November McGarvey

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African American Parental Perceptions of
Influenza Immunizations for Children 6-23 Months
Old
November McGarvey Childhood Influenza Project
Coordinator LA County Immunization Program
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Background

• The Advisory Committee on Immunization Practices
  recommends all children aged 6-23 months receive
  annual influenza immunizations.
• Data from the CA Los Angeles County (LAC)
  Kindergarten Retrospective Survey indicates that
  AA children under 2 have lower immunization
  coverage rates than other racial/ethnic groups.

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Project Objectives

• Among AA parents/guardians to
• Identify factors barriers influencing the
  completion of childhood influenza immunizations
• Assess knowledge, attitudes, practices related
  to childhood influenza immunization
• Identify culturally appropriate methods
  messages to encourage timely childhood influenza
  immunizations

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Research Questions

• What type of message dissemination mode (e.g.
  radio, TV, health care provider, word of mouth)
  can be utilized effectively for propagation of
  the ACIP childhood influenza immunization
  recommendation in the LA County AA community?
• What characteristics does the message require
  (e.g. types of information, tone, spokesperson)
  in order to be considered attractive culturally
  appropriate to the LA County AA community?

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Theoretical Framework

• Eco-Social Model examines the influence of the
  social physical environment (intrapersonal/
  interpersonal processes, org. structures,
  community norms) on health behavior
• Health Belief Model constructs are perceived
  susceptibility, severity, benefits, barriers
• Social Marketing uses the principle of voluntary
  exchange in which individual have resources that
  they are willing to exchange for perceived
  benefits.

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Target Population

• Primary parents/guardians of children ages 6-23
  months living in LA County
• 2ndary Children 6-23 months old of these
  parents/guardians

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Methods 1

• Oct-Dec 2004 7 focus groups (average of 6
  participants per group) were conducted in LAC to
  determine parental KAB regarding childhood
  influenza immunization.
• Target Areas Participants were recruited from 13
  zip codes, identified using 2000 Census data, as
  having a relatively high proportion of AAs
  (gt35), children under age five, residents
  below the 100 FPL (gt25).
• Eligible participants AA parents/guardians w/ a
  child 6-23 months old living w/ the child in
  the target area.

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Methods 2

• Recruitment posting passing out of culturally
  appropriate recruitment flyers at local community
  health fairs venues referrals from CBOs.
• Consent Project staff obtained signed written
  consent from all participants prior to focus
  groups.
• Focus groups 1.5-2 hours in 4 sites selected for
  their accessibility (a community center, 2 child
  care centers, a WIC center). Trained moderators
  were AA parents. Participants were compensated
  with a 25 gift certificate to a local
  supercenter or grocery store. Refreshments
  childcare were also provided. Focus groups were
  audiotaped later transcribed for use in data
  analysis. Participants also completed a written
  questionnaire to collect basic demographic data.

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Methods 3

• Focus Group continued The interview guide
  included questions regarding parental KAB related
  to influenza immunization and questions to inform
  social marketing. Some examples of questions
  asked during the focus groups were
• 1) How do you know when your child has the
  flu?
• 2) How important do you think it is that your
  child gets
• his/her flu shot?
• 3) What sources of information on health or
  immunization
• do you trust most?
• 4) What important information or facts can we
  provide
• parents that will make them more likely
  to take their
• children in for a flu shot?

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Focus Group Participation by Zip Code
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Results 1

• Most AA parents/guardians were generally aware of
  the flu shot recommendation, but were reluctant
  or unwilling to immunize their children.

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Results 2 Influential Factors

• Childhood influenza immunization practices
  among AA parents/guardians in LAC are primarily
  influenced by
• Recommendations by doctors trusted older family
  members
• Ive never had a doctor, and my oldest
  daughter is 9 years old, ask me if my child has
  had her flu vaccination.
• To really get my child the shot, the doctor
  would need to say that she needs the shot.
• Strong concerns about vaccine safety
  effectiveness
• We dont get sickIve never had a child
  with the flu If you get it (the flu shot), its
  going to give you the flu.

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Results 3 Influential Factors

• Belief that influenza is natural and inevitable
• If its going to happen, its going to
  happen. If you take care of it, its not deadly.
  Whats the differencefor me the flu season is
  inevitable and natural.
• View that the vaccine is only important
  effective for those with weak immune systems or
  certain chronic illnesses
• I never thought about getting the flu
  shotnever considered itfor me or my childrenI
  just thought it was something that older people
  went out to getI dont know if its important
  for my kids to get a flu shot...
• Its not that important to me whether my
  child gets the flu shot or not cause I feel like
  they are strong enough to fight the flu off. I
  feel like some Tylenol and the fever will be all
  right.

