University Students Immunized and Not Immunized for Measles
Pielak, Karen L., Hilton, Ann, Canadian Journal of Public Health
A Comparison of Beliefs, Attitudes, and Perceived Barriers and Benefits
Objective: To compare students who were immunized or not immunized during the 1997 Simon Fraser University measles outbreak in British Columbia.
Methods: Descriptive comparative study using the Health Belief Model as a theoretical framework. A self-administered questionnaire was mailed to a stratified random sample of 400 immunized and 400 non-immunized SFU students.
Results: Perceived susceptibility, severity, barriers, cues to action, threat and student age were significantly related to being immunized. Logistic regression analysis achieved an overall correct prediction rate of 84.7% by including the contribution of the four variables of susceptibility, barriers, cues to action, and health motivation. Content analysis of the non-immunized students' descriptions of what it would have taken for them to be immunized indicated the influence of these four variables.
Discussion: The Immunization Health Belief Model Scale is a valuable tool for ascertaining attitudes and beliefs relating to immunization decision-making. Interventions targeted to significant beliefs may increase immunization coverage levels and result in improved disease prevention.
In 1997, a measles outbreak began among students attending Simon Fraser University (SFU) in British Columbia (BC). Measles vaccine was offered to all SFU students, faculty and staff. Immunization clinic times and locations were widely advertised through posters, the campus radio station, and the university newsletter. Informed consent to be immunized was obtained from vaccine recipients, including informing them of the contraindications and non-indications for vaccine receipt. The 20% of the targeted population who were not immunized presented a public health concern as they remained potentially susceptible to a highly contagious, serious disease. The majority of students were susceptible as they had received only one previous dose of measles vaccine and two doses of vaccine are required for immunity.1
There is a paucity of research related to the immunization-seeking behaviours of the university-aged segment of our population, and specifically in response to a disease outbreak. Research has primarily examined immunization decision-making of health care workers as they pertain to the receipt of hepatitis B and influenza vaccines,2,3 the elderly and pneumococcal and influenza vaccines,4,5 and parents of children receiving the routine childhood immunization series.6,7 Ascertainment of the beliefs related to immunization decision-making of this university-aged cohort would inform public health providers and enable the design of evidence-based immunization and education strategies for future outbreak events.
A good deal of the knowledge regarding the factors influencing immunization decision-making has been obtained from studies using the theoretical framework of the Health Belief Model (HBM). According to the HBM,8-10 deciding to undertake a health-seeking behaviour will not take place unless a person is psychologically ready to take action relative to the particular threat. Readiness is influenced by the extent to which a person feels susceptible; regards the condition as having potentially serious consequences; believes the actions will reduce susceptibility to or severity of the condition should it occur; and believes that benefits outweigh the anticipated barriers (or cost) of taking action.8-10 In addition, cues to action (e.g., mass media, advice from others, illness in others), demographic, sociopsychological variables (e.g., personality, social class, peer and reference-group pressure, health motivation, confidence), and structural variables act as modifying factors that affect perception and indirectly influence a person's tendency to act.8-10 Research with health care workers, the elderly, and with parents of small children about immunization decision-making and follow-up suggests the importance of perceived disease severity, personal susceptibility, cues to action, and barriers related to inconvenience of being immunized, vaccine cost, safety and side effects in decision-making. …