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Flu news > Immunization Communications Research
and Pneumococcal Immunization: A Qualitative Assessment of the Beliefs of Physicians and Older Hispanic and African Americans
Contents of this page:
Related information:
Report Summary

During the period August 20-27, 2002, the National Immunization Program (NIP) at the Centers for Disease Control and Prevention (CDC) commissioned a series of consumer focus groups and physician interviews to collect qualitative data about beliefs, behaviors, and barriers that cause low influenza and pneumococcal immunization rates among older African-American and Hispanic populations. Historically, immunization rates for these relatively high-risk groups have been low. Focus groups and interviews were conducted in Chicago, IL; Jackson, MS; Milwaukee, WI; Rochester, NY; and San Antonio, TX.

The research was intended to

  • Identify beliefs and behaviors in these populations directly related to immunization against influenza and pneumonia
  • Increase understanding of physicians' attitudes and behaviors related to these immunizations
  • Assess impact and appeal of messages intended to increase immunization in these target populations

Beliefs about Flu and Flu Shots
Respondents indicated that they were aware of the dangers from flu and pneumonia especially, but they tended to perceive flu and pneumonia as part of a disease continuum that begins with colds. While respondents associated flu with winter and cold weather, they associated flu prevention or
protection with strategies typically used to avoid colds, such as hand washing and taking vitamins, or "stay healthy" behaviors such as avoiding stresses of cold, damp, chills, poor diet, and fatigue or inadequate sleep. Immunization was rarely mentioned as means of prevention.

Motivations for Immunization
Those who had previously received flu shots or expressed interest in them were motivated by past experience with the flu, by the influence of doctors, friends, or family members who convinced them to be immunized, and by a desire to protect family members, particularly grandchildren. They were least influenced by celebrity recommendations or endorsements.

Impact of Misconceptions
Misconceptions seemed to increase resistance to flu shots. Those who did not want to be immunized believed that the vaccine gives recipients the flu or that they could prevent infection by taking the anti-cold and "stay healthy" precautions already described. Finally, some of those who refused or opposed immunization expressed a strong "distrust of the government, physicians, and drug companies" and demonstrated a firm locus of internal control (i.e., belief in their personal ability to control health status and outcomes).

Findings from Focus Groups
Results of the focus groups suggest that:

  • Members of the target groups respond well to the concept of protecting others with their flu shots
  • Those who "adamantly decline" flu shots will likely resist any influenza immunization campaign messages
  • Messages should incorporate both emotional appeals (protecting loved ones) and compelling information about flu and pneumonia
  • Messages should be brief and should employ large font sizes
  • References to or association with CDC can positively influence target populations
  • Potential vaccinees are concerned about purity of vaccines and possible side effects of vaccines

Findings from Physician Interviews
Results from physician interviews suggest that:

  • Physicians support flu and pneumococcal immunization
  • Physicians tend to rely on informal systems to remind themselves when patients should be offered a vaccination
  • Physicians did not consider flu shots a "revenue generator"
  • Short, focused material with a scientific message works best for physicians
  • Hospitals and medical journals are prime communications channels for physicians
  • Immunization promotion efforts should include clinic and practice managers


Understanding Differences in Qualitative and Quantitative Research

Qualitative research is intended to develop insight and depth of understanding rather than quantitative estimates. Qualitative research elicits detailed, thoughtful responses about what people know, think, and feel. Participants represent carefully defined target populations; their unfiltered comments are collected and analyzed. While typically small (n<100), qualitative research samples must be large enough to ensure that most or all key perceptions can be observed, documented, and interpreted. Qualitative research helps sponsors of the research to understand and respond to behaviors and attitudes.

Quantitative research produces data that are important because the volume of data generated is such that, when analyzed, it indicates trends and patterns that can be used to predict or describe actions and behaviors of the entire population from which the research sample is drawn. Quantitative research frequently involves large numbers of respondents or participants (n>1000). Ideally, quantitative research can be duplicated, is compared to corresponding research conducted with control groups, and is used to identify trends and patterns rather than interpret them.


Slide Presentation About This Study

The design, conduct, results, and recommendations of this research are presented in a series of PowerPoint slides covering these aspects of the study:

  • Approach (qualitative research)
  • Design and methods
  • Target audiences
  • Results and interpretations
  • Recommendations for improving outcomes

The slides present main points of all aspects of the study and emphasize ways to improve immunization coverage through effective communications.

Slide presentation (.pdf)

text-only screen-reader device file

Screen-reader device version (text-only .rtf version)


Full Report

Because the full report contains many graphics, copying the report from the NIP website to your computer can take a very long time. To reduce the time required and prevent errors in transmitting the report, the report is available as a zipped file.

For a printable copy of the complete report, download the zipped copy of the report and open it on your computer. To open and view or print this report, you need a copy of both WinZip and Acrobat Reader software on your computer. To download the report, click the Full Report link and then

  • You can choose to open and then save the WinZip file. If you do this, the file opens automatically as an Adobe Acrobat (.pdf) file that you can then save to the location you choose on your computer.
  • You can first save the file to the location (file directory) of your choice on your computer and then open the report from your computer. Your computer saves the file as a .zip file. You can then use Windows Explorer to open the file. When you click the file to open it, your computer displays the file in a WinZip window, where it is listed as an Adobe Acrobat (.pdf) file. You click the file name to open it.

For more help with these files, see Downloading Files.

winzip file Full Report (zipped copy of .pdf version of report)

Microsoft Word file

Microsoft Word version of report (.doc version)

text-only screen-reader device file

Screen-reader device version of report (text-only .rtf version)

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This page last modified on September 26, 2003


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