The Role of Knowledge and Perception in Optimizing Vaccination against Influenza and Pertussis among Adults with Type 2 Diabetes Mellitus in Forsyth County, NC. Público
Emejuaiwe, Nkechinyere (2015)
Published
Abstract
The development and introduction of vaccines in the 20th century has significantly reduced the burden of several infectious diseases. However, new concerns have risen regarding poor uptake of vaccinations in spite of their proven efficacy. Vulnerable populations include children, the elderly and those with chronic diseases. In particular, the morbidity and mortality associated with diseases affecting the respiratory system such as influenza and pertussis are substantial in those with chronic diseases such as diabetes mellitus. Diabetes mellitus is a growing health problem in the United States associated with economic costs of about $245 billion each year. It is estimated that 29 million Americans have diabetes and annually 1.9 million adults over the age of 20 are diagnosed with diabetes mellitus. Abnormal metabolism of glucose in patients with diabetes has a deleterious effect on the immune system. Therefore, this group of patients is more susceptible to infections. Observational studies have shown that vaccination against influenza and administration of the pertussis booster can reduce the risk of hospitalization and death in those with diabetes. In order to improve vaccination rates, public health professionals need to understand and address the barriers to this preventive strategy. The goal of this research was to determine and understand factors that influence attitudes and behavior of people with diabetes regarding influenza and pertussis vaccination in Forsyth County, North Carolina. This thesis work implemented a cross-sectional study design with descriptive analysis. Focus group interviews (three in English and one in Spanish) were conducted between May, 2014 and March, 2015 and a total of 18 patients with diabetes participated in the study. An average of 78% of respondents reported regular receipt of the influenza vaccination compared to only 26% who had received the pertussis booster vaccination. The most salient patient-related barriers identified in the study were lack of knowledge, influence of healthcare providers and communication. Results of the current study provide an important opportunity to influence perceptions about vaccinations and ultimately improve health in those with diabetes.
Table of Contents
CHAPTER I: INTRODUCTION 1
Introduction and Rationale 1
Problem Statement and Statement of Significance 5
Hypothesis 9
Theoretical Framework 9
Purpose Statement 10
Research Question 11
Definition of Terms 12
CHAPTER II: REVIEW OF THE LITERATURE 13
Introduction 13
The Role of Knowledge 14
The Role of Culture and Race 15
The Role of Socioeconomic Status and Location of Care 16
The Role of Gender and Age 17
The Role of Provider Recommendation 17
Other Influences 18
Summary of current problem and study relevance 20
CHAPTER III: METHODOLOGY 21
Introduction 21
Population and Sample 21
Research design 21
Procedures 22
Instruments 23
Data Collection and Analysis 23
Limitations and Delimitations 24
CHAPTER IV: FINDINGS 26
Introduction 26
Findings/Results 26
What is known about the influenza and pertussis vaccine? 27
What is known about risk of these infections in people with diabetes? 28
What are some factors that influence vaccination uptake? 28
How can information about vaccinations be more effectively communicated and disseminated in the community? 31
Summary 32
CHAPTER V: DISCUSSION, IMPLICATIONS AND RECOMMENDATIONS 33
Introduction 33
Summary of study 33
Discussion 34
Implications 35
Recommendations 36
Identify demographic data that are associated with patients' knowledge and perceptions 36
Longitudinal follow up of study participants 36
Expand study instruments to include surveys 36
Conduct quantitative research 37
Evaluate current communication tools 37
Conclusion 37
APPENDIX A 39
APPENDIX B 40
APPENDIX C 41
APPENDIX D 42
REFERENCES 43
Figures
Figure 1.1 Percentage of Adults with Diabetes North Carolina versus United States, 2004-2012 1
Figure 1.2 Influenza and Pneumonia Mortality Rate North Carolina versus Healthy North Carolina 2020 Target, 2008-2011 2
Figure 1.3 Percentage of total estimated number of cases and overall cost of four major adult vaccine-preventable diseases in the United States, 2013 4
Figure 1.4 Reported Cases of Pertussis by State, 2011-2012 6
Figure 1.5 Reported Cases of Pertussis by State, 2013-2014 7
Figure 1.6 The Quality Health Outcomes Model 10
Figure 2.1 Milestones in Vaccine Development 13
Figure 4.1 Vaccination influences reported by study participants 30
Tables
Table 1.1 Hypothesized key influences on patients' willingness to receive vaccines 9
Table 4.1 Frequency of codes in focus groups 27
About this Master's Thesis
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