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Results 4 Influential Factors

• Perception of the influenza vaccine as optional
  rather than a routinely administered childhood
  vaccination
• If they made it (the flu shot) a regular
  shotall my kids would get the shot. If they made
  it a choice,then no. If they had to have it,
  then they would be there.
• Well if its that serious, how come its not
  like immunizations where you have to come back at
  this month and that monthHow come the flu shot
  is not part of that process? How come its nota
  mandatory thing?
• If they thought it (the flu) was really
  that bad they could mandate it.

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Results 5 Influential Factors

• Belief that traditional or home prevention
  methods are equally or more effective than the
  vaccine in preventing influenza
• Just stick with your home remedies I have
  more faith in my abilitiesin my chance to heal
  my child than exposing them to something (the flu
  shot) that might make them sick. I wouldnt do
  it.
• Little/no publicity or awareness about the
  influenza vaccine in AA communities or media
• I dont know too many people that have
  gotten the flu shotme and my girlfriends talk
  about a lot of things and the flu shot has never
  been one of them. Nobody says did you get your
  shot this month, this year?
• Inability to easily access influenza vaccine
  information

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Social Marketing Implications 1

• Mass Media Communication Potential effective
  channels for message dissemination in the AA
  community are
• Radio
• Billboards/posters
• Television
• Newspaper
• Magazines
• Fliers
• Direct mail
• Internet/email

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Social Marketing Implications 2

• Spokesperson
• Preferred spokespersons are AA, older, and
  experienced.
• A doctor (male or female) or a knowledgeable
  mother/grandmother-type might be most effective.
• Most participants in felt that although
  celebrities might be influential for convincing
  other people in their community to bring their
  children in for influenza vaccination, they,
  personally, would not trust celebrity
  recommendations.

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Social Marketing Implications 3

• Message Tone
• Some participants indicated that health campaign
  messages that inspired fear (e.g. severe
  consequences, widespread impact) were both
  memorable influential in changing behavior.
  However, parents also found them unattractive
  manipulative.
• Some participants also found health campaigns
  that used humor to be memorable.

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Social Marketing Implications 4

• Content Results suggest messages educational
  materials should focus on
• Increasing knowledge addressing common
  misconceptions about the flu flu shot.
• Stressing that the flu is an important routine
  childhood immunization is strongly recommended
  by health providers.
• Increasing parents perceptions of their children
  as being vulnerable by demonstrating that the
  numbers of children catching the flu are
  substantial that unvaccinated children are at
  increased risk for catching the flu.

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Social Marketing Implications 5

• Content continued
• Increasing parents perceptions of the flu as
  serious by showing that children between the ages
  of 6 23 months have an increased risk for
  flu-related hospitalizations complications,
  including death.
• Decreasing perceived risks/barriers/costs of the
  flu shot by alleviating parental concerns that
  the flu shot causes the onset of the flu or
  serious side effects.
• Increasing perceived benefits of the flu shot for
  children to include preventing the flu building
  a healthy immune system.

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Limitations

• Qualitative approach
• Convenience sampling
• Relatively small focus group sizes (smaller than
  intended)
• Specific eligibility requirements limit
  generalizability

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Conclusions 1

• Campaigns educational materials targeting AAs
  should aim to
• Alleviate fears that the flu shot causes
  influenza
• Use statistics and emotional appeals to
  illustrate disease severity consequences
• Provide clear data on vaccine safety and
  effectiveness
• Explain vaccine content and production process in
  an easy-to-understand manner.

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Conclusions 2

• Health care providers should be encouraged to
  actively recommend the flu shot to
  parents/guardians of children 6-23 months of age.

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Next Steps

• Development of culturally tailored messages and
  marketing materials (with pilot testing).
• Additional focus groups with providers to inform
  the development of childhood influenza
  vaccination messages aimed at providers.

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Thank you. Please send comments to November
McGarvey at november_at_ucla.edu
Immunization Program 3530 Wilshire Blvd Suite
700 Los Angeles, CA 90010 Phone
213-351-7800 Fax [phone] www.lapublicheal
th.org/ip/