Increasing Flu Vaccinations in Vaccine Hesitant Families Using a Standardized Educational Approach

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Background:The increasing rate of flu vaccine refusals is a growing concern in the Pediatric population. A key factor in our clinic for vaccine hesitancy is lack of education. Families know the vaccine is not required for school inclusion and therefore do not see it as necessary. Previously in our clinic, flu vaccine refusers did not receive any additional information about the vaccine. A standardized approach to family education among providers was warranted. Education booklets facilitate discussion about the vaccine and utilization of vaccine refusal forms have led to increased vaccination rates for other vaccines.

Objective:The aim of the study is to increase flu vaccine acceptance for vaccine-hesitant families in an urban Pediatric clinic. Specifically, we aimed to increase reversals by 30%, from zero, during the 2019-2020 flu season.

Design/Methods: The study focuses on patients between the ages of 6 months-18 years attending their well-child checks. Our clinic is a Pediatric Resident Practice in an urban center where 45 residents participated. Our intervention includes a 3-page flu vaccine booklet. The booklet includes impactful 2017-2018 flu statistics, vaccine-specific information, such as its effectiveness and common misconceptions, and a flu vaccine refusal form, which serves as a final attempt to reverse a family's decision. This intervention ensures a standardized educational approach which was not used in our clinic previously. If the family rejects the flu vaccine, the first 2 pages were reviewed by trained residents. If the vaccine is still declined, the refusal form is signed, demonstrating their understanding of the risks associated with not receiving the vaccine. Reasons for their refusal were also indicated.

Results: Data were collected over a 8-week period following the release of the flu vaccine, and the study is ongoing for the 2020-2021 flu season. So far, there were 46 refusals with 10 reversals noted, which demonstrates an approximate 22% reversal among vaccine-hesitant families based on our intervention. Reasons for family refusals ranged from "the vaccine makes us sick" to "unnecessary".

Conclusion: Using our standardized educational approach and refusal forms allows for informed decision-making and increased flu vaccinations among vaccine-hesitant families. Gathering reasons for refusals provides valuable information for providers when addressing vaccine hesitancy. Next steps include expanding this program to involve other clinic visits as well as investigate the influence of COVID-19 on influenza vaccine refusals in the pediatric population.

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