1. 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

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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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