TABLE 1.
Challenges faced in general and HTR populations with various approaches to raising routine influenza immunization levelsa
Objective | Challenges in the general population | Additional challenges in HTR populations |
---|---|---|
At the individual level | ||
Change attitudes | Philosophical beliefs | Distrust of government and the health care system |
Difficult to communicate importance of indirect protection (i.e., being vaccinated to protect others) | ||
Misinformation (e.g., about contraindications, adverse events) | ||
Increase motivation | Need for yearly revaccination | Immunization is low in priority among other health care issues |
Educate target population | High cost of mass education | Difficult to locate and/or engage target population |
Low educational level | ||
Language barriers | ||
At the provider level | ||
Improve vaccination practices and attitudes | Non-uniform vaccination recommendations | Difficulty in record keeping |
Legal/regulatory barriers to standing orders | ||
Track and follow-up with patients | Lack of provider motivation | Lack of provider motivation |
Poor record keeping | Not easily accessible | |
Broaden the provider base | Legal/regulatory barriers | |
Provide appropriate financial incentives | Limited reimbursement for adults | |
At the structural level | ||
Coordinate with vaccine manufacturers | Balancing vaccine supply and demand | |
Inadequate communication from vaccine suppliers | ||
Change social or professional norms | Unclear lines of responsibility for adult vaccination | |
Preventive care not the norm; lack of provider advocacy | ||
Mount community-based vaccination programs | Liability issues | Lack of coverage |
Coordination of bordering jurisdictions | Critical timing relative to influenza season | |
Provide convenient access | May shift people away from more comprehensive sources of care | Homelessness, transient (migrant) |
Homebound (immobile) | ||
Incarcerated | ||
Difficult to locate target populations | ||
Understand the dynamics of disease spread | People at direct risk may not be the most important reservoirs |
aChallenges outlined for the general population are not meant to be fully comprehensive and may also be applicable to HTR populations.