Promoting Adult Immunizations in Minority Communities Lessons Learned from One Year of Technical Assistance to the READII Pilot Sites Jim Bender, Joan Clayton-Davis Academy for Educational Development

Immunization Infrastructure in Communities Existing immunization infrastructure built around childhood immunization. Adult issue “bolted on” Funding streams Health department Community coalitions Providers

Building on Childhood Immunization Successes: Overview Differences At consumer level At provider level In the Community Coalition For the Health Department Ramifications for adapting childhood programs to promote adult immunizations

Childhood Immunizations: Consumer Perspective Childhood immunization an “opt-out” decision for consumers Immuz. accepted part of well-child visits Strong systems in place School requirement Decision maker (parent) for childhood immunization suffers lower cost No needle for parent Low perceived risk of adverse effects Possible to find a free shot Easy access

Adult Immunizations: Consumer Perspective Doctor recommendation may not occur Lower perceived need for immunization Higher perceived risk from immunization Vaccine availability problems (shortages and location) Immunization may not be available at all in office Limited window of time to get vaccine

Ramifications: Consumer Interventions Childhood (via parent) Goal is to PREVENT action (opt out/refuse shot offered) Communication to consumers relatively unimportant Adult Goal is to PROMOTE consumer action (ask for shot) Communication to consumers necessary (even if through providers) Much work needed to overcome barriers, promote benefits

Childhood Interventions: Provider Perspective Child visits more likely to focus on prevention Strong positive incentives to promote childhood immunizations Vaccine supply dependable Well-child visits generate revenue Established and strong systems in place Decision maker (parent) not likely to question vaccine recommendation

Adult Immunization: Provider Perspective Adults present with acute or chronic issues: focus is on treatment Disincentives to promote adult immunizations Supply interruptions. Short shelf life of flu vaccine Immunizations not perceived to be money maker Consumer resistance (perceived and real) Significant resistance in administrative systems--at multiple levels--to adult immunization

Ramifications: Provider Interventions Significant work needed to overcome disincentives and inertia Outreach to doctors for access Collaboration with allied health professionals to customize interventions to practice Environmental changes which would support changes to provider practices Vaccine purchase cooperatives Partnerships with professional organizations Forge links with mass immunizers

Childhood partnerships Adult partnerships Working with Community Coalitions and Local Health Departments: First Year Findings Childhood partnerships formed to meet needs of childhood programs know the agenda, know what to do individual partners know their role members have vested interest in success Adult partnerships new and/or weak by comparison lead organizations struggle to find right mix of partners struggle to develop mission and establish systems members believe in issue; yet less willing to commit resources

Recommendations Health departments and coalitions need time and support to Assess their community’s resources Develop new ways of approaching health issue Plan strategically Organize their community Tie immunization to what is already going on in the community Learn how to transfer successes from child programs to adult programs

Recommendations Help coalitions to understand how cultural issues affect their program Health disparities Rumors and misconceptions Suspicion of health system Help coalitions understand and communicate effectively with seniors

Recommendations More research on effective communication to providers More research on effective patient/ provider communication Examine and document the makeup of successful coalitions how pilot sites successfully develop and maintain partnerships how pilot sites bring providers on board and successfully use them