Increasing Influenza Vaccine Rates among College Students

1. Increasing Influenza Vaccine Rates among College Students Lisa C. Engel, MSN, RN, CNE

2. Introduction • Influenza is a serious respiratory infection that causes morbidity and mortality in the US. • It is mostly preventable by a seasonal influenza vaccination. • College students have consistently low vaccination rates, and they cite a variety of reasons for this low uptake. • Prevention in college students can decrease lost work and class time, fewer visits for medical care, and decreased transmission rates in a residential setting.

3. Problem Statement Will a campus wide influenza vaccine education project increase seasonal influenza vaccine rates among the student population as compared with current campus vaccine promotion practices? 

4. Background & Significance • In the 2016-2017 US influenza season (CDC, 2017) • Estimated 30.9 million cases of influenza • Estimated 14.5 million medical visits • Estimated 600,000 hospitalizations • Healthy People 2020 goal that 70% of adults ages >18 yrs. receive annual seasonal influenza vaccine • College students’ vaccine rates reported to be 20% to 30% Nichol, K.L., D’Heilly, S., & Ehlinger, E.P. (2008). Influenza vaccination among college and university students: Impact on influenza-like illness, health care use, and impaired school performance. Archives of Pediatric and Adolescent Medicine, 162(12), 1113-1118.  Poehling, K.A., Blocker, J., Ip, E.H., Peters, T.R., & Wolfson, M. (2012). 2009-2010 seasonal influenza vaccination coverage among college students from 8 universities in North Carolina. Journal of American College Health, 60(3), 541-547.

5. Project Purpose • Implement a mass media campaign about influenza prevention and vaccination on a residential college campus. • Impact Goal: • Determine effectiveness of educational campaign and plan for future influenza seasons.

6. Project Objectives • Educate students about seasonal influenza, its effects and the benefits of influenza vaccination through multi-media campaign. • Achieve influenza vaccination rate of 30% among students.  • Gather data to determine: • baseline vaccine rates for 2017-2018 • barriers and facilitators to vaccine uptake among college students.

7. Literature Synthesis • College students respond to a variety of educational sources • 4 studies had an intervention – all involved technology • Knowledge gaps exist • 6 studies reported gaps: • Flu vaccines cause flu illness • Flu vaccines are not safe • Flu is not a serious illness • Overall improved vaccine rates • 3 studies found improved vaccine rates

8. Literature Appraisal • Strengths • Education does increase vaccine uptake • Large student populations • Weaknesses • Limited use of social media • Statistical analyses were lacking • Gaps/Limitations • Few current studies

9. Theoretical Framework • Health Belief Model - The four main constructs of the theory are perceptions that the person holds: • perceived seriousness • perceived susceptibility • perceived benefits • perceived barriers • The greater the person sees the threat, the more likely that person is to act to modify behavior.  Hayden, J. A. (2014). Introduction to health behavior theory (2nd ed.). Burlington, MA: Jones & Bartlett Learning.

10. Individual Perceptions LikelihoodofAction ModifyingFactors Perceived susceptibility I probably won’t get the flu this year. Perceived Threat How likely am I to get the flu if I don’t get this vaccine? • Modifying Variables • Previous illness • Comorbidities (i.e. asthma) • Socioeconomic status Perceived seriousness If I get the flu, it won’t be that bad. Plus I can miss a few days of class. Likelihood of obtaining vaccine • Cues to Action: • Education • Social media campaign • Posters/flyers Perceived barriers Lack of money, cash only, timing, fear, illness from vaccine Self-efficacy Confidence in ability to care for one’s self. Perceived benefits Maybe I won’t get sick if I get the vaccine

11. EBP Implementation Framework • Iowa Model • Organizes thinking • Brings about organizational change • Can care be improved through use of research findings? • Considers the entire healthcare system • Seven step process Titler, M. G., Kleiber, C., Steelman, V. J., Rakel, B.A., Budreau, G., Everett, L. Q., Buckwalter, K. C., Tripp-Reimer, T., & Goode, C. J. (2001). The Iowa model of evidence-based practice to promote quality care. Critical Care Nursing Clinics of North America, 13(4), 497-509.

12. Project Design • Evidence-implementing • Evidence-generating • Design: quasi-experimental • Convenience sample

13. Project Methods • Setting: Harding University • Sample: Convenience • Inclusion criteria: • Undergraduate student at HU • Exclusion: • Those unable to get influenza vaccine (vaccine clinic only) • Project length • Educational campaign: September through December • Vaccines available in campus infirmary: September through end of supply • ADH vaccine day on campus – mid-October • Questionnaire – November through January

14. Data Collection Methods • Reports from infirmary and ADH for vaccine totals • Questionnaires (self-developed) distributed through: • Social clubs meetings • Student center • Classes • Influenza cases reported: infirmary • Data entered by investigator • Costs: $1100 covered by AIAC grant

15. Data Analysis & Results • Descriptive statistics • Demographics by age, class, gender, ethnicity, housing • Previous year’s vaccine status • Current year’s vaccine status & where obtained • Beliefs about vaccine, susceptibility to influenza, seriousness of influenza, side effects • Where information about vaccine was obtained and level of influence

16. Data Analysis & Results • Inferential statistics • Differences between groups – t-test and Χ2test • Test to determine statistical significance in increase in vaccines • Multivariate logistic regression to examine association between beliefs about vaccines

17. Anticipated Strengths & Limitations of Project • Strengths • New focus on campus • Public health focus • Low cost • Partnership with state agencies • Limitations • Lack of baseline data • Report of actual disease

18. Project Outcomes and DNP Project Objectives • Demonstrates synthesis of population education, current technology, & Health Belief Model (DNP Essentials I & III) • Embedded in a large organization that has multiple focuses and policies. (DNP Essential II) • Uses technology to improve care (DNP Essential IV) • Educates others regarding population outcomes (DNP Essential V) • Analyzes data related to population health (DNP Essential VII) • Implements & evaluates interventions based on nursing & health sciences (DNP Essential VIII)

19. Implications of Results on Nursing Practice & Health Care • Supports an objective of Healthy People 2020 & the American College Health Association Healthy Campus 2020 • Exercises a benefit provided by the Affordable Care Act. • Decreases disease incidence • Promotes lifetime health practice

20. Future Implications & Possibilities for Extension • Renew project annually to continue increased vaccines • Expand to other health outcomes

21. References References available on request #herdimmunity #getyourflushot