Results
Description of participants
Four focus groups (N=35) and 8 in-depth interviews were conducted with the public participants—African American adults ages 50 and over. As shown in the TABLE, most participants were female, had children, had less than a college degree, and earned less than $30,000 a year. Widows and widowers made up the largest percentage of participants.
One focus group (N=9) and 5 interviews were conducted with vaccine providers—professionals working in clinics that offered the flu vaccine and served African Americans—for a total sample of 14. As the providers were sampled according to their professional affiliation, demographics were not systematically recorded. These informants were nurses, physicians’ assistants, and vaccination program administrators.
TABLE
4 focus groups and 8 interviews included 43 public participants*
| VARIABLE | FOCUS GROUPS (N=35) | INTERVIEWS (N=8) |
|---|---|---|
| Age | ||
| 50–55 | 9 (26%) | 3 (38%) |
| 56–60 | 5 (14%) | 1 (12%) |
| 61–65 | 4 (11%) | — |
| 66–70 | 4 (11%) | — |
| 71–75 | 3 (9%) | 1 (12%) |
| 76–80 | — | — |
| 81–85 | 1 (3%) | 2 (25%) |
| 86 and older | 1 (3%) | 1 (12%) |
| Gender | ||
| Male | 6 (17%) | 2 (25%) |
| Female | 29 (83%) | 6 (75%) |
| Education | ||
| Less than high school | 4 (11%) | 1 (12%) |
| Some high school | 7 (20%) | 1 (12%) |
| High school diploma/GED | 7 (20%) | 1 (12%) |
| Some college | 9 (26%) | 4 (50%) |
| College degree | 5 (14%) | 1 (12%) |
| Graduate degree | 2 (6%) | — |
| Marital status | ||
| Single | 9 (26%) | 4 (50%) |
| Married/living with partner | 4 (11%) | 1 (12%) |
| Divorced or separated | 4 (11%) | — |
| Widowed | 17 (49%) | 3 (38%) |
| Children | ||
| Yes | 33 (94%) | 6 (75%) |
| No | 1 (3%) | 2 (25%) |
| Family income | ||
| Less than $10,000 | 13 (37%) | 3 (37%) |
| $10,000–$19,999 | 8 (23%) | 3 (37%) |
| $20,000–$29,999 | 3 (9%) | 1 (12%) |
| $30,000–$39,999 | — — | |
| $40,000–$49,999 | 3 (9%) | — |
| $50,000–$59,999 | 1 (3%) | — |
| $60,000–$69,999 | — | — |
| $70,000–$79,999 | 1 (3%) | — |
| * Not all participants answered all questions | ||
How patients and clinicians see things differently
Susceptibility. Most public participants were familiar with only a few of the high-risk groups recommended for vaccination. Many participants said that children needed the flu shot, but did not state that those in their 50s were also recommended to get the flu shot. Those never stricken with the flu didn’t consider themselves susceptible. “Because I have never gotten it before…. I get a lot of other things but I don’t get colds and things like that.”
The health care providers identified senior citizens as a high-risk group for influenza because of the high occurrence of comorbid conditions. Providers were especially concerned that seniors who don’t go out much may incorrectly believe they don’t need to get vaccinated.
Severity of the flu. While some of the public participants didn’t see influenza as a deadly disease, others did.
Providers recognized that some members of the public regarded the flu as more of a nuisance then a serious illness and emphasized the need to raise awareness.
Vaccine efficacy. The opinions that the public participants had about the effectiveness of the influenza vaccine varied. Some said it was effective; others believed the vaccine was not effective because they knew they could still get the flu even after being vaccinated. “I know people who got the flu shot and they still got the flu.” Many believed that home remedies, cleanliness, and staying away from others were more effective means of prevention.
Providers believed the vaccine is effective if it matches the correct strain of flu virus. They noted that even if a patient is vaccinated against the wrong strain, flu symptoms will be milder. Providers recognized patient concerns about vaccine efficacy, but none mentioned that it was important to encourage vaccination along with cleanliness and avoidance measures.
Safety and side effects. The most common concern about vaccine safety that the public participants discussed was that the influenza vaccine causes flu illness. Several respondents substantiated this concern with their own experiences, or those of others, where shortly after vaccination a flulike illness resulted. “It gave them the flu. And they were sick for 2 or 3 weeks.”
Another common safety concern was that the vaccine would interact with prescription medications for chronic illnesses. Many public participants also noted that health care providers neglected to discuss the matter. “[M]y reason for not taking the flu shot is because I’m on other medicine and I do have some concerns.… What are you putting in my body?” Some were also concerned about the safety of vaccine components and receiving a tainted vaccine. These participants also mentioned their fear of an allergic reaction to the flu vaccine.
Overall, providers did not have concerns about vaccine safety; however, they understood patients were afraid the influenza vaccine would give them the flu. They felt they should inform patients that full protection from the influenza vaccine takes up to 2 weeks. Providers were also aware that many African Americans who are 50 years of age and older distrust the medical system.
Main reason for vaccination: Doctor’s advice
All of the African American adults agreed that physicians and other health care professionals were important sources of vaccine information. Though initially ambivalent, a majority also reported receiving the vaccine primarily because of recommendations from their doctor. Some noted that providers can do more to encourage vaccination when patients express concerns. “I would have taken it if he had said, ‘I think you should take it.’” The public participants also got vaccine information from family, friends, broadcast media, and print material. They noted that they wanted to see the following in flu vaccination information: the pros and cons of the vaccine, efficacy of the vaccine, how the vaccine reduces flu severity, vaccine safety, and history and background of the vaccine.