The Influence of Behavioral Cues on Immunization Practices of Elders

Abstract

A quasi-experimental intervention study was designed to compare the influence of behavioral cues on immunization practices of elders. Elders also were surveyed to determine immunization practices related to influenza and pneumonia and to ascertain reasons for underimmunization among this age group. The Neuman Systems Model and the Health Belief Model were used as conceptual frameworks to guide the study. Data were collected utilizing a Demographic Survey (DS) and an Immunization Survey (IS). The study population was 1,047 elders who were patients in rural health clinics in medically underserved communities in northern Mississippi where nurse practitioners (NPs) were the only primary care providers. The final sample consisted of 393 elders.

The subjects were divided into 4 groups, which included 1 control group (Group 1) and 3 treatment groups (Groups 2, 3, and 4). Subjects in Group 2 received a postcard reminder as a cue to obtain inoculations. Elders in Group 3 did not receive a postcard reminder but did obtain care from NPs who received immunization fact sheets as a cue to increase awareness about underimmunization consequences for elders. Subjects in Group 4 received both a postcard reminder and care from NPs who were exposed to the fact sheets.

Descriptive statistics were used to analyze the DS and the IS. Additionally, for each group of elders, it was determined how many subjects received influenza, pneumonia, or both immunizations during the 3 months of data collection of October, November, and December, and a score was given to each group. A comparison of group mean scores were made among the 4 groups utilizing an analysis of variance (ANOVA), the Tukey, and the Least Significant Difference (LSD) procedure.

Data analysis revealed that, while the majority of the subjects (p = 289, 73.5%) had received an influenza inoculation last year, only 38.3% of the subjects had ever received an immunization to prevent pneumonia. Data analysis also indicated that the group of elders who received both a postcard reminder and care from an NP exposed to immunization fact sheets had significantly higher immunization rates than all other groups.

Additional data analysis of elders who had not received influenza immunization in the previous year had never received pneumonia inoculation, or both indicated that among these elders receiving care from NPs who were exposed to fact sheet cues alone or in combination with postcard reminders immunizations significantly increased. This mean group indicated the reason for not obtaining the influenza, pneumonia, or both immunizations in the past was "I did not think I needed it."

A conclusion from this study was that the practice of sending postcards to elders as a reminder to receive immunizations may be an effective strategy for NPs to pursue. Additionally, fact sheets for diseases preventable with inoculations should be developed and displayed as reminders to NPs working in primary care clinics.