Evaluation of a Computer-based Patient Education and Motivation Tool on Knowledge, Attitudes and Practice towards Influenza Vaccination

Introduction Influenza-related illnesses cause an average of 36,000 deaths (1) and 134,000 hospitalizations (2) every year in the United States. (3) Children less than 2 years of age have a high rate of influenza-related hospitalizations (4-6) and influenza infections can cause deaths among otherwise healthy children. (7) Among children aged less than 5 years, hospitalization rates have ranged from approximately 500/100,000 children for those with high-risk medical conditions to 100/100,000 children for those without high-risk medical conditions. (8) During 2003-2004, fifty-two deaths among children were attributed to influenza and its known complications (particularly secondary bacterial infections) (9) with more than 40% having severe outcomes (death or neurological sequel). (10,11) The Advisory Committee on Immunization Practices (ACIP) recommends influenza vaccination of children aged 24-59 months, as well as their household contacts and out-of-home caregivers. (10) ACIP also emphasizes that all children aged 6 months to 9 years who have not been previously vaccinated at any time with either live, attenuated influenza vaccine (LAIV) or trivalent inactivated influenza vaccine (TIIV) should receive 2 doses of vaccine. (10,11) The National Immunization Survey (NIS) data on Baltimore City showed that 39.8% of children aged 6 months-2 years had received only one vaccination while 25% had received the complete two doses. (12) Further improvements in vaccination coverage levels are needed, especially among children aged 6-59 months and children with known risk factors for influenza complications. (13) The ACIP influenza recommendations also highlight the importance of educating parents about the "impact of influenza and the potential benefits and risks of vaccinating young children". (14,15) Significant barriers to vaccination include both parental and patient misconceptions about the safety and efficacy of the vaccine (3). By understanding the barriers (e.g. knowledge, attitudes) to delivering influenza vaccine to a target population we can develop appropriate messages to improve vaccination rates for children aged 6 months to 5 years. Purpose of Study The objective of this research was to assess and describe changes in knowledge, attitudes and practice regarding influenza vaccination among parents of Baltimore children aged 6 months to 5 years in a pediatric emergency department and the University of Maryland inner city clinical practice using a self-guided, interactive computer-based influenza vaccine educational program. Methods Study design A pre-post study was conducted in a pediatric emergency department (ED) and a pediatric clinic (PC) setting at the University of Maryland, Baltimore during October 2007- November 2007. The aim of this pre-post study was to examine differences in influenza vaccine knowledge, attitudes and practice of the participants through use of an interactive computer based program. Parents or guardians of children between 6 months and 5 years presenting to the ED or clinic were provided information on the program and enrolled if they agreed to participate. No identifying information was collected, and the study was approved by the University of Maryland IRB. The inclusion criteria included all guardians of children aged 6 months-59 months of age presenting to the ED or PC for any medical complaint or in the case of the PC, routine well child care. The exclusion criteria included guardians of children less than 6 months or more than 59 months or children with presenting medical condition in the ED precluding computer education. Patients with existing prior contraindication to influenza vaccination such as severe egg allergy, aspirin therapy, previous severe reaction to influenza vaccination, history of Guillian Barre syndrome were also excluded from the study. Study Variables The study variables included socio-demographic characteristics, participants' knowledge, attitudes and practice related to influenza vaccination and the program evaluation. …