EMS• Nursing experience: maternal/child health, family

planning, low risk obstetric care, communicable disease treatment and tracking

• Teaching experience: curriculum development, test item development, classroom management, differentiated learning

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Influencing Factors in Topic Choice•Interest in communicable disease tracking from

previous work as a PHN•Use of flu trends and other public health data

from CDC website as a teaching tool for my current students

•Hospitalization of my 25 yr. old daughter for flu related Acute Respiratory Distress Syndrome (ARDS), December 2013▫Flu vaccine would likely have prevented her illness▫Began to wonder how many others in her situation

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Topic’s Relevance to Nursing• Nurses are trusted

healthcare professionals in both professional and community settings

• Specifically poised to correct misinformation re: flu illness and vaccine and encourage vaccination

• Can be accomplished via formal and informal encounters

Ask me about flu shots!

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Overview of Project• Up to 95% of vaccine preventable deaths every year are

adults with flu complications• $10.4 billion direct medical costs, $87 billion overall, and

yearly average of > 23,000 deaths • U.S. has low adult vaccine rates yearly when many have

resources to obtain vaccine• H1N1 virulence led to Advisory Committee On

Immunization Practices (ACIP) recommending all persons >6 mo. old receive flu vaccine in 2010-2011

• Need to determine and remove barriers to vaccination to decrease burden of flu

• 30 working adults surveyed re: risk perception for flu and knowledge of flu vaccine

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Project Development• Multiple informal questioning encounters

with coworkers to determine need for research (early January 2014)

• Literature review revealed barriers to vaccination and gaps in research

• RQ: What are the perceptions of working age adults in a secondary school system on flu illness and vaccine knowledge?

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Barriers to Vaccination and Gaps in Research

Barriers Research Gaps • Belief that vaccine

will cause flu illness • Vaccine is

ineffective• Inconvenience• Cost • Fear of injection• Unaware of need for

vaccination

• Need localized estimates of: ▫ Flu vaccination

coverage▫ Direct costs: provider

visits, prescriptions, inpatient care

▫ Indirect costs: lost wages for employees, lost productivity for employers

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Methodology•Quantitative descriptive design chosen to

determine impact of perceptions on intent to receive flu vaccine

•Survey items developed from most common misconceptions related to flu vaccine

•Answers to research question sought via survey instrument:▫Did they know they were at risk?▫What did they believe re: flu illness and vaccine?▫Did these beliefs impact intent to receive vaccine?

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Notable Results for the Group Overall• 97% felt flu is dangerous

for adults• 70% of the group

overall felt they were at risk for flu infection

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Notable Results for the Group Overall57% felt vaccine

can cause illness

63% felt access is inconvenient

87% felt vaccine might not work

67% intend to get vaccine for 2014-2015 flu season

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Notable Statistics by Age Division

10. Intent to get vaccine

9. Vaccine might not work

8. Vacc access is inconvenient

7. Vaccine is painful

6. Vaccine has side effects

5. Vaccine may cause flu

4. Flu is dangerous for adults

3. Feel I am at risk

0 20 40 60 80 100 120

87.5

87.5

75

0

37.5

25

50

75

69.2

76.8

69.2

7.8

30.8

54

92.2

69.2

100

100

40

20

40

80

100

80

50

100

50

0

50

100

80

50

21-30 yr. old31-40 yr. old41-50 yr. old51-64 yr. old

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Notable Statistics by Parental Status

10. Intent to get vaccine

9. Vaccine might not work

8. Vacc access is inconvenient

7. Vaccine is painful

6. Vaccine has side effects

5. Vaccine may cause flu

4. Flu is dangerous for adults

3. Feel I am at risk

0 20 40 60 80 100 120

79.2

83.3

66.7

4.2

37.5

50

95.8

83.3

16.7

100

50

16.7

16.7

83.3

100

16.7

Non-parentParent, de-pendent or independent children

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Conclusions•Higher percentage than expected for the

group overall of those who intend to be vaccinated

•Younger participants and non-parents have the least intent to be vaccinated

•Concept of infection risk increases with age while concept of flu severity decreases with age

•Higher numbers than expected for belief that vaccine can cause actual flu infection

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Challenges Encountered• Literature review:

finding current literature/statistics, synthesizing resources, staying organized

• Primary challenge was in creating a concise survey instrument that would collect data that answered research question

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Strategies to Overcome Challenges

Application to Future Research

• Reviewed multiple previous studies for most common barriers and beliefs about flu illness and vaccine

• Combined with information gained from informal encounters with population of interest to develop most pertinent constructs for survey▫ Demo data▫ Risk perception and

susceptibility▫ Flu vaccine knowledge

• Organization and categorization of sources by these three constructs

• Thorough literature reviews vital before beginning research

• Develop organizational system for sources

• Check for gaps in literature and previous research during preliminary idea development; don’t chase “red herrings”

• Design research to eliminate gaps; ensure work is meaningful

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Limitations of Research• Small sample size• Numbers of

respondents per age division disproportionate

• Limited number of variables assessed

• Homogenous group; results cannot be applied to all adults

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Strategies to Strengthen Research•Increase sample size and diversify to

include adults with varying socioeconomic statuses

•Include the following variables▫Previous vaccine receipt▫Previous clinician recommendation▫Gender▫Race

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Strengths of Research

Application to Future Research

• Thorough literature review revealed clear direction for research design/implementation

• Statistical differences noted that could help tailor vaccine campaign to increase vaccine acceptance in this population

• Enthusiastic participation from population of interest

• Most pertinent variables assessed in relation to intent to receive vaccine; brief survey increased participation

• Literature reviews for clear direction in research

• Concise design of survey instrument to answer research question

• Brief time needed for participation on behalf of respondents

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Future Research on This Topic•Impact of severity of 2013-2014 flu season

on intent to receive vaccine•Impact of timing of survey; research

implemented in October 2014, height of flu vaccine campaigns in the community

•2014-2015 statistics on vaccine receipt and actual infection rate

•Impact of participation in survey on actual vaccine receipt

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Application of Capstone Concepts to Current Work Environment• Increased ability to utilize assessment data to impact

future teaching and determine areas for review• Assessments contain more higher order thinking

questions that determine students’ abilities to apply, analyze, and synthesize information

• Current high school students to complete research using CDC weekly surveillance data▫Will compare and contrast morbidity and mortality

from past flu seasons with vaccine receipt data▫Increase knowledge base and ability to synthesize

statistical data