Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Efforts to increase influenza vaccine acceptance must consider the importance of patient education and familiarity with vaccinations and influenza in the emergency department (ED), particularly for populations without another primary source of healthcare. This is the first study, to our knowledge, to assess in-depth perceptions regarding the influenza vaccine and identify barriers and facilitators to influenza vaccination among COVID-19 unvaccinated adult ED patients.

Methods: We conducted a qualitative idiographic interview study from July 12, 2021, to September 24, 2021, at four EDs in urban cities across the United States. We recruited adult ED patients (18 years and older) unvaccinated for COVID-19, without a primary care clinician, who were fluent in either English or Spanish. The primary finding was a detailed understanding of patient perceptions regarding the influenza vaccine, with secondary findings assessing influenza vaccination rates, barriers and facilitators to being vaccinated, sources of information, and future vaccination intentions. We used a content analysis approach to identify themes around patient experiences, concerns, barriers, information sources, and future intentions regarding influenza vaccination.

Results: Of 65 participants interviewed, 48 discussed the influenza vaccine and were included in this analysis. Among these participants, the median age was 34 years, 21 (43.8%) were women, and 14 (29.2%) were Hispanic. We found three core themes influencing influenza vaccine hesitancy: 1) previous experiences with influenza illness and/or the vaccine; 2) knowledge about the influenza vaccine; and 3) confidence in vaccine safety and effectiveness. In our cohort, 10 (20.8%) participants demonstrated knowledge of the purpose and mechanism of the influenza vaccine. In addition, 14 (29.2%) patients suggested they would accept the vaccine if offered, while 18 (37.5%) patients stated they did not plan to receive the influenza vaccine and/or expressed strong hesitancy due to concerns about lack of vaccine effectiveness, fear of side effects, and lack of concern regarding influenza illness.

Conclusion: Our findings identify an important barrier that could be overcome by ED-based vaccine education, particularly for underserved patient populations. Interventions to increase influenza vaccine uptake could focus on overcoming hesitancy related to prior experiences and understanding of vaccine safety and effectiveness.