Background
Yearly bouts of seasonal influenza and even pandemic influenza strains can be fairly different in how quickly and pervasively they spread, the severity of illness they cause, and the groups of people most at risk of infection. Consequently, the general public may experience confusion about who is at risk for influenza from year to year, making demand for vaccine unpredictable.
Specific issues
- Community variation. Needs, attitudes, beliefs, and behaviors about influenza vaccination vary from community to community and may change over time. As a result, vaccination campaigns may be effective one year and ineffective for a different strain of flu or different community circumstances.
- Lack of comprehensive assessment. Currently, public health agencies do not have a way to comprehensively assess and evaluate community opinions and behaviors related to influenza vaccination.
The practice
The San Francisco Bay Area Advanced Practice Center created a toolkit to help local health agencies conduct yearly survey, assessment, and implementation activities related to flu vaccination within their communities.
The Seasonal and Pandemic Influenza Vaccination Assessment Toolkit provides an array of information that allows users to measure vaccination rates in specific subpopulations, identify how to communicate vaccination clinic information, provide insight into how to reach at-risk populations, and gather feedback from community members to improve planning.
The toolkit provides materials and training for local health agencies to determine their communities' behavior and beliefs each year during influenza seasons. The goal of these annual assessments is to give agencies the dynamic information they need to educate the public and tailor clinic services to best meet demand for vaccine. A secondary, but no less important, goal is to better understand the community factors that inform vaccine uptake in preparation for a pandemic or other infectious disease emergency.
The toolkit highlights tools needed for three methods for community assessment – key informant interviews, focus groups, and community-based surveys – in the following topics and sections:
- An orientation to how community assessment methods can serve the goal of emergency preparedness
- An overview of how key informant interviews and focus groups can inform successful community assessments
- A step-by-step survey guide for designing and conducting effective vaccination surveys
- Lists and descriptions of online tools and resources that may assist with data collection and analysis, such as publicly available community health and census data, online survey tools, relational database software, Epi Info software, and EpiData Open Source software
- Examples of successful community assessments that demonstrate how counties have implemented assessments in their jurisdictions
- Guidance on how to use key informant interviews, focus groups, and surveys specifically to inform vaccination campaigns and increase vaccine uptake
- Training in the use of community assessment techniques to evaluate outcomes. Instruction on how to create and tailor a survey is particularly thorough and includes guidance on defining goals, selecting an appropriate design, designing a sampling method, creating a questionnaire, pretesting the survey, and communicating relevant findings.
- Strategies to improve communication to populations that may be traditionally hard to reach through techniques such as meeting with community leaders, identifying potential new clinic sites, integrating interpreters and translators in vaccination outreach efforts, managing crowds, collecting data, and promoting health-related causes and activities
- Ways to assure that the data can be used quickly and effectively to identify trends in vaccine beliefs and uptake
- Approaches to managing resources and a variety of personnel, such as Community Emergency Response Teams (CERTs), Medical Reserve Corps (MRC) volunteers, health sciences students, community-based organizations, and outreach workers
- Multi-media methods for training, including videos on conducting key informant interviews, focus groups, and surveys
Toolkit appendices provide tools and examples, while illustrating how community assessments have been used to inform several local vaccination campaigns. Appendices provide resources such as:
- A focus group guide used in Alameda County, California, to better understand health workers' attitudes and behaviors related to influenza vaccination
- A bank of potential survey questions in English and Spanish
- A survey used in Broome County, New York, to assess the public's satisfaction with the health agency's H1N1 response
- A sample job action sheet for a vaccination clinic worker who might administer surveys to clinic visitors
What made this practice possible?
- Funding from the National Association of County and City Health Officials (NACCHO) in collaboration with CDC
- Development and testing by the San Francisco Bay Area Advanced Practice Center, a partnership between the San Francisco Department of Public Health and the University of California Berkeley Center for Infectious Diseases and Emergency Readiness
- Alignment with federal and state guidance on implementing mass vaccination campaigns
- An incremental approach to integrating community assessment methods into public health programs as a way to improve vaccine uptake over time
- A focus on developing tools and guidance that were shaped by local health agencies' experiences with the strong demand for influenza vaccine and a heightened rate of agency response during H1N1
Results
- Community assessments have benefits for assessing beliefs, behaviors, and needs in communities that may be generally difficult to reach. They also inform planning, marketing, and risk communication efforts for seasonal and pandemic influenza.
- The toolkit fosters relationships with local clinics, private providers, and community-based organizations by integrating assessment methods and data into current and future vaccination practices.