Understanding Why Patients Accept Vaccination: A Socio-Behavioral Approach at the University of Louisville Vaccine and International Health and Travel Center

Kelly Westhusing MPH CPH, Dawn Balcom RN BSN, Ana Macchiavelli BS, Johnson Britto MD, Ramy Hussainy DO, Murali Kolikonda MD, Robert Kelley PhD, Julio Ramirez MD, Ruth Carrico PhD RN, Tim Wiemken PhD MPH.

Division of Infectious Diseases, Department of Medicine, University of Louisville School of Medicine. Louisville, Kentucky

ABSTRACT

METHODS

REFERENCES

RESULTS

Background: Preventing disease through vaccination is one of the most important public health interventions. Despite the availability and the safety of vaccines, adult immunization rates remain much lower than the goals outlined in Healthy People 2020. Understanding the reasons adults accept or decline immunization is important for development of targeted interventions. The objective of this study was to define socio-behavioral factors associated with the intention to be vaccinated among individuals seeking travel-related preparation at the University of Louisville Vaccine and International Travel Center (UL-VITC).

Materials and Methods: The research team used previously validated questions to create a survey rooted in the Theory of Planned Behavior (TBP) (Image 1). The survey was then administered to individuals seen at the UL-VITC during their travel-related visits. Ordinary least squares regression was performed to define associations between socio-behavioral constructs of the TPB and the intention to be vaccinated.

Results: A total of 70 surveys were included in the analysis. None of the constructs were statistically associated with the behavioral intention to receive recommended vaccinations for international travel: attitude (β=0.26, SE=0.17, P=0.133), subjective norm (β= -0.3, SE=0.22, P=0.906), and perceived behavioral control (β=0.37, SE=0.28, P=0.192).

Discussion: This pilot study suggests that none of the constructs of the Theory of Planned Behavior significantly predict the behavioral intention for vaccination among individuals who are international travelers. Although not statistically significant, there were trends present, suggesting the utility of the attitude and perceived behavioral control constructs when developing clinical interventions to influence the intention to be vaccinated of these subjects.

Using previously validated questions rooted in the Theory of Planned Behavior (Image 1), a survey was developed in both paper and electronic formats. Established patients seen in the UL-VITC from May-August 2013 were invited to participate in the survey process. At the time of their appointment, the survey was explained to the patient by the clinic research coordinator and, if willing to participate, a paper copy of the survey or an electronic link using an iPad was provided to them. Informed consent was obtained at the time the survey was administered to each patient.

1. Theory at a Glance: A Guide for Health Promotion Practice, 2nd Edition. National Cancer Institute, September 2005.

Understanding socio-behavioral issues that influence the intent to be immunized is a critical factor in program planning and development. Although research has been done in identifying barriers to immunization, little has been done to identify these factors among patients who are seeking immunization for specific purposes.

The Theory of Planned Behavior (TBP) distinguishes the relationship between behaviors and beliefs, attitudes, and ultimately, intention to perform a particular behavior. At the heart of TPB are three constructs believed to impact behavioral intention: (1) personal attitude, or evaluation of a behavior; (2) subjective norms, or whether those important to the individual agree or disagree of a particular behavior; and (3) perceived behavioral control, or the individual’s belief that they can control the behavior. Little work has been done to evaluate the utility of the TBP for adult vaccination decisions.

The objective of this study was to define socio-behavioral factors associated with the intention to be vaccinated among individuals seeking travel-related preparation at the University of Louisville Vaccine and International Travel Center (UL-VITC).

Continued exploration of methods to predict intent to be vaccinated, as well as barriers to that intention is critical if progress is to be made in improving adult immunization across all population groups.

Understanding intention among groups that seek immunization and are therefore more likely to consider immunization favorably can provide insight into new approaches that may improve intervention success.

The pilot portion of this study has suggested that none of the theoretical constructs significantly predict the intent to be vaccinated among the population of international travelers studied.

However, there is some suggestion that the attitude and behavioral control constructs may have some utility when using them to develop clinical interventions aimed at influencing the intention to be vaccinated among individuals in this group.

We appreciate the opportunity to partner with the University of Louisville Vaccine and International Health and Travel Center and its patients.

AKNOWLEDGEMENTS

CONCLUSIONS

Figure 1. Results of survey (n=70)

INTRODUCTION

Upon completion of the survey, the patients proceeded with their pre- or post-travel counseling appointment with the clinic nurses. During that appointment, recommendations for immunization were provided according to the usual clinic practices using CDC and WHO travel recommendations, as well as recommendations addressing routine immunization. After the counseling, the researcher gathered information regarding which vaccines, if any, had been recommended as part of that counseling and which vaccines, if any, had been accepted by the individual patient. A declination reason for any vaccine that was recommended, but not accepted at the time of the appointment, was also recorded.

METHODS, CONTINUED

All data were entered into an online database, and a total of 70 patients were included in the final analysis. Figure 1.

Image 1. Theoretical constructs of the Theory of Planned Behavior