Developing and testing a decision model for predicting influenza vaccination compliance.

W. B. Carter · Lee Roy Beach · Thomas S. Inui · John P. Kirscht · J. C. Prodzinski

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Vaccine Coverage and Hesitancy Patient-Provider Communication in Healthcare Behavioral Health and Interventions

Abstract

Influenza vaccination has long been recommended for elderly high-risk patients, yet national surveys indicate that vaccination compliance rates are remarkably low (20 percent). We conducted a study to model prospectively the flu shot decisions and subsequent behavior of an elderly and/or chronically diseased (at high risk for complications of influenza) ambulatory care population at the Seattle VA Medical Center. Prior to the 1980-81 flu shot season, a random (stratified by disease) sample of 63 patients, drawn from the total population of high-risk patients in the general medicine clinic, was interviewed to identify patient-defined concerns regarding flu shots. Six potential consequences of influenza and nine of vaccination were emphasized by patients and provided the content for a weighted hierarchical utility model questionnaire. The utility model provides an operational framework for (1) obtaining subjective value and relative importance judgments from patients; (2) combining these judgments to obtain a prediction of behavioral intention and behavior for each patient; and, if the model is valid (predictive of behavior), (3) identifying those factors which are most salient to patient's decisions and subsequent behavior. Prior to the 1981-82 flu season, the decision model questionnaire was administered to 350 other high-risk patients from the same general medicine clinic population. The decision model correctly predicted behavioral intention for 87 percent and vaccination behavior for 82 percent of this population and, more importantly, differentiated shot "takers" and "nontakers" along several attitudinal dimensions that suggest specific content areas for clinical compliance intervention strategies.

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References

1961Behavioral Decision Theory 1977Selected Psychosocial Models and Correlates of Individual Health-Related Behaviors 1979The relationship of health beliefs and a postcard reminder to influenza vaccination.

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2002Health utility estimation 2000Increasing influenza and pneumococcal immunization rates: a randomized controlled study of a senior center–based intervention 2006Determinants of influenza vaccination in hard-to-reach urban populations 1995Women's Competence in Conversation 1986The flu shot study: Using multiattribute utility theory to design a vaccination intervention 2002Attitudinal factors among adult prescription recipients associated with choice of where to be vaccinated1 2009Attitudes of Internal Medicine Residents Regarding Influenza Vaccination 1993Perceptions of Vaccine Efficacy, Illness, And Health Among Inner-City Parents

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