"The Flu...Is a Little More Complicated than a Cold": Knowledge, Beliefs, and Practices Related to Influenza and Influenza Vaccination among At-Risk Populations and Health Professionals in Peru

"The information shared in the focus groups and interviews suggests important gaps in knowledge and practice among HPs, including physicians, common misconceptions among community members, and systemic barriers to vaccine administration, all of which likely result in poor vaccine uptake and need to be addressed."

Although influenza vaccination in Peru is offered for free through the Ministry of Health (MOH), estimated national coverage is low, estimated at 25-50% among young children and older adults. In an effort to guide efforts to increase uptake, this study explored knowledge, beliefs, attitudes, and practices related to influenza vaccination among populations at higher risk for infection and/or complications and health professionals (HPs) in Peru, and their perspectives on health communication channels.

Nine focus groups with 66 community participants particularly at risk for influenza-related morbidity and mortality, as well as in-depth interviews with 25 HP key informants, were carried out between September and October 2016 in 3 geographically distinct cities: Lima, Peru's capital, located in a coastal desert; Cuzco, located in the Andes highlands; and Iquitos, located in the Amazon Basin.

Each sub-section of the article presents results organised by theme and sub-themes, including a brief summary and participant quotes.

• Knowledge about influenza: HPs seemed to significantly underestimate the local prevalence of influenza, and they did not see themselves as belonging to a group at high risk for infection. Community participants felt that influenza cases were isolated and overall quite rare in their community, and none mentioned that influenza could cause death. Though they correctly mentioned that children and older adults were at high risk for influenza-related complications, community participants - including pregnant/postpartum women - did not mention pregnant women as a high-risk group.
• Knowledge, perspectives, and practices regarding the influenza vaccine: Many HPs reported they themselves often show poor uptake of the influenza vaccine. Many also held beliefs that are inconsistent with research into vaccine safety yet are propagated by the anti-vaccine movement. HPs reported that many patients, especially older adults, had positive views of the benefits of the vaccine; these attitudes were borne out in focus group discussions. Community participants repeatedly mentioned having heard about the influenza vaccine through the media. Many incorrectly thought the influenza vaccine is like most other vaccines, which are received once or a few times in a person's lifetime. Some of these erroneous beliefs may be due to the provision of unclear, incomplete, or inaccurate information on the part of HPs.
• System-related barriers and facilitators of influenza vaccination: HPs and community members cited shortage of vaccines, timeliness of vaccine delivery relative to influenza season, and problematic vaccine-related administration practices, including long waiting times.
• Information needs related to influenza, the influenza vaccine, and SMS (text) messages: Many community participants expressed a desire and need for more information regarding influenza and the vaccine. When asked about text messages as a way to disseminate information on the influenza vaccine, many focus group participants were receptive to the idea. However, they noted that older adults are less likely to use cellular phones.

The researchers cite other studies finding that when HPs recommend the influenza vaccine to their patients, including high-risk patients, these patients are more likely to undergo vaccination. "Therefore, obtaining HP buy-in regarding the importance of the vaccine should be an important component in any influenza vaccination campaign, especially amongst high risk patients."

Furthermore: "Given that media was mentioned multiple times by community members as a positive source of information, mass media campaigns aimed at promoting awareness of influenza and the vaccine should be also encouraged. However, text messaging and other means of communication about the benefits of vaccination would have minimal or even negative value in areas where systemic barriers to vaccine uptake, such as vaccine stock-outs, are especially prevalent..."

Concluding recommendations: "Governments should focus on improving knowledge about influenza epidemiology and addressing myths regarding influenza vaccination among HPs and the general population. In addition, it is imperative to put forward ongoing public communication about the safety of the seasonal influenza vaccine and the need for annual vaccination for the overall community....Lastly, the government should evaluate strategies to avoid missing the opportunity to vaccinate at-risk populations by assuring timely availability of influenza vaccines at health establishments and improving the services provided at these sites."