Influenza Immunizations in Low-Income Communities

Abstract

The problem under investigation is the low rates of influenza vaccination in low-income communities. Based on the literature review, the proposed solution includes a combination of patient education performed by healthcare providers and a reminder call system. The first part of the intervention is a face-to-face discussion between the clinician and the person or a child in need of influenza vaccination, which occurs during the influenza season. The meeting includes information about three main topics: influenza, vaccine, and state regulations. These elements are included to ensure that people understand the infection and how vaccination can help them and their communities combat it. Reminder letters are suggested to ensure that people who do not receive vaccinations right after the conversation are still aware of their opportunity to get vaccinated in time. It is expected that the rate of vaccinations in the chosen community will increase by 5-10%. Furthermore, people’s understanding of vaccination can improve, and the number of influenza cases in the population will decrease.

Proposed Programming

As was discovered in the study by Aigbogun et al. (2015), one of the potentially useful solutions to low influenza immunization rates among low-income communities is patient education with reminders about vaccination times. Learning for patients can come in many forms, including online and offline discussions, handout materials, and social media campaigns. However, according to Niccolai and Hansen (2015), the most effective type of education is provided face-to-face by clinicians who talk to patients or guardians of children needing immunization. Niccolai and Hansen (2015) found that 12 out of 14 educational programs increased vaccination rates significantly, although the authors focused on HPV and not influenza. Nevertheless, they show that physician-led interventions can help patients understand the value of vaccination in health prevention. One can conclude that direct conversations with the parents about vaccinations have proven effective.

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Based on the research, the present program “Activate Your Health – Vaccinate!” has two distinct types of reaching out to people to increase the rate of influenza vaccination. The first part is a face-to-face discussion with people and parents of children who need to receive the annual flu shot. The educational part of the program will help low-income communities in the US, as the latter have limited access to health-related knowledge (Orr & Beck, 2017). Additionally, much stigma surrounding the risks of vaccination exists (Eskola, 2015). The conversation moves outside of the clinics and to the places that people visit frequently – schools, workplaces, and local religious centers. A team of healthcare providers arranges meetings before and during the influenza season and talks about three topics:

  1. The virus. Here, the healthcare provider discusses why the virus is dangerous, which symptoms indicate it, and how it spreads in the community. Local rates of infection, complications, and deaths should be used – Scott et al. (2019) found that handouts with local data numbers about influenza were more effective in encouraging people to vaccinate than no information or national data.
  2. The vaccine. The healthcare provider covers the benefits of the vaccine and dispels the myths regarding the vaccine’s use or risks. Many people do not believe that influenza vaccines are necessary, even thinking that they are harmful (Kempe et al., 2020). The program’s goal is to challenge these assumptions by discussing common fears.
  3. The process. Finally, a conversation about the state’s regulation of vaccination happens. The healthcare provider talks about how to access the vaccine and one’s ability to refuse if necessary (Burke et al., 2019).

The second part of the program is a reminder campaign. Here, people from low-income communities receive letter reminders with information about the upcoming or open influenza vaccination season. Reminders during the season that describe local historical rates, dispel myths, and provide contacts for arranging a doctor’s visit should provide people with an incentive to vaccinate (Aigbogun et al., 2015; Niccolai & Hansen, 2015; Scott et al., 2019).

The program will run from September to March to cover the whole influenza period (Scott et al., 2019). The main measurement of success is the rate of vaccination. The rates for the period of the program’s duration will be compared to the numbers collected from the same area in the previous year. The feedback from people who attend meetings will be collected with the help of short surveys, containing questions such as “Do you believe that vaccines are helpful against influenza?” and “Did this meeting improve your opinion of vaccination?”

To summarize, the intervention to address the problem of low influenza immunization rates in low-income communities “Activate Your Health – Vaccinate!” will focus on clinician-provided education and letter reminders. It will include face-to-face conversations and cover such topics as the virus, vaccine, and access. The program will take place from September to March (the approximate duration of the flu season). The intervention’s effectiveness will be measured by collecting data about vaccinations in the chosen community in the selected period and short surveys for additional feedback.

