Abstract
Objective: To compare students who were immunized or not immunized during the 1997 Simon Fraser University measles outbreak in British Columbia.
Methods: Descriptive comparative study using the Health Belief Model as a theoretical framework. A self-administered questionnaire was mailed to a stratified random sample of 400 immunized and 400 non-immunized SFU students.
Results: Perceived susceptibility, severity, barriers, cues to action, threat and student age were significantly related to being immunized. Logistic regression analysis achieved an overall correct prediction rate of 84.7% by including the contribution of the four variables of susceptibility, barriers, cues to action, and health motivation. Content analysis of the non-immunized students’ descriptions of what it would have taken for them to be immunized indicated the influence of these four variables.
Discussion: The Immunization Health Belief Model Scale is a valuable tool for ascertaining attitudes and beliefs relating to immunization decision-making. Interventions targeted to significant beliefs may increase immunization coverage levels and result in improved disease prevention.
Résumé
Objectif: Comparer les données d’étudiants vaccinés et non vaccinés durant l’éclosion de rougeole à la Simon Fraser University (Colombie-Britannique) en 1997.
Méthode: Étude descriptive comparative prenant pour cadre théorique le modèle de croyance à la santé. Un questionnaire à remplir soi-même a été posté à un échantillon aléatoire stratifié de 400 étudiants vaccinés et de 400 étudiants non vaccinés de la SFU.
Résultats: La prédisposition subjective, la gravité, les obstacles, les facteurs poussant à l’action, la menace et l’âge de l’étudiant(e) présentaient des liens significatifs avec le fait d’être vacciné. Par analyse de régression logistique, nous avons obtenu un taux de prédictions exactes de 84,7 % dans l’ensemble, en incluant l’action de quatre variables: la prédisposition, les obstacles, les facteurs poussant à l’action et la motivation liée à la santé. L’analyse du contenu des descriptions des étudiants non vaccinés sur ce qu’il aurait fallu pour les convaincre de se faire vacciner confirme l’influence de ces quatre variables.
Discussion: L’échelle fondée sur le modèle de croyance à la santé est un outil précieux pour établir avec précision les attitudes et les convictions liées à la décision de se faire vacciner ou non. Les interventions axées sur les convictions ancrées pourraient accroître les niveaux de couverture vaccinale et améliorer la prévention des maladies.
References
- 1.National Advisory Committee on Immunization. Consensus conference on measles. Can Commun Dis Rep. 1993;19-10:72–79. [PubMed] [Google Scholar]
- 2.Pennie RA, O’Connor AM, Garvock MJ, Drake ER. Factors influencing the acceptance of hepatitis B vaccine by students in health disciplines in Ottawa. Can J Public Health. 1991;82:12–15. [PubMed] [Google Scholar]
- 3.Weingarten S, Riedinger M, Bolton L, Miles P, Ault M. Barriers to influenza acceptance. A survey of physicians and nurses. Am J Infect Control. 1989;17(4):202–7. doi: 10.1016/0196-6553(89)90129-6. [DOI] [PubMed] [Google Scholar]
- 4.Centers for Disease Control. Adult immunization: Knowledge, attitudes and practices — DeKalb and Fulton counties, Georgia. MMWR. 1988;37:657–61. [PubMed] [Google Scholar]
- 5.Montano DE. Predicting and understanding influenza vaccination behaviour. Alternatives to the health belief model. Med Care. 1986;24(5):438–53. doi: 10.1097/00005650-198605000-00007. [DOI] [PubMed] [Google Scholar]
- 6.Bennett P, Smith C. Parents’ attitudinal and social influences on childhood vaccination. Health Educ Res. 1992;7/3:341–48. doi: 10.1093/her/7.3.341. [DOI] [PubMed] [Google Scholar]
- 7.Li J, Taylor B. Factors affecting uptake of measles, mumps, and rubella immunization. Br Med J. 1993;307:168–71. doi: 10.1136/bmj.307.6897.168. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Rosenstock IM. The health belief model and preventive health behavior. Health Educ Monogr. 1974;2:354–86. doi: 10.1177/109019817400200405. [DOI] [Google Scholar]
- 9.Becker MH. The health belief model and personal health behavior. Health Educ Monogr. 1974;2:324–473. doi: 10.1177/109019817400200401. [DOI] [Google Scholar]
- 10.Janz NK, Becker MH. The health belief model: A decade later. Health Educ Q. 1984;11:1–47. doi: 10.1177/109019818401100101. [DOI] [PubMed] [Google Scholar]
- 11.Cummings KM, Jette AM, Brock BM, Haefner DP. Psychosocial determinants of immunization behavior in a swine influenza campaign. Med Care. 1979;17(6):639–49. doi: 10.1097/00005650-197906000-00008. [DOI] [PubMed] [Google Scholar]
- 12.Feigelman S, Stanton B, Rubin JD, Cartelli NA. Effectiveness of family notification efforts and compliance with measles post-exposure prophylaxis. J Community Health. 1993;18:83–93. doi: 10.1007/BF01324417. [DOI] [PubMed] [Google Scholar]
- 13.Maiman LA, Becker MH, Kirscht JP, Haefner DP, Drachman RH. Scales for measuring health belief model dimensions: A test of predictive value, internal consistency, and relationships among beliefs. Health Educ Monogr. 1977;5:215–30. doi: 10.1177/109019817700500303. [DOI] [PubMed] [Google Scholar]
- 14.Rao M, Wilkinson J, Millar M, Richards G. Measles vaccination in primary schools. The Colchester project. Public Health. 1988;102(5):477–83. doi: 10.1016/S0033-3506(88)80086-6. [DOI] [PubMed] [Google Scholar]
- 15.Roberts RJ, Sandifer QD, Evans MR, Nolan-Farrell MZ, Davis PM. Reasons for non-uptake of measles, mumps, and rubella catch-up immunization in a measles epidemic and side effects of the vaccine. Br Med J. 1995;310:1629–32. doi: 10.1136/bmj.310.6995.1629. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Sass J, Bertolone K, Denton D, Logsdon MC. Exposure to blood and body fluid. Factors associated with non-compliance in follow-up HIV testing among health care workers. AAOHN J. 1995;43:507–13. doi: 10.1177/216507999504301004. [DOI] [PubMed] [Google Scholar]
- 17.Zimmerman RK, Ahwesh ER, Mieczkowski TA, Block B, Janosky JE, Barker DW. Influence of family functioning and income on vaccination in inner-city health centers. Arch Pediatr Adolesc Med. 1996;150:1054–61. doi: 10.1001/archpedi.1996.02170350056010. [DOI] [PubMed] [Google Scholar]
- 18.Lwanga SK, Lemeshow S. Sample Size Determination in Health Studies: A Practical Manual. Geneva: World Health Organization; 1991. [Google Scholar]
- 19.Champion VL. Instrument refinement for breast cancer screening behaviours. Nurs Res. 1993;42:139–42. doi: 10.1097/00006199-199305000-00003. [DOI] [PubMed] [Google Scholar]
- 20.Simon Fraser University Student Services and Registrar. SFU Fact Book 1997. Available on-line at: http://www.sfu.ca:80/analytical-studies/FactBook/d-student/sectd.html
- 21.Kerlinger FN. Foundations of Behavioral Research. 3rd ed. New York, NY: Holt, Rinehart and Winston; 1986. [Google Scholar]