RESEARCH
Effects of a student pharmacist consultation on patient knowledge and attitudes about vaccines Tony I-Fan Chou, David Benjamin Lash, Benjamin Malcolm, Layla Yousify, Julie Yennhi Quach, Sandy Dong, and Junhua Yu
Abstract Objective: To measure the impact of student pharmacists’ consultation on participant knowledge and attitudes about influenza and tetanus–diphtheria–acellular pertussis (Tdap) vaccines. Design: Pre- and post-consultation surveys. Setting: Free health care service and immunization clinics in Vallejo and Martinez, CA. Participants: Children and adults 13 years of age or older. Intervention: A convenience sample of participants completed a preintervention survey (PrIs) on basic vaccine knowledge and attitudes. Student pharmacists then delivered the intervention, which consisted of a 5-minute consultation on vaccines. A postintervention survey (PoIs) was administered immediately after the intervention. Main outcome measures: Cumulative scores for eight knowledge-based questions and four attitude-based questions. Results: 198 participants completed both PrIs and PoIs. Compared with the PrI scores, the PoI scores showed significant improvement in basic vaccine knowledge and attitudes toward receiving vaccinations. Participants also were more likely to view pharmacists as a source of information about vaccines after the intervention. Student pharmacists administered 109 total vaccinations during the study, including 68 influenza vaccinations and 41 Tdap vaccinations.
Received June 4, 2013, and in revised form August 5, 2013. Accepted for publication September 24, 2013. Published online in advance of print March 7, 2014. Tony I-Fan Chou, PharmD, BCPP, Assistant Professor of Pharmacy Practice, West Coast University School of Pharmacy, Los Angeles, CA. David Benjamin Lash, MPH, 2014 PharmD candidate; Benjamin Malcolm, 2014 PharmD/ MPH candidate; Layla Yousify, PharmD, Assistant Professor; Julie Yennhi Quach, 2014 PharmD/MPH candidate; Sandy Dong, 2015 PharmD candidate; Junhua Yu, MS, PhD, Assistant Professor, College of Pharmacy, Touro University California, Vallejo. Correspondence: David Benjamin Lash, MPH, College of Pharmacy, Touro University California, 1310 Club Dr., Mare Island, Vallejo, CA 94592. E-mail: [email protected] Disclosure: The authors declare no conflicts of interest or financial interests in any product or service mentioned in this article, including grants, employment, gifts, stock holdings, or honoraria. Funding: American Pharmacists Association Foundation Incentive Grants for Innovation in Immunization Practices, and California Society of Health-System Pharmacists Student Chapter Grants Program. Previous presentations: American Public Health Association Annual Meeting, San Francisco, CA, October 27–31, 2012, and California Pharmacists Association Annual Meeting, March 15–18, 2013, Monterey, CA.
Conclusion: A short, 5-minute consultation by a student pharmacist may increase vaccination rates and help serve as a vehicle to change the public’s view of vaccines as well as pharmacists and their role in primary and preventive care. Keywords: Community pharmacy services, pharmacy practice, student pharmacists, diphtheria–tetanus–acellular pertussis vaccines, health knowledge, health attitudes, influenza vaccine, disease prevention and control. J Am Pharm Assoc. 2014;54:130–137. doi: 10.1331/JAPhA.2014.13114
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P
harmacists, who are now able to immunize in all 50 states and U.S. territories, play a significant role in the delivery of immunizations. Despite the dramatic increase in immunization access provided by pharmacists, however, immunization rates for the 2010–11 influenza season were reported to be 51.0% for children aged 6 months to 17 years old and 40.5% for adults aged 18 and older.1 These rates are far below the 2010 and 2020 goals of the Centers for Disease Control and Prevention (CDC), which call for immunization of more than 80% for noninstitutionalized, non–high-risk children and adults.2 Pertussis has been on the rise nationwide recently, with a peak of 27,550 cases in 2010, the highest since 1959.3 Furthermore, in 2010, reported cases of pertussis totaled 9,156 in California, constituting a statewide epidemic that claimed the lives of 10 infants.4 This triggered the California Department of Public Health’s recommendation for all adults to receive a tetanus–diphtheria–acellular pertussis (Tdap) booster. The ongoing burdens of disease associated with influenza and rising incidence of pertussis could be greatly reduced by increased vaccination rates among
