Health education and factors influencing acceptance of and willingness to pay for influenza vaccination among older adults.
BACKGROUND
The influenza vaccine is recommended in older population. However the immunization coverage varies globally. It has been reported as low as 10-20 % in some countries. This study explored the acceptance of and willingness to pay for influenza vaccination, comparing acceptance and willingness to pay before and after health education.


METHODS
The study was conducted with 2693 older people in Bangkok, Thailand. Participants were divided into an education group (n = 1402) and a control group (n = 1291). A validated questionnaire measuring acceptance of and willingness to pay for vaccination was administered during semi-structured interviews before and after education. Data on factors influencing acceptance were analyzed.


RESULTS
Participants' mean age was 69.5 years, 80 % were women and 82.1 % had at least one co-morbidity. Of the participants, 43.5 % had previously received vaccination more than once, although 92.8 % expressed acceptance of vaccination. Acceptance was associated with a positive attitude toward vaccination (OR 2.1, 95 % CI 1.5-2.9) and a history of receiving vaccination (OR 4.1, 95 % CI 2.8-6.1). At baseline, there were no differences between the education and control groups in terms of work status (p = 0.457), co-morbidities (p = 0.07), medical status (p = 0.243), and previous vaccination (p = 0.62), except for educational background (p = 0.004). Acceptance of vaccination increased to 95.8 % (p < 0.001) after education and willingness to pay increased to 82.1 % (p < 0.001). Education significantly affected those with primary school-level education and no previous vaccination history, with acceptance increasing from 83.3 to 92.6 % (p < 0.001); more than twice as high as the control group (OR 2.4, 95 % CI 1.2-4.7). Viewing an educational video increased the proportion of participants with a high level of knowledge from 29.2 to 49.2 % (p < 0.001), and increased the proportion of participants with a positive attitude from 52.4 to 70.7 % (p <0.001). No significant difference was found in any parameter between the first and second assessment in the control group.


CONCLUSIONS
The strategies to increase positive attitudes may enhance the acceptance of vaccination. Health education using an educational video demonstrated a significant impact on acceptance, willingness to pay, knowledge and attitude in older people. This may lead to increased sustainability of the immunization program in older people.
Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand. rawipun_wor@hotmail.com.
Rawipun
R
Worasathit
Bangkok Metropolitan Administration (BMA), Mitmaitree Road, Dindang, Bangkok, 10400, Thailand. dddjj117@hotmail.com.
Wantanee
W
Wattana
Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand. kamolnetr.oka@mahidol.ac.th.
Kamolnetr
K
Okanurak
Sirindhorn College of Public Health, 89 Moo2 Thanon Trang-Kantang Thambon Kuanthani Amphoe Kantang, Trang Province, 92000, Trang, Thailand. ar_song@yahoo.com.
Archin
A
Songthap
Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand. jittima_pu@yahoo.com.
Jittima
J
Dhitavat
Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand. punnee.pit@mahidol.ac.th.
Punnee
P
Pitisuttithum
D000368:Aged; D005252:Fees, Pharmaceutical; D005260:Female; D006801:Humans; D007252:Influenza Vaccines / Q000191:economics / Q000627:therapeutic use; D007251:Influenza, Human / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000379:methods*; D011795:Surveys and Questionnaires; D013785:Thailand; D014611:Vaccination / Q000191:economics / Q000379:methods / Q000523:psychology
D007252:Influenza Vaccines