Running Head: HEALTH PROMOTION: PEDIATRIC INFLUENZA VACCINATION 1

Health Promotion: Pediatric Influenza Vaccination

Keston Trammell
Auburn University / Auburn University Montgomery

HEALTH PROMOTION: PEDIATRIC INFLUENZA VACCINATION

Health Promotion: Pediatric Influenza Vaccination

Influenza is a virus that infects and kills many people every year. Once one has
influenza (the flu), there is no specific treatment as a cure and antiviral medications only
lessen symptoms. Those subject to dehydration and complications related to viral illness
are most susceptible to be severely ill from the flu. This includes the elderly and children
specifically. Children are, a majority of the time, not responsible for their vaccination
selection and thus education regarding vaccination must be given to parents. Based on a
lack of vaccination of children at Southeastern Pediatrics a health promotion plan was
developed based on promoting awareness about the severity and susceptibility patients
may have from the flu and demonstrating the benefits and risks of receiving the influenza
vaccine. Evaluation of this education would be made by administering a post education
questionnaire to determine change in knowledge as well as likelihood of future
vaccination.
The Problem
Influenza is a contagious virus affecting the nose, throat, and respiratory system.
It can present as a mild or severe illness and can lead to death (Centers for Disease
Control and Prevention [CDC], 2014c). In the United States alone between fifteen and
sixty-five million people get the influenza virus yearly (United States Department of
Health & Human Services [HHS], 2014a). This leads to an average of 224,000
hospitalizations and 36,000 deaths annually (CDC, 2014c). Specific to pediatrics, 20,000
children under the age of 5 are hospitalized every year with influenza and secondary
infections. Also, over 100 children aged 0-17 years die annually due to influenza
infections (CDC, 2014a). In the 2013-2014 influenza season 58.9% of children ages 6

HEALTH PROMOTION: PEDIATRIC INFLUENZA VACCINATION

months 17 years old received the influenza vaccine CDC, 2014b). This is more than
20% lower than the recommendations of HealthyPeople 2020 (HHS, 2011b). Reluctance
of parents to have their children vaccinated has been previously documented. Smith et al.,
(2011) documented that parents of children, were reluctant to have their children
vaccinated due to lack of perceived benefit, lack of trust in vaccinations, and inability to
remember to get their children vaccinated.
Description of Implementation
Southeastern Pediatrics is located in Dothan, Alabama. They are a pediatric clinic
featuring two offices, with seven physicians and two nurse practitioners serving
approximately thirteen-thousand patients. Last year despite promotion of influenza
vaccine clinics through social media and television advertisement, only 15-20% of
patients received vaccination in the 2013-2014 season. This year, primary methods of
promotion for influenza vaccination have been simply by asking parents if the patient had
received the vaccine this season, and if they wanted to get the vaccine today. Dr. Searcy,
one of the pediatricians in the office, acknowledged that there was currently no method of
promotion being used in the clinic and after receiving a new electronic medical record,
there has been difficulty tracking which patients have received the vaccine without a
lengthy chart review.
With numbers below the state average last year per Dr. Searcys report and with
no current vaccination promotion plan, a decision was made to make efforts to promote
vaccination and determine the reasons for lack of vaccination from parental perspective.
At this facility, when patients are diagnosed with certain ailments or reach certain age
ranges, they are given handouts and teaching based on the handouts to help simplify the

HEALTH PROMOTION: PEDIATRIC INFLUENZA VACCINATION

education process. Based on this successful method of education it was decided that a
brochure and brief education session may be beneficial in promoting vaccination as well
as determining parental perception regarding influenza and the influenza vaccine.
Project Design
To promote an increase in the amount of children vaccinated at the Southeastern
Pediatric Clinic, an awareness plan featuring a brochure and education session was used
to teach parents the severity of the influenza virus, the vaccine and vaccination routes,
and the risk and benefits or immunization. After the education session was complete the
participants were allowed to take the brochure home and also filled out a questionnaire
regarding education objectives and likelihood of future immunization. The specific topics
of the education session and those included in the brochure were chosen based on the
reasons parents were reluctant to have their children vaccinated in a study by Smith et al.
(2011). The specific identification of risk and benefit led to the use of the health belief
model which looks to generate action by promoting benefits that outweigh the risks
University of Twente, 2014).
Project Delivery
The delivery format of this health promotion project was based on the Health
Belief Model. The Health Belief Model is based on the theory that one will take an action
towards their health if the following are true: There must be a negative health problem
that can be avoided, an action can be taken to avoid the negative health problem, and
there is a belief that the action can be done successfully or consistently without issue
(University of Twente, 2014). There are six concepts that create a pathway down the
Health Belief Model structure. First, there must be a perceived susceptibility to an illness.