At a Glance Synopsis: A brief intervention by 17 student pharmacists at eight California health and immunization clinics had significant effects on patient knowledge and attitudes concerning vaccines and pharmacists’ patient care roles. A convenience sample of 198 adolescents and adults completed a preintervention survey, received a 5-minute consultation by student pharmacists on influenza and tetanus–diphtheria–acellular pertussis (Tdap) vaccines and pharmacists’ roles in vaccine information and delivery, and completed a postintervention survey. Results showed significant improvements in basic vaccine knowledge and attitudes and significant shifts toward viewing pharmacists as a source of information about vaccines. Student pharmacists also administered 109 total vaccinations during the study, including 68 influenza vaccinations and 41 Tdap vaccinations. Analysis: Vaccination rates for influenza have consistently been under national goals, and the recent pertussis epidemic has helped publicize the lack of proper vaccination. Several studies have shown that a pharmacist consultation improves medication adherence and outcomes, but few studies have investigated pharmacy consultations on vaccinations. This is the first study to show that a brief consultation on vaccines can improve patient knowledge and attitudes regarding vaccinations. Future studies are needed to investigate if these changes result in improved vaccination rates.
Journal of the American Pharmacists Association
RESEARCH
high-risk populations, especially those who are underserved due to lack of awareness and access to providers. This indicates a need for more potent immunization interventions in accordance with both national recommendations and local community needs. Several studies have found that noninteractive educational interventions such as pamphlets or written materials have little impact in changing patients’ knowledge or attitudes about vaccinations.5–7 A recent study showed that consultations by student pharmacists in a community setting increased patient knowledge of novel H1N1 immunization recommendations and confirmed an increasing comfort level in public perception of pharmacists as immunizers.8 These results suggest that consultation by pharmacists is effective in promoting immunization awareness, yet how much impact these interventions can have on patients’ attitudes toward common vaccinations such as influenza and Tdap is still undetermined.
Objectives The study objectives were to (1) describe knowledge and attitudes about influenza and Tdap vaccinations within the Vallejo and Martinez, CA, populations; (2) assess the impact of a student pharmacist–delivered consultation on patient knowledge of the benefits of immunizations, as well as specific CDC recommendations for influenza and pertussis; and (3) assess the impact of a student pharmacist–delivered consultation on patient attitudes about receiving vaccinations and recommending vaccinations to others.
Methods This study was approved by the Institutional Review Board at Touro University California. Survey development and implementation A preintervention survey (PrI) and postintervention survey (PoI) were designed to assess immediate changes in immunization knowledge of current influenza and pertussis immunization recommendations, attitudes regarding receipt and recommendation of immunizations, and patient demographics. Knowledge-based immunization questions were developed from educational CDC materials, including influenza and Tdap Vaccine Information Statements. The intervention focused on the benefits of vaccines, including disease prevention; dispelling common vaccination myths, such as that vaccinations cause disease or autism; and general administration information and scheduling. Attitude-based immunization questions were adapted from previous studies.9,10 Intervention consultation points were designed to address each question or piece of immunization knowledge. Data from the PrIs served as baseline for comparison with the PoIs. Surveys were piloted for readability, clarity, and length at the Touro University Student-Run j apha.org
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Free Clinic (SRFC), a planned site of survey administration, to ensure appropriateness for the study’s sample population. Direct feedback from pilot participants was incorporated into the final version of the surveys. No patient identifiers were collected during the administration of the survey.
and PoIs) was 10–15 minutes. Participants had the opportunity to ask questions during and after the consultation. Student pharmacists spoke an estimated 75% of the time. No written materials or other forms of multimedia were given to patients. Patient-specific recommendations were not a structured part of the intervention.
