Does patient education improve influenza vaccination uptake?

Both individualized counselling (IC) and pamphlets have improved the uptake of influenza vaccination, but IC does not appear to be superior to pamphlets alone at improving vaccine acceptance, according to a Singapore study.

“Performing vaccination at the initial point of contact with the healthcare provider may improve actual uptake rates,” the researchers said.

This randomized controlled study was conducted in two government polyclinics. The researchers randomly assigned 320 patients to IC (intervention group; n=160) and to pamphlets alone (control group; n=160). Recruited participants (aged ≥65 years) were attending for doctor consultation.

All participants received an educational pamphlet on influenza vaccination, while those in the intervention group received additional face-to-face counselling. They also filled a pre- and postintervention questionnaire to assess knowledge of influenza and attitudes toward the vaccine.

The researchers then performed follow-up calls and verified electronic records at 3 months to determine actual vaccine uptake.

Sixteen patients (10 percent) in the intervention group and 20 (12.5 percent) in the control group had completed influenza vaccination at 3 months (p=0.48).

Willingness to receive vaccination immediately after intervention (adjusted odds ratio [aOR], 12.15, 95 percent confidence interval [CI], 4.42‒33.38) and male gender (aOR, 2.96, 95 percent CI, 1.23‒7.12) positively correlated with vaccine uptake. [Singapore Med J 2021;doi:10.11622/smedj.2021222]

Notably, counselling was more effective than pamphlets alone in improving knowledge (p<0.01), but better knowledge scores in the IC group did not translate to higher vaccination uptake rates (aOR, 1.10, 95 percent CI, 0.90‒1.3).

“This may be consistent with the results of a study in Hong Kong where education via IC seemed to affect mainly the subgroup of patients with uncertain intent to receive vaccination,” the researchers said. [Health Educ Res 2017;32:455-464]

“[I]n contrast, univariate analysis of data from the National Health Surveillance Survey showed that women were more likely to be vaccinated (OR, 1.22, 95 percent CI, 1.02–1.46), though this was no longer significant after multivariate analysis,” they added. [Epidemiol Infect 2017;145:775-786]

Proactive approach

These findings have implications in primary care practice settings, as family practitioners looking to holistic management often struggle balancing time constraints and preventive care needs of their patients, according to the researchers.

This potentially explains the lack of awareness of influenza vaccination among the study cohort. Moreover, pamphlets are usually placed in the waiting areas, which requires patients to take the initiative to pick up the brochure and proactively approach their healthcare provider with questions on vaccination.

“Our results suggest that healthcare providers can initiate the conversation by recommending influenza vaccination to their patients and support their decision-making process by handing them the educational pamphlet for further self-reading,” the researchers said.

The current study was limited by the selection of only literate patients to participate. This could constrain the generalizability of the results.

“Future research should focus on enabling systematic interventions to facilitate persons who have already indicated willingness to undergo vaccination,” the researchers said. “Similar studies on persons with lower literacy levels could be conducted, as they may have different perceptions and barriers towards vaccination.”

The World Health Organization recommends annual seasonal influenza vaccination for pregnant women, children, older adults, persons with specific chronic medical conditions, and healthcare workers. [www.who.int/immunization/policy/position_papers/influenza/en/]