Article Title

System Alignment for VaccinE Delivery (SAVED): Qualitative Interviews Inform a Technology-Based Intervention to Improve Influenza and Pneumococcal Vaccination Rates

Publication Date



flu vaccine, qualitative


Background/Aims: Influenza and pneumococcal vaccines are beneficial but underutilized. Patient interviews may help identify effective outreach strategies and increase vaccination rates.

Methods: We conducted in-depth qualitative interviews with a purposive sample of adults whose primary care physicians were part of a large multispecialty group practice in central Massachusetts. Interviews occurred between April and October 2014, with individuals who were not up to date on either influenza or pneumococcal vaccines. The goal of the interviews was to: (a) understand barriers to influenza and pneumococcal vaccination, and (b) inform development of provider educational materials and patient outreach materials.

Results: We interviewed 14 people, 57% under age 65 (8 out of 14); 64% female (9 out of 14) (additional interviews are in process). Major themes included trust, influence of family and friends, and impact of vaccination choice on others. Many participants trusted their doctor’s recommendations but did not trust vaccine safety and efficacy. In some cases, the safety of influenza vaccines was compared unfavorably with other vaccines because “they make it up fresh each year” as compared to a vaccine where “it has been given for years.” The majority of participants cited relationships of family, friends or coworkers as influencing their own vaccination decision. While some participants cited concern for others’ health as a reason to get vaccinated (“it’s not fair if you get sick and spread it to everybody else”), others voiced concerns that care-giving responsibilities could be compromised if the vaccine induced illness. Several participants had not previously heard of the pneumococcal vaccine. Preferred modes of information on vaccination included verbal and electronic; hard-copy handouts were preferred by slightly fewer patients. When asked about effective messaging, some responded unfavorably to message components perceived to be condescending or intrusive (“our records indicate that you haven’t yet gotten this vaccine”).

Discussion: We identified several potential barriers to vaccination for patients who were not up to date with influenza or pneumococcal vaccination. Based on these findings, we are developing patient messages that include references to protecting the health of friends and family but which minimize language implying that the sender has been monitoring vaccination behavior.