D1.3 - Segmentation & Communication Needs of Target Groups

The knowledge of those factors that influence different segments of population in adopting protective behaviours towards influenza are essential to plan effective strategy.
This report consider three aspects:

• the compliance with vaccination against seasonal influenza;
• the compliance with non‐pharmacological interventions to prevent the spread of influenza;
• the relationships between communication and compliance.

Compliance with influenza vaccination and factors affecting the compliance Introduction

Historically, compliance with vaccination against seasonal influenza has been extremely variable. In the first part of this report, we reviewed the literature on the compliance of healthcare workers, the elderly, the chronically ill, pregnant women and the paediatric population with vaccination against influenza, in order to identify the main factors affecting compliance.

Healthcare workers. Compliance among healthcare professionals varied from very low (less than 10%) to around 40‐50% and no clear pattern can be distinguished. In general, compliance in the US tends to be higher than in other countries. Factors that may affect compliance include the desire for self‐protection, the desire to avoid infecting patients and family members, the perceived safety and efficacy of the vaccine, the perception of the seriousness of the diseases and the associated risk, access to vaccine and its cost, and the that the vaccine itself could cause disease.

Elderly. In the United States, since 1973, there has been a constant increase in the compliance rates to influenza vaccination. The main factors effecting compliance rates with influenza vaccines among the elderly in both Europe and the US is the number of visits the person pays to a physician during the year. Major reasons for non‐compliance with influenza vaccination among the elderly include disbelief of this group in the efficiency and safety of the vaccine and fear of side‐effect or influenza resulting from the vaccine

Chronically ill. Compliance rates of the chronically ill with influenza vaccine in the US have been increasing over the years. On the contrary, in Europe are relatively low. Most of the factors effecting the compliance with influenza vaccinations are identical to those effecting compliance among the healthy elderly population.
Pregnant women. Pregnant women tend to comply better with the seasonal influenza vaccine than with the pandemic vaccine. The main reasons for them not to receive the influenza vaccination were the lack of knowledge about the importance of the vaccine and where to get it, concerns for effects of the vaccine on foetal and maternal health, and their health care provider recommendation.

Children. Factors found to have a positive effect on vaccination rates of children include the child’s influenza vaccination in the previous year, the child’s receipt of all recommended immunizations, the child’s uninterrupted health insurance coverage, and the mother’s unmarried status. Factors that were found to have a negative effect on vaccination rates of children include using a family doctor rather than a paediatrician for well‐child visits, parents belief that the vaccine was unneeded or that their child was getting too many shots, and parents having a hard time obtaining the vaccine

Efficacy of and compliance with non‐pharmacological interventions

A number of non‐pharmacological interventions (NPIs) are recommended both for primary prevention of influenza and as a complement to vaccination to prevent the spread of the disease. In the second part of this report, the authors reviewed the literature for evidence on the efficacy of NPI’s to prevent the spread of influenza in different target groups, the compliance with NPI’s and the factors affecting the compliance.

Key elements of the analysis are the real and perceived efficacy of the interventions, since most of them are perceived more as a benefit for the society than for an individual. In general, only a few of the non‐pharmacological methods have been systematically evaluated. Other than for healthcare workers, very few focus specifically on target groups.
The most prominent interventions that have been evaluated are hand‐washing and the use of face‐masks.

In case‐control studies, hand washing and wearing face masks appear to reduce the spread of influenza. In some randomised trials, there is evidence that hygienic measures in younger children can reduce the spread in households. There is no good evidence that global measures such as screening at entry ports are effective. Evidence is limited for social distancing being effective.

In trials of the efficacy of face masks in the general population in reducing the spread of influenza, there is no clear evidence of a reduction of influenza in the face masks groups. Factors independently associated with the adoption of the preventive measures include education, perceived susceptibility to infection, perceived effectiveness of the measures and perceived usefulness of the information available. Trust in medical organizations is a factor that may affect the perceived efficacy of officially recommended protection measures.

Communication and compliance

During a disease outbreak, media plays a key role in moving the public to action. In the third part of this report, we reviewed the literature for the roles played by the media during infectious disease crises. To this end, a systematic review of English‐language studies from 1974 to 2012 has been carried out. It yielded 118 articles that fulfilled the established criteria.

Most of the studies in the literature are summative evaluation studies aimed at "explaining" and analysing the barriers that explain non‐compliance. Furthermore, few of the existing studies in the literature provide deep analysis of the contents and rhetorical strategies that characterize the way the media covers epidemics for the public. The literature clearly indicates a gap between models and theories of risk communication during crises, and the failure of governments and organizations to utilize them.

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D1.3 - Segmentation & Communication Needs of Target Groups