Understandings of influenza and promoting influenza vaccination among high-risk urban dwelling ...

358 Pages·2013·13.52 MB·English

Understandings of influenza and promoting influenza vaccination
among high-risk urban dwelling Thai adults
Yupares Payaprom
Thesis submitted in fulfilment of the requirements for the degree of
Doctor of Philosophy, 2011.
Cardiff University
School of Nursing and Midwifery Studies
UMI Number: U567269
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This thesis is dedicated to my parents, who instilled in me the value and
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iii
Acknowledgements
This thesis has been made possible through the support of many people. I would like
to take this opportunity to convey my gratitude and appreciation to the following
individuals and organisations for their invaluable contribution and support.
My deep gratitude to Prof. Paul Bennett, I truly appreciate his patience and tireless
supervision through the years of my study. He has a unique way of guiding me through
various stages in conducting research. His teaching style is relaxed, yet efficient and
informative. He was the first person to introduce me to “health psychology”. I have
learnt a lot of interesting things under his supervision. Paul, I am so grateful for your
unflinching encouragement and support that really help me get through the ups and
downs of my PhD journey, and I hope this research will be the start of our future
collaborations.
I am greatly indebted to Dr. Erica Alabaster for her guidance and advice during my
years of study; spending time to read my thesis chapters thoroughly and providing me
with excellent feedback and comments. Above of all, she provided great support and
encouragement in many ways, especially during the final stage of my PhD study.
Dr. Katie Featherstone provided me invaluable advice and constructive comments
on my qualitative study. And she helped make my fieldwork in Thailand possible.
Thank you Dr. Katie, I am indebted to you. I also sincerely appreciate for all
of the hard work you have done for us (PhD students).
I am grateful to Prof. Philip Bumard for his generous supervision during my first year
study. He also spent his precious time for discussion with me about my first fieldwork
during his stay in Bangkok; providing guidance for my qualitative data collection and
analysis. My warmest appreciation goes to him.
For my fieldwork, I wish to thank the health authorities (Chiang Rai Provincial Health
Office and Chiang Rai hospital) and the staff of health centres for their approval and
coordination in implementing my research project. I extend my thanks to Dr. Sanga
Intajak who gave me the generous support during my fieldwork, and my special thanks
to all the study participants for their kind participation and contribution to my research
study.
Most importantly, this thesis would not have been completed without support,
encouragement and patience of my family. My warmest gratitude goes to my mum,
brother and sister. Also, my special thanks go in particular to Dr. Manus Potapom,
Dr. Hutsaya Tantipong, Ms. Kanokpan Pancharoen for their kind help and great support
during my fieldwork as well as for their long-distance friends.
Finally, I would like to acknowledge the support from the Royal Thai Government
for scholarship grant for my PhD study, and I wish to extend acknowledgement to the
School of Nursing & Midwifery Studies, Cardiff University for partial financial support
for my fieldwork in Chiang Rai province, Thailand.
v
Abstract
The 2004 outbreak of influenza A H5N1 and the WHO’s recommendation for a
national influenza pandemic plan has led the Thai Ministry of Public Health to develop
an influenza vaccination programme for high-risk adults. One approach adopted by this
programme has focus on implementing influenza vaccination in people with chronic
medical conditions. However, influenza vaccination uptake rate among this high-risk
group was relatively low, particularly in Chiang Rai province. Accordingly, the main
objectives of this research were two-fold. This first objective was to explore beliefs
about influenza and influenza vaccination, and the social influences on decisions
whether or not to accept the influenza vaccination in a sample of urban-dwelling Thai
adults. To reach this objective, a qualitative research approach was adopted. The second
objective was to test the effect of a Health Action Process Approach (HAPA) based
leaflet and action planning intervention on influenza vaccination behaviours among
these high-risk individuals and to evaluate the impact of a HAPA-based leaflet on
potential mediators of behavioural change. A controlled before and after trial was
performed to evaluate the intervention effects. As the HAPA model was used as a
conceptual framework for study two; the model’s predictive utility was, thus, also
examined. The results of the first study supported the development of the leaflet used
in study 2.
