Beliefs Act as Barriers to Flu Immunization

Certain individuals may avoid getting a flu shot because of beliefs they hold, such as concern about unknown ingredients in the vaccine, suggest the results of a small study of elderly low-income community residents.

"The potential impact of alternative beliefs and mistrust of the health care system on health behavior has only begun to be recognized over the last several years," said lead author Katrina Armstrong, MD, MSCE, of the University of Pennsylvania in Philadelphia.

"Despite decades of effort, underutilization of influenza immunization remains an important public health issue in minority populations," she added.

Yearly immunization -- recommended for individuals over 65 -- decreases flu mortality by more than 50 percent. Yet more than one third of elderly Americans are not immunized each year, according to the study.

Twenty percent of the nearly 500 elderly individuals Armstrong and colleagues interviewed said they were concerned about unknown ingredients in the flu shot. These individuals were less likely to be vaccinated than those who were unconcerned about the contents of the shot, the researchers found. The study results are published in the current issue of the American Journal of Preventive Medicine.

"Directly addressing concerns about the contents of the influenza vaccine in outreach efforts and physician patient interactions offers a new approach to increasing influenza immunization rates among low income populations," said Armstrong.

Other beliefs associated with not being vaccinated included perceptions that immunization is inconvenient or painful. To address these concerns, alternative approaches such as nasal vaccines should be explored, suggested the researchers.

Individuals with a history of previous side effects from immunization were also less likely to receive the flu shot, the researchers found. "Although a sore arm from the shot is generally the only side effect associated with the vaccination -- which can easily be treated with acetaminophen -- patients continue to believe otherwise," said Armstrong. More education is needed to improve understanding of side effects and increase use of acetaminophen, the researchers noted.

The researchers found one factor positively associated with flu vaccination: recommendation by a physician. "Further efforts to encourage physicians to recommend immunization at all opportunities are needed," said Armstrong.

"Influenza immunization has the potential to save thousands of lives each year, but only if it reaches those who will benefit from it," the researcher added.

This study was funded by the University of Pennsylvania Research Foundation and the Matthew Slap Award from the Division of General Internal Medicine at the University of Pennsylvania.

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The American Journal of Preventive Medicine, sponsored by the Association of Teachers of Preventive Medicine and the American College of Preventive Medicine, is published eight times a year by Elsevier Science. The Journal is a forum for the communication of information, knowledge and wisdom in prevention science, education, practice and policy. For more information about the Journal, contact the editorial office at (619) 594-7344.