HEALTH PROMOTION: PEDIATRIC INFLUENZA VACCINATION

Second, a perceived severity of the illness must be present. Next, the participant must
perceive a benefit from action. Next, perceived barriers must be dealt with to determine if
the action is necessary. Fifth, A cue to action must be given be either reminder or
education. Finally, self-efficacy must be evaluated to see if this is something the
participant can do and will do consistently. The recommended method of evaluation for
the health belief model is the use of a survey (University of Twente, 2014).
For this health promotion project, the six concepts were delivered in the form of a
brochure and education session and post-education questionnaire given to parents to
promote influenza vaccination for their children. The perceived susceptibility and
severity were discussed in terms of infection and death rates of both adults and
specifically children. Next the perceived benefits and barriers were discussed in terms of
vaccination and incidence of the influenza virus as well as allergy reaction and common
side effects of the influenza vaccine. After the education session a questionnaire
regarding patient influenza vaccination history was given including attitudes towards
future immunizations. This was done to bring forth a cue to action based on the education
given. Self-efficacy was measured in changed likelihood of the parent to get their
children vaccinated or to make further attempts to have them vaccinated earlier in the
influenza season.
During the intervention, parents of patients in a pediatric office were asked if they
would be will to participate in an education session and survey. They were not informed
as to the nature of the session prior to beginning the session. No specific selection criteria
were made for selection of the education and all patient parents during the two-day time
period were asked if they would like to participate. A three to four minute education

HEALTH PROMOTION: PEDIATRIC INFLUENZA VACCINATION

session that went over the education brochure was given to the parent in presence of the
children. Each section of the brochure was discussed including statistics, vaccine
information, benefits and risks of vaccination. The parents were then asked if they had
any questions. After questions were answered a six-item questionnaire was left with them
for them to fill out and leave in the room. The questionnaire as described above assessed
vaccination history, understanding of benefits and risks of vaccination and likelihood of
future vaccination for influenza.
Evaluation of Intervention
The education session and questionnaire responses revealed several things in
regards to parental decision making regarding vaccination and knowledge of influenza
and the influenza vaccine in general. There were a total of thirty-five individuals given
the education session and brochure with thirty-four individuals completing the post
education questionnaire. Yearly, fourteen of the thirty-four have their children vaccinated
with the influenza vaccine while twenty of the thirty-four regard having no vaccination
for influenza before or having been less frequent than yearly. There were eight parents
who had children diagnosed with influenza that day, including a mother with three
children diagnosed with influenza on that day. All of these current influenza-diagnosed
patients had not received the influenza vaccination this year or prior. All of the
participants in this education session remarked having learned something new from this
education session as well as having a better understanding of the risks and benefits of
vaccination. Of the twenty parents who reported not having their children vaccinated,
sixteen reported being more likely to have their children vaccinated and twelve either had
their child vaccinated that day or set up appointments to have their children return for

HEALTH PROMOTION: PEDIATRIC INFLUENZA VACCINATION

vaccination. Even in this small sample size, vaccination rates went from 41% to 76%
with one education session. This is near the goals set by HealthyPeople 2020 (HHS,
2011b). Of those who had previously vaccinated their children, eleven remarked that they
would make sure to have them vaccinated earlier in the influenza season. Of those not
vaccinating their children prior to the education session, most listed that they had not
realized the severity and likelihood that their child would get influenza and thus they did
not vaccinate. Other parents reported that their children were always sick when coming to
the clinic and could not have their child vaccinated or that there child was very rarely sick
and did not think about getting the vaccination for them. There were four parents who
stated they were unchanged regarding vaccinations and would never have themselves or
their child vaccinated.
Conclusion
Infection rates, hospitalizations, and deaths from the flu virus will continue to be
high unless proper promotion of vaccination is made. As children are not responsible for
their vaccinations, education delivered to parents must focus on risks specific to their
children to promote pediatric vaccination. Parental reluctance in vaccinating their
children was noted in this project as well as in previous projects. By providing education
on risk and benefits of action in education sessions and brochures during health visits,
parents may be more likely to have their children vaccinated. Southeastern Pediatrics has
now decided to use this health promotion brochure to add to their current efforts at
promoting vaccination among their clients.

HEALTH PROMOTION: PEDIATRIC INFLUENZA VACCINATION

References
Centers for Disease Control and Prevention. (2014). Children, the flu, and the flu vaccine.
Retrieved from http://www.cdc.gov/flu/protect/children.htm
Centers for Disease Control and Prevention. (2014). Flu vaccination coverage, United
States, 2013-14 influenza season. Retrieved from
http://www.cdc.gov/flu/fluvaxview/coverage-1314estimates.htm
Centers for Disease Control and Prevention. (2014). Key facts about influenza (flu) & flu
vaccine. Retrieved from http://www.cdc.gov/flu/keyfacts.htm
Health Belief Model. (2014) Retrieved from
http://www.utwente.nl/cw/theorieenoverzicht/theoryclusters/health
communication/health_belief_model/
Smith, P. J., Humiston, S. G., Marcuse, E. K., Zhao, Z., Dorell, C. G., Howes, C., &
Hibbs, B. (2011). Parental delay or refusal of vaccine doses, childhood
vaccination coverage at 24 months of age, and the Health Belief Model. Public
Health Reports, 126:135-146. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed
United States Department of Health and Human Services. (2014). Seasonal Flu.
Retrieved from http://www.flu.gov/about_the_flu/seasonal/
United States Department of Health and Human Services. (2014). Immunization and
infectious diseases. Retrieved from https://www.healthypeople.gov/2020/topicsobjectives/topic/immunization-and-infectious-diseases/objectives