Student pharmacist recruitment and training Three student pharmacists were directly involved in the design of the study as well as in the training of other student pharmacists to deliver the intervention, and two pharmacist preceptors oversaw student activity. The student pharmacists involved with study design were in their second and third professional year and were dual master of public health students with previous institutional review board training, survey experience, and certificates in protecting human research participants. Recruitment of student pharmacists to deliver the intervention was conducted via e-mails and classroom information sessions. In total, 17 student pharmacists delivered the intervention, 4 of whom were in their second or third years of the PharmD curriculum during the time of this study; the remaining 13 were in their first or second professional years. All Touro University student pharmacists held APhA Pharmacy-Based Immunization Delivery certification. A bullet-point list of intervention consultation points, standardized script, and sample intervention video were used for training purposes in an effort to minimize bias, self-beliefs, and interstudent variations (see Appendix 1, supplemental content available on JAPhA.org).
Data collection and statistical analysis Demographics and other baseline characteristics were examined using descriptive statistics such as frequencies and percentages. The survey consisted of eight knowledge-based questions and four attitudes-towardvaccination questions. Knowledge-based questions were assessed as either correct or incorrect. A blank response was scored as incorrect. Any PrIs or PoIs containing more than one blank response in the knowledge section were deemed incomplete and excluded from the final analysis. The attitude questions were conducted using a five-point Likert-type response scale (1, strongly disagree, to 5, strongly agree). A blank response was scored as a 3 or neutral, and only one blank response in the attitude section was permitted per survey. Change in individual question response, total cumulative correct knowledge score, and mean cumulative attitude scores were compared from PrIs to PoIs using Student’s t tests for paired data. Cumulative knowledge and attitude scores were then categorized as “Pass” or “Fail” and “Positive” or “Negative,” respectively. A cumulative correct score of greater than or equal to six out of eight questions or 75% on the knowledge portion was considered “Passing,” and a mean attitude of 3 or greater was considered “Positive.” Changes from PrIs to PoIs in these measures were analyzed using Student’s t tests for paired data. Post-hoc analysis was completed using chi-square tests for bivariate analysis followed by multivariate linear regression or logistic regression. All bivariate tests were performed with the demographic data as collected and consisted of testing the PrIs and PoIs raw scores and change in raw scores. Demographic variables were condensed for the regression models. Location was coded as either Vallejo or Martinez; age as 25 years old or younger, 26–50, and older than 50; employment as unemployed, student, employed, or retired; and education as those without a college degree, those with a college degree, and those with a graduate degree. Data on gender and ethnicity were used as is (not coded). Multivariate linear regression models were constructed for raw PrIs and PoIs cumulative knowledge and cumulative attitude scores as well as change in raw score from PrIs to PoIs. Logistic regression models were constructed for “positive attitude” in PrIs, PoIs, and change from PrIs to PoIs. Similar models were constructed for having a “passing knowledge” score in PrIs and PoIs and change from PrIs to PoIs. All statistical analyses were completed using Stata version 12.0.
