The Role of Knowledge of the Universal Recommendation in Receipt of Influenza Vaccination during the 2011-2012 Flu Season Open Access
Berns, Abby Lynn (2013)
Abstract
Vaccination is the best method to prevent influenza, a disease that causes significant morbidity and mortality in adults and children. In February 2010, the Advisory Committee on Immunization Practices recommended that all individuals over 6 months of age receive influenza vaccination each year. This recommendation was intended to simplify vaccination delivery and increase coverage. Since the universal recommendation, vaccination coverage has remained relatively stable among adults, despite campaigns promoting the recommendation. No studies have previously examined the association between knowing the recommendation and receiving vaccination. The purpose of this study was to determine if knowledge of the universal recommendation is associated with receipt of influenza vaccination. The secondary goal of the study was to characterize those who know and don't know about the universal recommendation. Data were analyzed from the March 2012 National Flu Survey, a random-digit-dialed telephone survey of the US population.
Using multivariate logistic regression, we determined that people who knew about the universal recommendation were more likely to receive flu vaccination than those who did not know (Prevalence Ratio: 1.19, 95% CI 1.12, 1.27). Using Chi-squared analysis, we found that people who were female, had high risk health conditions, fell into a group previously recommended for vaccination and perceived themselves to be recommended were more likely to know about the universal recommendation than those who were male, without high risk conditions, were not previously recommended for vaccination and did not perceive themselves recommended (α=0.05). Those who believed that vaccine is safe or effective, those who believed themselves susceptible to influenza, and those who thought their daily activities would be disrupted by influenza were more likely to know about the universal vaccination, and were more likely to be vaccinated themselves. Using a second logistic regression model, we identified that sex, age, perception of being recommended, and belief of severity of and susceptibility to influenza were associated with knowledge of the universal recommendation. Our findings point to a need to increase public knowledge of influenza vaccination recommendations. Health communicators and immunization programs must collaborate to improve both knowledge of the universal recommendation and the receipt of vaccination.
Table of Contents
Table of Contents
Introduction 8
Background 11
Healthy People 2020 11
History 11
2007 Consultation and Subsequent ACIP Meetings 14
2009 H1N1 Pandemic 16
Universal Recommendation 18
After the Recommendation 19
Knowledge, Attitudes and Beliefs and Flu Vaccination 20
Knowledge of the Universal Recommendation 21
Research Questions and Implications 25
Methods 27
Study Design and Sample 27
Measurement 28
Knowledge of Universal Recommendation 28
Vaccination Receipt 28
Knowledge, Attitude, and Belief Covariates 28
Additional Covariates 29
Demographic Covariates 30
Interaction Terms 31
Analysis 31
Logistic Regression Modeling 32
Collinearity Diagnostics 33
Modeling Strategy Results 34
Interaction Assessment 34
Confounding Assessment 35
Knowledge of Universal Recommendation as Outcome 37
Analysis Results 38
Discussion 43
Limitations 50
References 53
Tables 60
Appendix A. IRB Exemption 71
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