Objective: The objective of this study is to describe and compare patient characteristics, patient perceived barriers and motivators, and patient decision-making between two groups of hospitalized patients, those who received flu vaccines and those who do not receive the vaccines. There is much effort every year to improve vaccination rates, especially among high risk patient groups. Little is known however regarding motivators and barriers and other factors that effect individual patient decisions to obtain flu vaccines (Hutchinson & Norman 1995; Satterthwaite, 1997). Patients hospitalized with CDC identified ICD-9 codes for flu, pneumonia, and upper respiratory diagnoses represent high risk, vulnerable patient populations (MMWR, 1997). The goal of this study therefore is to generate data to describe barriers, motivators, and decision-making about obtaining flu vaccines among patients hospitalized with upper respiratory infections.
Design: This study will use a descriptive comparative design that will document patient flu vaccination histories, barriers and motivators surrounding flu vaccinations, and decision-making about obtaining flu vaccinations among patients hospitalized for flu, pneumonia, and upper respiratory diagnoses. It is descriptive in that it will describe all of the above for all patients. It is comparative in that it will compare barriers/motivators and decision-making between those patients who received vaccines and those who did not. Comparative descriptive designs examine and describe differences in variables in two or more groups that occur naturally in the setting (Burnes & Grove, 1993).
Population, Sample, Setting, Years: The population for this study is medical patients hospitalized with upper respiratory infections. The sample will consist of all (estimated at N=300) patients who are hospitalized with CDC identified ICD-9 codes (MMWR, 1997) for flu/pneumonia diagnoses from December 2001 to March 2002 in one hospital (324 beds) within a large HMO located in Southern CA.
Variables Studied Together: Variables include 1) patient flu vaccination histories, 2) patient perceived barriers and motivators to obtaining flu vaccinations, and 3) patient decision-making regarding obtaining vaccinations.
Methods: Data collection methods include extracting data from hospital data bases and mailing 2 surveys to discharged patients. Data will be collected in March 2002 on 1) patient characteristics (age, gender, ethnicity, education, geographic location, payor, diagnosis, admit & discharge date, number of hospitalizations during previous 6 months, percieved general health & medical risk status, flu vaccination history 1997-2002) using hospital data bases; 2) percieved barriers/motivators regarding flu vaccination as measured by an investigator designed Flu Vaccination Survey; and 3) patient decision-making process regarding obtaining flu vaccines as measured by the Decisional Conflict Scale (O'Connor, 1999). The Flu Vaccination Survey will mailed to patients. It is a nine item investigator-designed survey for identifying barriers/motivators regarding flu vaccination as well as measuring patient demographics not available in any of the data bases. A review of the scientific literature regarding patient barriers/motivators regarding influenza vaccinations assisted in generating the survey items for the investigator designed survey. The Decisional Conflict Scale (DCS) will also be mailed to patients. It measures a patient's degree of uncertainty about the course of action to take. This uncertainty can arise because of factors inherent in the decision itself (uncertainty about the outcome and the need to make value trade-offs between benefits and risks) and potentially modifiable factors (inadequate knowledge, unrealistic expectations, unclear values and norms, and inadequate support). The DCS is a 16-item scale consisting of five subscales. DCS test-retest coefficients and alpha coefficients are > 0.80 (N>1000). Instrument testing has been done regarding a number of decision contexts (i. e., flu vaccination, breast screening, prenatal testing, hormone replacement therapy, treatments for lung cancer, heart disease, and atrial fibrillation). Pre and post studies which have tested decision support interventions demonstrate change in both total scale as well as subscales (effect size ranges from 0.40 to 1.2 for the total scale). Decision making regarding flu vaccines has been tested in 3 populations: health science students (effect size 0.82), health care employees (effect size 0.62), and cardiac/respiratory patients (effect size 0.62) (O'Connor, 1999).
Findings: Findings will be available in May 2002 after data analysis.
Conclusions: Conclusions will integrate the findings of this study with the state of the science regarding patient decision-making regarding immunizations.
Implications: Little is known regarding motivators and barriers and other factors that effect individual patient decisions to obtain flu vaccines (Hutchinson & Norman 1995; Satterthwaite, 1997). Given the potential negative consequences of contracting the flu, prevention is the best strategy. Prevention is contingent upon motivating patients to obtain an annual flu vaccine. The findings from this study will add to our knowledge in regards to patients' decision-making about obtaining flu vaccines.
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