Participant recruitment The study was conducted at eight different sites in Vallejo and Martinez, CA, between March 2012 and November 2012. Sites included Touro University SRFC, health outreach fairs, middle school–based immunization clinics, and a community pharmacy. The study was also conducted at every Touro University outreach event that occurred within the study timeframe. To gather data from the diverse populations of Vallejo and Martinez, all individuals readily accessible at each event were considered potential study participants and were invited to take part. Study participants were recruited via convenience sample, with student pharmacists instructed to solicit every person possible and to not discriminate among possible participants. Intervention by student pharmacists Once participants were recruited, student pharmacists verbally explained the informed consent and administered the PrIs to those who gave consent. After completing the PrIs, patients received a consultation intervention lasting approximately 5 minutes. Patients then took the PoIs immediately after the consultation. The completion time for the entire process (PrIs, consultation, 132 JAPhA | 5 4 :2 | M AR/AP R 2014
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Table 1. Demographics of study participants (n = 198) Characteristic Gender Boys and men Girls and women Age (years) 50 Ethnicity Non-white Hispanic White Asian/Pacific Islander Black Other or mixed ethnicity Occupation Student Employed fulltime Employed parttime Unemployed Retired Other Highest education level completed None Elementary school Middle school High school College Graduate school No response Medical expenses paid Out of pocket Private health insurance Employer-provided insurance Government entitlement Medicare and MediCal Family/friends No response
RESEARCH
Table 2. Participants’ vaccine history (n = 198) No. (%) 81 (40.9) 117 (59.1) 26 (13.1) 19 (9.6) 24 (12.1) 42 (21.2) 87 (43.9) 32 (16.2) 81 (40.9) 33 (16.7) 35 (17.7) 17 (8.6) 38 (19.2) 58 (29.3) 34 (17.2) 21 (10.6) 41 (20.7) 6 (3.0) 1 (0.5) 14 (7.1) 9 (4.5) 49 (24.8) 82 (41.4) 40 (20.2) 3 (1.5) 36 (18.2) 12 (6.1) 82 (41.4) 41 (20.7) 12 (6.1) 13 (6.6) 2 (1.0)
Results A total of 207 interventions were conducted at eight different sites across Martinez and Vallejo, CA. Nine surveys (4.3%) were considered incomplete because of either an incomplete presurvey (n = 2) or an incomplete postsurvey (n = 7). Final analysis was conducted on the remaining 198 completed surveys. Demographic information is provided in Table 1. Women made up 59.1% of the study population, and more than half of all participants were under the age of 50 (56.1%). Participants came from diverse backgrounds: non-white HispanJournal of the American Pharmacists Association
Characteristic Vaccines administered as part of intervention Influenza Tdap Both Neither Previous influenza vaccination 10 years Previous Tdap/Td booster vaccination 10 years Main reason for not getting vaccinated regularly Cost Availability Fear of receiving shots Belief that vaccines will increase chance of getting sick Unaware that vaccinations are available Lack of information Nothing Other I found today’s information session educational.a Strongly agree Agree Neutral Disagree Strongly disagree
No. (%)
51 (25.8) 24 (12.1) 17 (8.6) 106 (53.5) 71 (35.9) 85 (42.9) 7 (3.5) 8 (4.0) 27 (13.6) 30 (15.2) 51 (25.8) 25 (12.6) 17 (8.6) 75 (37.9)
18 (9.1) 7 (3.5) 13 (6.6) 12 (6.1) 8 (4.0) 13 (6.6) 101 (51.0) 26 (13.1)
115 (58.1) 70 (35.4) 12 (6.1) 1 (0.5) 0 (0)
Abbreviations used: Td, tetanus–diphtheria; Tdap, tetanus–diphtheria–acellular pertussis. a Response scale: from 1 (strongly disagree) to 5 (strongly agree).
ics (16.2%), Asians/Pacific Islanders (16.7%), blacks (17.7%), and whites (40.9%). Vaccinations Table 2 describes the study population’s vaccine history along with vaccines administered during the study. Student pharmacists administered 109 total vaccinations during the study, including 68 influenza vaccinations and 41 Tdap vaccinations. Of those surveyed, 35.9% reported receiving a seasonal influenza vaccination in the past year. The majority of participants (78.8%) had rej apha.org
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Table 3. Participants’ knowledge about vaccine before and after student pharmacist consultation Questiona How often should you receive an influenza vaccination? Every year How often should you receive a Td booster? Every 10 years Vaccines cause more harm than good. False If I am very sick, I can still get a vaccination. False The influenza/Tdap shot can cause me to get the disease I am trying to prevent. False Vaccines help to cure disease. False Vaccines help to prevent disease. True Vaccines contain parts of microorganisms (virus or bacteria) or weak microorganisms, which allow the body to learn to fight them off without causing you to get sick. True Passing score (≥75% correct) Passed Failed Mean score Mean correct 95% CI
