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Rachael Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare Executive, and Medical Economics.
Telling stories about people like them, or reminding them of a previous illness may be the best thing physicians can do to nudge patients toward flu shots.
For a variety of reasons, there are just some individuals who refuse to get flu shots. That decision, however, can be dangerous and costly.
New research using principles of psychology and economics reveals why some patients continue to refuse to be vaccinated for influenza, and how physicians might be able to change their minds.
Every year, about 5% to 20% of Americans get the flu, resulting in more than 200,000 hospitalizations, thousands of deaths, and a cost of more than $80 billion, according to the report. Although efficacy of flu vaccines varies from year to year, the Centers for Disease Control and Prevention (CDC) says the vaccine typically reduces infection by about 60% when there is a good match between the virus strains in the vaccine and those circulating in a particular flu season.
Most physicians have probably heard the top excuses for refusing the flu shot-people believe the vaccine will make them get the flu. Some think it just doesn’t work. Others believe that they are so unlikely to get the flu that the shot is pointless. There are also individuals who have problems with access or cost.
Frederick Chen, associate professor of economics at Wake Forest University an co-author of the new study, told Medical Economics these misconceptions people have about the costs and benefits of flu shots are the very reason for low vaccination rates. The traditional method of handing patients a pamphlet to read in hopes it will change their mind won’t help, according to researchers.
“Simply giving people information about vaccines is not effective and can actually lead to greater distrust of vaccines. People do not take in new information and come to a better conclusion,” Chen said. “Instead, recognizing that people’s situations and understanding of flu shots can differ widely, we recommend methods that humanize the issue and employ a more personal, concrete approach.”
In order to clarify these misconceptions, Chen had this advice for physicians.
“Based on the latest research in the behavioral sciences, we believe that adopting a more personal and humanistic approach that makes it easier for people to relate to the flu and its consequences would help increase vaccination rate,” Chen said.
Rather than describing the benefit of flu shots with statistics or other numeric terms, he said physicians should “put a face on” the issue, and convey the importance of vaccination with stories about real individuals in the target population. Caregivers may also find success by having patients recall their own previous experiences with flu. Many people are overly optimistic about their chances of not getting sick, Chen added, and they may need a reminder of when they found themselves ill
“Because people often consider themselves to be above average in many domains of life-and thus may think they are less susceptible to illnesses and diseases-it may be helpful to prompt them to think about their previous experiences with the flu or the experiences of those they are close to,” Chen said. “Even relatively simple steps such as helping people plan more concretely when they will get a flu shot have been shown to be effective in raising the vaccination rate.”
People are also more likely to remember stories about bad things happening over the good-like the one person they know who got sick after receiving the flu shot compared to many more that did not.
Chen and his team refer to this as the “availability heuristic,” which means that people place more emphasis on negative factors when weighing the risks of a decision.
“We see when the vaccine fails to protect us; but when the vaccine does work, we do not see anything different from our normal state of being. Thus, negative experiences with the flu shot-either one’s own or those of friends, family members or colleagues-should be more salient and memorable than the positive experiences, which, by the availability heuristic, could cause us to overestimate the failure rate of flu shots,” the report states.
On a similar note, when guidance is framed using principles of loss aversion rather than risk reduction, people respond better, according to the report.
The researchers point to a personal experience with an automated flu shot reminder in the report as an example. When comparing a risk reduction technique-suggesting that the flu shot will reduce the chance of getting the flu by 80%- to a loss aversion technique-suggesting that not getting the flu shot increases the risk of getting the flu by 400%-the latter is most effective.
“From the economist’s perspective, people’s decision to get vaccinated or not ultimately comes down to some sort of cost-benefit analysis: an individual would choose to be vaccinated if the (perceived) benefit of vaccination outweighs its (perceived) cost; and if the cost outstrips the benefit, then an individual would choose not to get a flu shot,” the team notes in its report.