Threat-responsiveness and the decision to obtain free influenza vaccinations among the older adults in Taiwan

BMC Public Health, Jul 2009

Background Although older adults are encouraged by government agencies to receive influenza vaccinations, many do not obtain them. In Taiwan, where universal health care coverage has significantly reduced the barriers of access to care, the health care system has provided free influenza vaccinations for people 65 years or older since 2001. Nevertheless, the numbers of people who use this service are much fewer than expected. The aim of this study was to explore major factors that might affect the decision to receive influenza vaccinations among older adults in Taiwan. Methods Using national representative health insurance medical claims from the National Health Insurance Research Database between 2002 and 2004, we investigated the role of threat-responsiveness, represented by prior vaccinations and prior physician visits for flu-like respiratory conditions, in the decisions of older adults to obtain vaccinations in Taiwan. Results Among the sample of 23,023 older adults, the overall yearly vaccination rates in this study were 38.6%, 44.3% and 39.3% for 2002, 2003, and 2004, respectively. Adjusting for covariates of individual and health care facility characteristics, the multivariate logistic regression revealed that older adults who had had prior vaccinations were ten times more likely to be vaccinated during the following influenza season than those who had not (OR = 10.22, 95%CI: 9.82–10.64). The greater the frequency of prior physician visits for flu-like respiratory conditions, the greater the likelihood that one would decide to be vaccinated. Visits during prior interim (non-epidemic) season exerted a stronger positive influence than prior influenza season on this likelihood (OR = 1.59, 95% CI: 1.46–1.73 vs. OR = 1.11 95% CI: 1.01–1.22, respectively). Conclusion Threat-responsiveness, or perceived risk, greatly influences influenza vaccination rates among the older adults in Taiwan. These findings can be used to help design public health campaigns to increase the influenza vaccination rate in this vulnerable group of citizens. Particularly, older adults who never had influenza vaccinations can be identified, educated, and encouraged to participate.

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Threat-responsiveness and the decision to obtain free influenza vaccinations among the older adults in Taiwan

BMC Public Health Threat-responsiveness and the decision to obtain free influenza vaccinations among the older adults in Taiwan Ying-Chun Li* and Chi-Mei Liu 0 Address: Institute of Health Care Management, National Sun Yat-Sen University , 70 Lien-Hai Rd., Kaohsiung 804, Taiwan , Republic of China Background: Although older adults are encouraged by government agencies to receive influenza vaccinations, many do not obtain them. In Taiwan, where universal health care coverage has significantly reduced the barriers of access to care, the health care system has provided free influenza vaccinations for people 65 years or older since 2001. Nevertheless, the numbers of people who use this service are much fewer than expected. The aim of this study was to explore major factors that might affect the decision to receive influenza vaccinations among older adults in Taiwan. Methods: Using national representative health insurance medical claims from the National Health Insurance Research Database between 2002 and 2004, we investigated the role of threatresponsiveness, represented by prior vaccinations and prior physician visits for flu-like respiratory conditions, in the decisions of older adults to obtain vaccinations in Taiwan. Results: Among the sample of 23,023 older adults, the overall yearly vaccination rates in this study were 38.6%, 44.3% and 39.3% for 2002, 2003, and 2004, respectively. Adjusting for covariates of individual and health care facility characteristics, the multivariate logistic regression revealed that older adults who had had prior vaccinations were ten times more likely to be vaccinated during the following influenza season than those who had not (OR = 10.22, 95%CI: 9.82-10.64). The greater the frequency of prior physician visits for flu-like respiratory conditions, the greater the likelihood that one would decide to be vaccinated. Visits during prior interim (non-epidemic) season exerted a stronger positive influence than prior influenza season on this likelihood (OR = 1.59, 95% CI: 1.46-1.73 vs. OR = 1.11 95% CI: 1.01-1.22, respectively). Conclusion: Threat-responsiveness, or perceived risk, greatly influences influenza vaccination rates among the older adults in Taiwan. These findings can be used to help design public health campaigns to increase the influenza vaccination rate in this vulnerable group of citizens. Particularly, older adults who never had influenza vaccinations can be identified, educated, and encouraged to participate. - Background Influenza poses a significant threat to the health of older adults and presents a critical disease burden to health care delivery systems around the world [1-3]. While many studies and government health systems consider vaccination to be a cost-effective means of preventing influenza in older adult populations [4-7], vaccination rates do not reach the number of people targeted to receive them in many countries [8-11]. In Taiwan, where universal health care coverage has significantly reduced the barriers to care [12], the health care system has provided free influenza vaccinations for people 65 years or older since 2001. In fact, Taiwan's federal government has set a vaccination rate goal of 68% for older adults by 2010. Although the barriers to preventive services have been reduced and people have been encouraged to use them, the number of people using them are much fewer than expected [13]. Therefore, public health authorities and policy makers may be interested in what other factors may be involved in the decision of an older adult to obtain an influenza vaccination. Threat-responsiveness is the hypothesis that individuals will alter their prevention behaviors when threat is perceived. Threat-responsiveness can be interpreted as fear of sickness. Therefore, it is assumed the greater the prevalence of disease, the greater the perceived threat and the greater the level of prevention. Threat-responsiveness would be expected to operate in human populations faced with any infectious disease, and has been found, for example, to influence whether a person would take measures to prevent such infectious diseases as influenza, measles, or AIDS [14-17]. Perceived threat has also been found to be predictive of whether older adults would obtain influenza vaccinations [18]. However, few studies have empirically tested the influence of perceived threat on utilization of preventive medicine on a national level. To the best of our knowledge, no such study has been conducted in Taiwan. Using national health insurance claims data, we studied the association between threat-responsiveness, represented by prior influenza vaccinations and prior visits to physicians for flu-like respiratory conditions, and the decision to receive influenza vaccinations during a current epidemic season in Taiwan. Methods We collected demographic and medical information for 200,000 individuals for the years 2002 to 2004 from a random sample of Taiwan's National Health Insurance cla (...truncated)


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Ying-Chun Li, Chi-Mei Liu. Threat-responsiveness and the decision to obtain free influenza vaccinations among the older adults in Taiwan, BMC Public Health, 2009, pp. 275, 9, DOI: 10.1186/1471-2458-9-275