Before consultation No. participants (%)
After consultation No. participants (%)
167 (84.3)
183 (92.4)
0.003
65 (32.8)
160 (80.8)
Effects of a student pharmacist consultation on patient knowledge and attitudes about vaccines Tony I-Fan Chou, David Benjamin Lash, Benjamin Malcolm, Layla Yousify, Julie Yennhi Quach, Sandy Dong, and Junhua Yu
Abstract Objective: To measure the impact of student pharmacists’ consultation on participant knowledge and attitudes about influenza and tetanus–diphtheria–acellular pertussis (Tdap) vaccines. Design: Pre- and post-consultation surveys. Setting: Free health care service and immunization clinics in Vallejo and Martinez, CA. Participants: Children and adults 13 years of age or older. Intervention: A convenience sample of participants completed a preintervention survey (PrIs) on basic vaccine knowledge and attitudes. Student pharmacists then delivered the intervention, which consisted of a 5-minute consultation on vaccines. A postintervention survey (PoIs) was administered immediately after the intervention. Main outcome measures: Cumulative scores for eight knowledge-based questions and four attitude-based questions. Results: 198 participants completed both PrIs and PoIs. Compared with the PrI scores, the PoI scores showed significant improvement in basic vaccine knowledge and attitudes toward receiving vaccinations. Participants also were more likely to view pharmacists as a source of information about vaccines after the intervention. Student pharmacists administered 109 total vaccinations during the study, including 68 influenza vaccinations and 41 Tdap vaccinations.
Received June 4, 2013, and in revised form August 5, 2013. Accepted for publication September 24, 2013. Published online in advance of print March 7, 2014. Tony I-Fan Chou, PharmD, BCPP, Assistant Professor of Pharmacy Practice, West Coast University School of Pharmacy, Los Angeles, CA. David Benjamin Lash, MPH, 2014 PharmD candidate; Benjamin Malcolm, 2014 PharmD/ MPH candidate; Layla Yousify, PharmD, Assistant Professor; Julie Yennhi Quach, 2014 PharmD/MPH candidate; Sandy Dong, 2015 PharmD candidate; Junhua Yu, MS, PhD, Assistant Professor, College of Pharmacy, Touro University California, Vallejo. Correspondence: David Benjamin Lash, MPH, College of Pharmacy, Touro University California, 1310 Club Dr., Mare Island, Vallejo, CA 94592. E-mail: [email protected] Disclosure: The authors declare no conflicts of interest or financial interests in any product or service mentioned in this article, including grants, employment, gifts, stock holdings, or honoraria. Funding: American Pharmacists Association Foundation Incentive Grants for Innovation in Immunization Practices, and California Society of Health-System Pharmacists Student Chapter Grants Program. Previous presentations: American Public Health Association Annual Meeting, San Francisco, CA, October 27–31, 2012, and California Pharmacists Association Annual Meeting, March 15–18, 2013, Monterey, CA.
Conclusion: A short, 5-minute consultation by a student pharmacist may increase vaccination rates and help serve as a vehicle to change the public’s view of vaccines as well as pharmacists and their role in primary and preventive care. Keywords: Community pharmacy services, pharmacy practice, student pharmacists, diphtheria–tetanus–acellular pertussis vaccines, health knowledge, health attitudes, influenza vaccine, disease prevention and control. J Am Pharm Assoc. 2014;54:130–137. doi: 10.1331/JAPhA.2014.13114
130 JAPhA | 5 4 :2 | M AR/AP R 2014
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P
harmacists, who are now able to immunize in all 50 states and U.S. territories, play a significant role in the delivery of immunizations. Despite the dramatic increase in immunization access provided by pharmacists, however, immunization rates for the 2010–11 influenza season were reported to be 51.0% for children aged 6 months to 17 years old and 40.5% for adults aged 18 and older.1 These rates are far below the 2010 and 2020 goals of the Centers for Disease Control and Prevention (CDC), which call for immunization of more than 80% for noninstitutionalized, non–high-risk children and adults.2 Pertussis has been on the rise nationwide recently, with a peak of 27,550 cases in 2010, the highest since 1959.3 Furthermore, in 2010, reported cases of pertussis totaled 9,156 in California, constituting a statewide epidemic that claimed the lives of 10 infants.4 This triggered the California Department of Public Health’s recommendation for all adults to receive a tetanus–diphtheria–acellular pertussis (Tdap) booster. The ongoing burdens of disease associated with influenza and rising incidence of pertussis could be greatly reduced by increased vaccination rates among