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Expected Outcomes

The outcomes of the discussed intervention should directly address the project’s problem – the influenza vaccination rate in low-income communities in the US. Patient education will target both adults and children in these communities, reaching out to people with face-to-face discussions and letters. It is expected that the intervention will lead to increased vaccinations among people who received the education. As per the program’s measurement system, the change in people’s health will be measured using local statistics on influenza vaccination. The rates from the last influenza season will be compared to this year’s results. The study by Scott et al. (2019) demonstrated that this approach helped show how the groups differed in results.

The results demonstrating a change in people’s vaccination choices cannot become apparent immediately. For instance, Scott et al. (2019) covered the whole influenza season, researching for eight months (from August to March). The present program will last from September to March, and the results will not be apparent until this period is over. Some people would not vaccinate immediately due to personal reasons, thus highlighting the need to compare two groups only when the season is over.

The rate of vaccination is the primary measure to assess the effectiveness of the intervention. Based on Orr and Beck’s (2017) findings, only about 60% of children received an influence vaccine in the 2014-2015 season. Scott et al. (2019) showed similar results; their baseline group had agreed to vaccination in approximately 65% of cases. The vaccination rate of 60% will become the baseline number for this program. Using the conclusion by Scott et al. (2019), one may expect a 10% increase in vaccination rates among people who undergo an educational meeting. Similarly, reminder calls or letters should increase vaccination rates by 5-10% (Aigbogun et al., 2015). Thus, while the rates are not expected to rise significantly, the 10% increase (from 60% to 70%) can influence the overall health of the population and impact hundreds of lives in the future.

Some other outcomes can also be expected in this project – they are related to education and vaccination rates. First, more exposure to vaccination can decrease the number of influenza cases during the season. The primary goal of vaccination is to protect against the disease’s spread population. Furthermore, although people who undergo immunization still can get sick, their immune system should be prepared to fight the infection, thus lessening the risk of long-term adverse outcomes on one’s body (Kempe et al., 2020). Therefore, the high vaccination rate can positively impact the course of battling the infection and the population’s overall resilience to the flu. The local numbers of complications repeat hospitalizations, and deaths from infections serve as a measure of this outcome.

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Apart from that, education about the influenza vaccine can indirectly impact people’s overall view of vaccination and reduce the negative stigma surrounding this practice. The survey can be used to measure the change in people’s opinions. Many people are currently hesitant to vaccinate themselves and their children, thinking that immunization is either useless or harmful (Kempe et al., 2020). An educational program highlighting the benefits of vaccines and challenging common misconceptions is designed to combat such perceptions and answer questions that people may want to ask about vaccination. Thus, other vaccination rates may be influenced, including immunization against other conditions and influenza vaccination rates in the following years.

References

Aigbogun, N. W., Hawker, J. I., & Stewart, A. (2015). Interventions to increase influenza vaccination rates in children with high-risk conditions—A systematic review. Vaccine, 33(6), 759–770.

Burke, K., Schwartz, S., & Breda, K. (2019). Don’t hesitate, vaccinate! An influenza vaccine education program. Nursing Forum, 54(4), 553-556.

Eskola, J., Duclos, P., Schuster, M., & MacDonald, N. E. (2015). How to deal with vaccine hesitancy? Vaccine, 33(34), 4215-4217.

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Kempe, A., Saville, A. W., Albertin, C., Zimet, G., Breck, A., Helmkamp, L., Vangala, S., Dickinson, M., Rand, C., Humiston, S., & Szilagyi, P. G. (2020). Parental hesitancy about routine childhood and influenza vaccinations: A national survey. Pediatrics, 146(1), e20193852.

Niccolai, L. M., & Hansen, C. E. (2015). Practice- and community-based interventions to increase human papillomavirus vaccine coverage: A systematic review. JAMA Pediatrics, 169(7), 686-692.

Orr, C., & Beck, A. F. (2017). Measuring vaccine hesitancy in a minority community. Clinical Pediatrics, 56(8), 784–788.

Scott, V. P., Opel, D. J., Reifler, J., Rikin, S., Pethe, K., Barrett, A., & Stockwell, M. S. (2019). Office-based educational handout for influenza vaccination: A randomized controlled trial. Pediatrics, 144(2), e20182580.

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