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Addressing Low Vaccination in a Free Clinic

Description

Background: Vaccination is an effective public health tool; however, immunization rates are low in American adults, with disparities existing for Hispanics compared to non-Hispanic Caucasians, uninsured individuals, undocumented immigrants, and low-income individuals (Lu et al., 2014; Lu et al., 2015; Williams et al., 2016). Consequently, 42,000 adults still die each year in the United States (US) from vaccine-preventable diseases, and nine billion dollars are spent on associated healthcare costs and lost productivity (ADHS, 2015; Wilson et al., 2019). To improve adult vaccination rates, the National Vaccine Advisory Committee recommends the Standards for Adult Immunization Practices, including regular assessment, recommendation, delivery or referral, and documentation during follow-up on vaccination (Orenstein et al., 2014; CDC, 2016). Local problem: A free clinic in Arizona serving uninsured, undocumented Latin American immigrants had low vaccination rates and a deficiency in vaccination documentation in electronic medical records. Methods: An evidence-based quality improvement project was conducted to address low vaccination rates and provider practices using a multi-component intervention. The effect and usage were evaluated through chart audits and pre- post-intervention surveys. Interventions: A vaccination questionnaire was administered at all in-person primary care visits. Brief educational videos were provided to providers and office staff before the intervention addressing the questionnaire's use, purpose, and goals. Adult immunization schedule printouts were made available in all patient rooms and provider charting areas. Additionally, a resource sheet on local free immunization programs was created for providers and patients. Results: The intervention's effect was unable to be determined due to a breakdown in the protocol after the second week of implementation. However, 92% of completed questionnaires reviewed indicated the patient needed one or more vaccination. Sixty-five percent of electronic medical records reviewed had no vaccination documentation historically for assessment, recommendation, referral, follow-up, or scanned vaccination records. No charts reviewed had these areas documented regularly. Conclusion: Vaccination rates and the Standards of Adult Immunization Practices are low at the free clinic. Further quality improvement measures are indicated addressing barriers present.

ContributorsDukes, Alyssa (Author) / Ochieng, Judith (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)

Created2021-04-27

Addressing Vaccine Hesitancy in the Prenatal Population

Description

False accusations concerning the development of autism and other hazardous side effects have triggered parental vaccine hesitancy, leading to outbreaks of vaccine-preventable diseases. This opposition to vaccination risks the health of both individuals and entire communities. The purpose of this project was to determine the effectiveness of prenatal education on maternal vaccine hesitancy and infant immunization rates. In a pretest posttest design, pregnant mothers greater than or equal to 30 weeks gestation were recruited by The Arizona Partnership for Immunization (TAPI) and virtually educated about infant immunization. A voice-over PowerPoint presentation was delivered to the participants virtually and focused on vaccine knowledge, intention to vaccinate, and vaccine hesitancy. These outcomes were evaluated virtually pre- and post-intervention with the Parent Attitudes about Childhood Vaccines (PACV) survey (⍺ = 0.84), and the infants’ vaccination records were compared against the recommended immunization schedule at two months of age. Using the Wilcoxon Signed-Ranks test, data analysis revealed vaccine hesitancy was significantly reduced between pre- and post-intervention (Z = 27.70, p = .000), and 100% of the 2-month-old infants were fully immunized with the recommended vaccines. The effect size (d = 12.807) also indicated a strong relationship between pre- and post-intervention vaccine hesitancy. Vaccine hesitancy remains a threat to public health. With prenatal education, pregnant mothers will likely become more knowledgeable of vaccine benefits and better prepared to make informed decisions. Confident vaccination will decrease vaccine hesitancy and improve immunization rates, while promoting individual and societal health.

ContributorsWolsey, Carly M. (Author) / Chen, Angela (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)

Created2021-04-27

Health Care Provider Use of Motivational Interviewing to Address Vaccine Hesitancy in College Students

Description

Background: Vaccine-preventable diseases significantly influence the health and academic success of college students. Despite the known negative impact of these diseases, vaccination rates routinely fall short of national goals and recommendations. Although vaccination decisions are complex, a recommendation from a health care provider is one of the key motivators for individuals receiving a vaccine. Motivational interviewing (MI), a counseling approach primarily used to address substance abuse, can be applied to other health-related behaviors.

Local Problem: Despite previous quality improvement efforts aimed at increasing vaccine rates for influenza, human papillomavirus (HPV), and meningitis B (MenB), vaccinations at large university health centers have been well below benchmarks set by Healthy People 2020.

Methods: This study was guided by the Theory of Planned Behavior and included MI training and regular reinforcement for health care providers to address vaccine hesitancy with college students.

Results: Influenza vaccination rates improved, but HPV vaccine rates remained stable and MenB vaccine rates decreased compared with the previous year. Clinicians demonstrated a significant increase in knowledge of MI techniques after a targeted educational intervention. Repeat measures indicate the potential for sustained improvement when ongoing reinforcement is provided.

Conclusion: MI can be an effective part of a strategy to increase vaccination rates.

ContributorsWermers, Rita (Author) / Ostroski, Tammy (Author, Thesis advisor) / Hagler, Debra (Author, Thesis advisor)

Created2019-04-26