Analysis of CDC research identifies facilitators and barriers to getting annual flu vaccinations

Convincing people to get an annual flu vaccination is often a difficult challenge in the United States, but thanks to an analysis of 29 flu vaccine-related communication studies led by Glen Nowak of the University of Georgia, the reasons why people decide whether or not to be vaccinated are now more clear.  All of the studies were sponsored by the Centers for Disease Control and Prevention’s (CDC) National Center for Immunization and Respiratory Diseases.

Nowak, the director of the Center for Health and Risk Communication at the Grady College of Journalism and Mass Communication, worked with Kelli Bursey at the Oak Ridge Institute for Science and Education to systematically analyze the communication research reports. The reports summarized methods and key findings from qualitative research projects sponsored by NCIRD between 2000 and 2013, but none of the findings had ever been published. The research identified seven reasons that facilitated people getting annual flu vaccinations and six barriers, or reasons they did not get vaccinated for the flu.

The research was published in the June 2015 issue of Vaccine and was presented at the National Adult and Influenza Immunization Summit held in Atlanta May 12-14, 2015. Along with Nowak and Bursey, the article included three CDC co-authors Kristine Sheedy, Teresa M. Smith and Michelle Basket.

The main reasons for undertaking the meta-analysis were to bring together all of the findings into a usable form and identify consistent or repeating themes and findings. 

“This research makes information from 29 individual studies more widely and broadly available, especially to those working to promote influenza vaccination,” Nowak said. “It highlights the things that cause people to get a flu vaccine, as well as the barriers that still persist. Overall, these studies consistently found that people need to see flu as real and serious health threat—either through personal experience or communication messages and materials—in order to get vaccinated. They also consistently found that misperceptions, such as believing the vaccine causes the flu, remain and are sometimes held by health care providers.”

The 29 studies that were analyzed and summarized as part of qualitative meta-analysis encompassed a broad spectrum of participants including health care workers, parents, and people with chronic illnesses.

Seven facilitators for people getting the flu vaccinations included:

•   those vaccinated have to believe they are susceptible to getting the flu

•   those vaccinated have to believe the vaccine matters and works

•   older people and those with a chronic health conditions are more likely to get vaccinated

•   a recommendation from a doctor makes a positive difference

•   those who have experienced bad flu or flu-like illness are more likely to get vaccinated

•   active promotion of getting vaccinated makes a positive difference

•   convenience and easy access to flu vaccine make a positive difference

Six barriers, or reasons people didn’t get the flu vaccination, were identified:

•   people believe that flu is a “manageable illness”

•   people do not believe the flu vaccination recommendation applies to them

•   people do not believe flu vaccines are effective

•   there is concern about getting the flu from the vaccine

•   people believe other measures are more effective

•   people have a personal experience with the vaccine that has been negative, rather than positive

“One of the most important findings was that personal experiences mattered a lot, both for people who got an annual flu shot on a regular basis and for those who didn't,” Nowak said. “I think that is an important reminder that it is really hard to overcome personal experience with persuasive communications.  A lot of time communicators think they can just educate someone or just persuade them to take action, but that isn’t always the case. It may take a new or better product.”

One of the biggest surprises in the research involved the perceptions of health care workers and their view about flu vaccinations. 

“Some health care workers are aware they can contract the flu, but they didn't acknowledge they can transmit the flu,” Nowak said.  “They saw patients as the threat, and not themselves, which created a barrier for them to get vaccinated.”

According to the 2013 National Health Interview Survey, the most recent report used by the CDC, 29.6% of adults ages 18- to 49-years-old get the flu vaccination.  That number increases to 46.5% for adults ages 50- to 64-years-old, and 67.9% for adults over 68-years-old.

Date: May 27, 2015
Author:  Sarah Freeman,
Contact:  Glen Nowak,