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

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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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Career Masters of Public Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Medicine and Surgery
Palavra-chave	Pertussis Influenza Vaccination Diabetes
Committee Chair / Thesis Advisor	Westfall, David Noel, Emory University
Committee Members	Bell, Ronny, Wake Forest University
Partnering Agencies	University, college or educational institution (other than Emory)

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