Pneumococcal Vaccination Q&A With Kenzie A Cameron, PhD, MPH

Each year, approximately 18,000 older Americans die from pneumococcal disease, which can cause pneumonia, meningitis, and bloodstream infections. Some of those deaths could be avoided by increasing pneumococcal vaccination rates among patients 65 years and older because, according to the latest data, only 61% of older adults receive the recommended pneumococcal vaccination.

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Dr. Kenzie A. Cameron, of Northwestern University Feinberg School of Medicine in Chicago, recently helped develop a 2-minute educational video designed to inform elderly patients about the importance of pneumococcal vaccination. Northwestern Memorial Hospital sent the video through online portals to 116 patients over a 6-month period. The 90% of patients who watched at least part of the video were 3 times more likely to receive the vaccine. Dr. Cameron recently spoke about the new way to educate patients about preventative care and how the video can increase pneumococcal vaccination coverage among the elderly, who often don’t fully grasp the importance of protecting themselves against the potentially deadly disease.

What was the ultimate goal of producing the video?

We wanted to give patients information about the pneumococcal vaccine before they saw primary care physicians, so they would have some knowledge about the importance of vaccination before being offered the shot. It’s critical that adults who are newly eligible for vaccination receive accurate information. Preconceived notions about vaccinations and incomplete information may cause individuals to initially refuse the shot. Once patients refuse the shot, healthcare providers are put in the position of changing someone’s response as opposed to shaping an initial response. That’s much more difficult to do.

Why did some patients not want to be vaccinated?

Patients who refused vaccination might not have perceived themselves to be susceptible to pneumonia. They certainly understood the severity of the disease — they understood that it could kill them — but believed they already did a good enough job of taking care of themselves to prevent infection by regularly washing their hands, staying away from sick people, and bundling up in the cold. We also saw a difference in their perceptions about the importance of childhood versus adult vaccination, so we wanted to educate individuals about the importance of vaccination across the lifespan.

How did you know what issues to focus on in the video?

The overall message of the video was developed by first surveying patients to find out the specific concerns they had about vaccination and why they refused the shots. There are concerns that the influenza vaccine causes the flu, which is not true, but we didn’t hear the same concerns about the pneumonia shot. Some individuals did express a general fear of vaccination, because they have the perception that the form of the virus being injected is as dangerous as the disease itself.

Does the video allay concerns about vaccination in ways physicians can’t?

The video isn’t necessarily more effective than discussions patients have with physicians — we believe the information in the video can augment that conversation. Patients seemed to respond to the video because it showed how quickly pneumococcal disease can spread throughout a community and that everyone, particularly older individuals, is at risk of infection. One of our former patients shared a story about his wife, who took great care of herself but still died from pneumonia. It was a very powerful message that resonated with people who also try to do everything right to prevent infection. They heard their experiences in his words.

What can be done to improve vaccination coverage among older patients who don’t have access to an educational video?

Ensure that patients receive information about the pneumococcal vaccine before they’re asked if they want it, because some patients simply might not feel like getting a shot on the day they’re being treated for other health issues. Having an understanding of why the vaccine is needed might reduce knee-jerk refusals. Acknowledge that patients are trying to take care of themselves with preventive behaviors. Encourage those behaviors, but also inform them that the vaccine can help in those efforts. Recognize that older adults are more susceptible to dying from pneumonia. That message is out there, but it needs to be reinforced. It’s not that we’re trying to simply prevent pneumonia; we’re trying to prevent patients from dying from it. A lot of older individuals might have a very positive message about vaccines for their grandchildren, and they also need to realize that vaccination is important and needed at different points throughout life.