At a Glance Synopsis: A brief intervention by 17 student pharmacists at eight California health and immunization clinics had significant effects on patient knowledge and attitudes concerning vaccines and pharmacists’ patient care roles. A convenience sample of 198 adolescents and adults completed a preintervention survey, received a 5-minute consultation by student pharmacists on influenza and tetanus–diphtheria–acellular pertussis (Tdap) vaccines and pharmacists’ roles in vaccine information and delivery, and completed a postintervention survey. Results showed significant improvements in basic vaccine knowledge and attitudes and significant shifts toward viewing pharmacists as a source of information about vaccines. Student pharmacists also administered 109 total vaccinations during the study, including 68 influenza vaccinations and 41 Tdap vaccinations. Analysis: Vaccination rates for influenza have consistently been under national goals, and the recent pertussis epidemic has helped publicize the lack of proper vaccination. Several studies have shown that a pharmacist consultation improves medication adherence and outcomes, but few studies have investigated pharmacy consultations on vaccinations. This is the first study to show that a brief consultation on vaccines can improve patient knowledge and attitudes regarding vaccinations. Future studies are needed to investigate if these changes result in improved vaccination rates.
Journal of the American Pharmacists Association
RESEARCH
high-risk populations, especially those who are underserved due to lack of awareness and access to providers. This indicates a need for more potent immunization interventions in accordance with both national recommendations and local community needs. Several studies have found that noninteractive educational interventions such as pamphlets or written materials have little impact in changing patients’ knowledge or attitudes about vaccinations.5–7 A recent study showed that consultations by student pharmacists in a community setting increased patient knowledge of novel H1N1 immunization recommendations and confirmed an increasing comfort level in public perception of pharmacists as immunizers.8 These results suggest that consultation by pharmacists is effective in promoting immunization awareness, yet how much impact these interventions can have on patients’ attitudes toward common vaccinations such as influenza and Tdap is still undetermined.
Objectives The study objectives were to (1) describe knowledge and attitudes about influenza and Tdap vaccinations within the Vallejo and Martinez, CA, populations; (2) assess the impact of a student pharmacist–delivered consultation on patient knowledge of the benefits of immunizations, as well as specific CDC recommendations for influenza and pertussis; and (3) assess the impact of a student pharmacist–delivered consultation on patient attitudes about receiving vaccinations and recommending vaccinations to others.
Methods This study was approved by the Institutional Review Board at Touro University California. Survey development and implementation A preintervention survey (PrI) and postintervention survey (PoI) were designed to assess immediate changes in immunization knowledge of current influenza and pertussis immunization recommendations, attitudes regarding receipt and recommendation of immunizations, and patient demographics. Knowledge-based immunization questions were developed from educational CDC materials, including influenza and Tdap Vaccine Information Statements. The intervention focused on the benefits of vaccines, including disease prevention; dispelling common vaccination myths, such as that vaccinations cause disease or autism; and general administration information and scheduling. Attitude-based immunization questions were adapted from previous studies.9,10 Intervention consultation points were designed to address each question or piece of immunization knowledge. Data from the PrIs served as baseline for comparison with the PoIs. Surveys were piloted for readability, clarity, and length at the Touro University Student-Run j apha.org
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Free Clinic (SRFC), a planned site of survey administration, to ensure appropriateness for the study’s sample population. Direct feedback from pilot participants was incorporated into the final version of the surveys. No patient identifiers were collected during the administration of the survey.
and PoIs) was 10–15 minutes. Participants had the opportunity to ask questions during and after the consultation. Student pharmacists spoke an estimated 75% of the time. No written materials or other forms of multimedia were given to patients. Patient-specific recommendations were not a structured part of the intervention.
