Determinants of Refusal of A/H1N1 Pandemic Vaccination in a High Risk Population: A Qualitative Approach

Abstract

Background Our study analyses the main determinants of refusal or acceptance of the 2009 A/H1N1 vaccine in patients with cystic fibrosis, a high-risk population for severe flu infection, usually very compliant for seasonal flu vaccine. Methodology/Principal Findings We conducted a qualitative study based on semi-structured interviews in 3 cystic fibrosis referral centres in Paris, France. The study included 42 patients with cystic fibrosis: 24 who refused the vaccine and 18 who were vaccinated. The two groups differed quite substantially in their perceptions of vaccine- and disease-related risks. Those who refused the vaccine were motivated mainly by the fears it aroused and did not explicitly consider the 2009 A/H1N1 flu a potentially severe disease. People who were vaccinated explained their choice, first and foremost, as intended to prevent the flu's potential consequences on respiratory cystic fibrosis disease. Moreover, they considered vaccination to be an indirect collective prevention tool. Patients who refused the vaccine mentioned multiple, contradictory information sources and did not appear to consider the recommendation of their local health care provider as predominant. On the contrary, those who were vaccinated stated that they had based their decision solely on the clear and unequivocal advice of their health care provider. Conclusions/Significance These results of our survey led us to formulate three main recommendations for improving adhesion to new pandemic vaccines. (1) it appears necessary to reinforce patient education about the disease and its specific risks, but also general population information about community immunity. (2) it is essential to disseminate a clear and effective message about the safety of novel vaccines. (3) this message should be conveyed by local health care providers, who should be involved in implementing immunization.

A Qualitative Study of Vaccine Acceptability and Decision Making among Pregnant Women in Morocco during the A (H1N1) pdm09 Pandemic

“…In addition, rumors were also linked to specific fears related to pregnancy and child bearing; both of high importance in Moroccan society where motherhood continues to define the role and status of women, and children are at the center of life. Unique communication needs surrounding the A (H1N1) pdm09 pandemic in pregnant women have been previously established in studies among pregnant women in the US and in Canada [11] , [12] , [17] , [27] , [28] , [29] , [30] . Messages directing pregnant women to adopt influenza vaccine recommendations should include detailed pregnancy-specific descriptions of the risk/benefit ratio for the fetus.…”

“…In general, where vaccination was successful, health staff did not coerce compliance but rather helped their patients make an educated choice. Recent studies elsewhere also conclude that health providers play a key role in the success of vaccine campaigns [29] , [31] and in conveying vaccine-related messages [32] , [33] . Provider knowledge of the monovalent A (H1N1) pdm09 vaccine has been shown to correlate with improved vaccine uptake in other countries [14] , [17] , [21] , [34] , which further highlights the importance educating health providers about influenza and vaccination.…”

Factors influencing H1N1 vaccine behavior among Manitoba Metis in Canada: a qualitative study

“…Being the first global pandemic in several decades, the H1N1 outbreak provides an opportunity to examine factors that influence uptake or refusal of a novel vaccine, and indeed this has been the focus of a growing body of literature [ 3 , 4 ]. However, studies looking at designated priority groups during the H1N1 pandemic have primarily focused on pregnant women, health care workers, or populations with high-risk co-morbidities [ 3 - 5 ]. The quantity of research that examines attitudes of particular ethnic groups towards novel vaccines (or even seasonal influenza vaccines) is quite limited [ 6 - 13 ], and an even greater gap exists for studies that investigate vaccine behaviors and related attitudes among Aboriginal communities in Canada.…”

“…Survey-based research has supplied information about many of the key factors in people’s pandemic vaccination decision-making processes: perception of disease risk, perceptions of vaccine risk and vaccine safety, established vaccine behavior, social discourses and environments, communication structures, knowledge of vaccines and influenza, and input from healthcare professionals [ 4 , 13 , 32 - 36 ]. Recent studies have also employed focus group methods, where participants can express their feelings, worries, and thoughts in their own words, thereby supplying deeper insight into these factors [ 5 , 37 - 39 ]. Focus group research with particular ethnic groups shows that factors reported in more general populations are mediated in different ways by different communities.…”

Representations of influenza and influenza-like illness in the community - a qualitative study

“…Similarly, a French qualitative study, conducted on a group of patients with cystic fibrosis, a high risk population for severe flu infection, emphasized the role of information sources in these patients in deciding to accept or refuse the H1N1 vaccine. Those who refused the vaccine mentioned receiving multiple and indecisive information, whereas those who accepted the vaccine reported having received unequivocal advice from their healthcare provider [10]. Globally, results from these qualitative studies emphasize that the public need to receive transparent and factual information about the specific actions to be take, and this should be provided by people they can trust [9].…”