A qualitative study using in-depth interviews was carried out with 20 high-risk
individuals who were either (i) aged 65 and over, or (ii) under 65 years with chronic
diseases that had clinical indications requiring influenza vaccination. Findings indicate
that most participants had insufficient knowledge about influenza and influenza
vaccination. Their decisions whether or not to get vaccinated against influenza were
based on a number of factors, including salience of risk, influence of others, perception
of the need for preventive health care, and the availability of influenza vaccine. These
findings underscore the need to consider and understand factors underlying people’s
vaccination decisions to create an effective influenza vaccination programme.
Subsequently, a controlled before and after trial was conducted to compare the effects of
a theory-based educational leaflet and action planning intervention with a standard
government information leaflet on influenza vaccination behaviours among high-risk
urban dwelling Thai adults. Participants in the intervention group (n = 99) received a
leaflet based on the HAPA and asking them to form an action planning as to where, when
and how they would seek vaccination. Those in the comparison condition (n = 102)
received a standard government information leaflet. The intervention had positive effects
in changing risk perceptions, outcome expectancies, self-efficacy, and intention relative
to the comparison condition. Stronger intentions to become vaccinated against influenza
in the intervention group than the comparison group were explained by change in
outcome expectancies and self-efficacy for arranging time and transportation. No
significant difference in vaccination rates was observed between two groups. Influenza
vaccination was predicted by self-efficacy and intention. A theory-based educational
leaflet may be a useful tool to increase individual’s vaccination intention, but larger trials
are required to confirm these findings and to examine further the impact of similar
interventions on influenza vaccination rates.
Publications
This thesis contains findings that have been presented in the following publications.
1. Payaprom, Y., Bennett, P., Bumard, P., Alabaster, E., & Tantipong, H. (2010).
Understandings of influenza and influenza vaccination among high-risk urban
dwelling Thai adults: a qualitative study. Journal of Public Health, 32 (1), pp.
26-31. doi: 10.1093/pubmed/fdp086 First published online: August 25, 2009
2. Payaprom, Y., Bennett, P., Alabaster, E., & Tantipong, H. (2011, May 2). Using
the Health Action Process Approach and Implementation Intentions to Increase
Flu Vaccine Uptake in High Risk Thai Individuals: A Controlled Before-After
Trial. Health Psychology. Advance online publication, doi: 10.1037/a0023580
ABBREVIATIONS
ANCOVA-Analysis of Covariance
AE-COPD-Acute Exacerbation of Chronic Obstructive Pulmonary Disease
BSE-Breast Self-Examination
CDC-Centers for Disease Control and Prevention
Cl-Confidence interval
COPD-Chronic Obstructive Pulmonary Disease
C&R-Circulatory and Respiratory
CSF-Cerebrospinal fluid
DFA-Direct Fluorescent Antibody test
ELISA-Enzyme-Linked Immunosorbent Assay
GBS-Guillain-Barre syndrome
GP-General Practitioner
HA- Haemagglutinin
HAI-Haemagglutination-inhibiting antibody
HAPA- Health Action Process Approach
HBM-Health Belief Model
HEF-Haemagglutinin-esterase-fusion
ICU-Intensive Care Unit
IFA-Immunofluorescent Antibody
IFN-a-Interferon-alpha
IL-6-Interleukin-6
IQR-Interquartile range
LAIV-Live, Attenuated Influenza Vaccine
M1 -Matrix protein 1
MAART-Medically Attended Acute Respiratory Illness
MANOVA-Multivariate Analysis of Variance
MAP-Model of Action Phase
NA- Neuraminidase
NI-Neuraminidase inhibiting
NS2- Non-structural protein
OR-Odds Raito