Student pharmacist recruitment and training Three student pharmacists were directly involved in the design of the study as well as in the training of other student pharmacists to deliver the intervention, and two pharmacist preceptors oversaw student activity. The student pharmacists involved with study design were in their second and third professional year and were dual master of public health students with previous institutional review board training, survey experience, and certificates in protecting human research participants. Recruitment of student pharmacists to deliver the intervention was conducted via e-mails and classroom information sessions. In total, 17 student pharmacists delivered the intervention, 4 of whom were in their second or third years of the PharmD curriculum during the time of this study; the remaining 13 were in their first or second professional years. All Touro University student pharmacists held APhA Pharmacy-Based Immunization Delivery certification. A bullet-point list of intervention consultation points, standardized script, and sample intervention video were used for training purposes in an effort to minimize bias, self-beliefs, and interstudent variations (see Appendix 1, supplemental content available on JAPhA.org).
Data collection and statistical analysis Demographics and other baseline characteristics were examined using descriptive statistics such as frequencies and percentages. The survey consisted of eight knowledge-based questions and four attitudes-towardvaccination questions. Knowledge-based questions were assessed as either correct or incorrect. A blank response was scored as incorrect. Any PrIs or PoIs containing more than one blank response in the knowledge section were deemed incomplete and excluded from the final analysis. The attitude questions were conducted using a five-point Likert-type response scale (1, strongly disagree, to 5, strongly agree). A blank response was scored as a 3 or neutral, and only one blank response in the attitude section was permitted per survey. Change in individual question response, total cumulative correct knowledge score, and mean cumulative attitude scores were compared from PrIs to PoIs using Student’s t tests for paired data. Cumulative knowledge and attitude scores were then categorized as “Pass” or “Fail” and “Positive” or “Negative,” respectively. A cumulative correct score of greater than or equal to six out of eight questions or 75% on the knowledge portion was considered “Passing,” and a mean attitude of 3 or greater was considered “Positive.” Changes from PrIs to PoIs in these measures were analyzed using Student’s t tests for paired data. Post-hoc analysis was completed using chi-square tests for bivariate analysis followed by multivariate linear regression or logistic regression. All bivariate tests were performed with the demographic data as collected and consisted of testing the PrIs and PoIs raw scores and change in raw scores. Demographic variables were condensed for the regression models. Location was coded as either Vallejo or Martinez; age as 25 years old or younger, 26–50, and older than 50; employment as unemployed, student, employed, or retired; and education as those without a college degree, those with a college degree, and those with a graduate degree. Data on gender and ethnicity were used as is (not coded). Multivariate linear regression models were constructed for raw PrIs and PoIs cumulative knowledge and cumulative attitude scores as well as change in raw score from PrIs to PoIs. Logistic regression models were constructed for “positive attitude” in PrIs, PoIs, and change from PrIs to PoIs. Similar models were constructed for having a “passing knowledge” score in PrIs and PoIs and change from PrIs to PoIs. All statistical analyses were completed using Stata version 12.0.
Participant recruitment The study was conducted at eight different sites in Vallejo and Martinez, CA, between March 2012 and November 2012. Sites included Touro University SRFC, health outreach fairs, middle school–based immunization clinics, and a community pharmacy. The study was also conducted at every Touro University outreach event that occurred within the study timeframe. To gather data from the diverse populations of Vallejo and Martinez, all individuals readily accessible at each event were considered potential study participants and were invited to take part. Study participants were recruited via convenience sample, with student pharmacists instructed to solicit every person possible and to not discriminate among possible participants. Intervention by student pharmacists Once participants were recruited, student pharmacists verbally explained the informed consent and administered the PrIs to those who gave consent. After completing the PrIs, patients received a consultation intervention lasting approximately 5 minutes. Patients then took the PoIs immediately after the consultation. The completion time for the entire process (PrIs, consultation, 132 JAPhA | 5 4 :2 | M AR/AP R 2014
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Table 1. Demographics of study participants (n = 198) Characteristic Gender Boys and men Girls and women Age (years) 50 Ethnicity Non-white Hispanic White Asian/Pacific Islander Black Other or mixed ethnicity Occupation Student Employed fulltime Employed parttime Unemployed Retired Other Highest education level completed None Elementary school Middle school High school College Graduate school No response Medical expenses paid Out of pocket Private health insurance Employer-provided insurance Government entitlement Medicare and MediCal Family/friends No response
RESEARCH
Table 2. Participants’ vaccine history (n = 198) No. (%) 81 (40.9) 117 (59.1) 26 (13.1) 19 (9.6) 24 (12.1) 42 (21.2) 87 (43.9) 32 (16.2) 81 (40.9) 33 (16.7) 35 (17.7) 17 (8.6) 38 (19.2) 58 (29.3) 34 (17.2) 21 (10.6) 41 (20.7) 6 (3.0) 1 (0.5) 14 (7.1) 9 (4.5) 49 (24.8) 82 (41.4) 40 (20.2) 3 (1.5) 36 (18.2) 12 (6.1) 82 (41.4) 41 (20.7) 12 (6.1) 13 (6.6) 2 (1.0)
Results A total of 207 interventions were conducted at eight different sites across Martinez and Vallejo, CA. Nine surveys (4.3%) were considered incomplete because of either an incomplete presurvey (n = 2) or an incomplete postsurvey (n = 7). Final analysis was conducted on the remaining 198 completed surveys. Demographic information is provided in Table 1. Women made up 59.1% of the study population, and more than half of all participants were under the age of 50 (56.1%). Participants came from diverse backgrounds: non-white HispanJournal of the American Pharmacists Association
Characteristic Vaccines administered as part of intervention Influenza Tdap Both Neither Previous influenza vaccination 10 years Previous Tdap/Td booster vaccination 10 years Main reason for not getting vaccinated regularly Cost Availability Fear of receiving shots Belief that vaccines will increase chance of getting sick Unaware that vaccinations are available Lack of information Nothing Other I found today’s information session educational.a Strongly agree Agree Neutral Disagree Strongly disagree
No. (%)
51 (25.8) 24 (12.1) 17 (8.6) 106 (53.5) 71 (35.9) 85 (42.9) 7 (3.5) 8 (4.0) 27 (13.6) 30 (15.2) 51 (25.8) 25 (12.6) 17 (8.6) 75 (37.9)
18 (9.1) 7 (3.5) 13 (6.6) 12 (6.1) 8 (4.0) 13 (6.6) 101 (51.0) 26 (13.1)
115 (58.1) 70 (35.4) 12 (6.1) 1 (0.5) 0 (0)
Abbreviations used: Td, tetanus–diphtheria; Tdap, tetanus–diphtheria–acellular pertussis. a Response scale: from 1 (strongly disagree) to 5 (strongly agree).
ics (16.2%), Asians/Pacific Islanders (16.7%), blacks (17.7%), and whites (40.9%). Vaccinations Table 2 describes the study population’s vaccine history along with vaccines administered during the study. Student pharmacists administered 109 total vaccinations during the study, including 68 influenza vaccinations and 41 Tdap vaccinations. Of those surveyed, 35.9% reported receiving a seasonal influenza vaccination in the past year. The majority of participants (78.8%) had rej apha.org
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Table 3. Participants’ knowledge about vaccine before and after student pharmacist consultation Questiona How often should you receive an influenza vaccination? Every year How often should you receive a Td booster? Every 10 years Vaccines cause more harm than good. False If I am very sick, I can still get a vaccination. False The influenza/Tdap shot can cause me to get the disease I am trying to prevent. False Vaccines help to cure disease. False Vaccines help to prevent disease. True Vaccines contain parts of microorganisms (virus or bacteria) or weak microorganisms, which allow the body to learn to fight them off without causing you to get sick. True Passing score (≥75% correct) Passed Failed Mean score Mean correct 95% CI
Before consultation No. participants (%)
After consultation No. participants (%)
167 (84.3)
183 (92.4)
0.003
65 (32.8)
160 (80.8)
