1. November 5, 2013
Social and Behavioral Determinants of
Adult Vaccination: Literature Review
Prepared by: Stephanie Gati

2. Goal for Literature Search
• Determine the research that has been done thus
far
• Learn from prior vaccination campaigns
• Identify gaps in current research
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3. Literature Search for Social and Behavioral Determinants of Adult
Vaccination
Initial Search and High-Level Screening Sources
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MeSH/PubMed
Keyword searches
Free-text Google search
Publications
 Key organization Web sites
(e.g. WHO, GAVI, PATH, etc.)
 GAVI Investment Cases
 Unpublished papers
32
Less Relevant
Publications
71 Publications
Reviewed in Detail
39
Relevant
Publications
25 Social
Determinants
Publications
9
High-Income
Countries
3
Low/Middle
Income
Countries
 WHO Bulletins
 Grey papers (unpublished)
 Abstracts
13
General
14 Behavioral
Determinants
Publications
13
High-Income
Countries
1
Low/Middle
Income
Countries
3

4. Social Determinants
• Few articles addressed social determinants of
vaccination, but many addressed social
determinants of health
• Plans of action to address social determinants of
health are applicable to increasing adult
vaccination
• Access to vaccination may be an important
component of social determinants of health
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5. Models of Social Determinants of Health
• Diderichsen Model: Social stratification and status
correspond to differential exposure and
vulnerability to disease (3 papers)
• Intermediary Determinants of Health (2 papers)
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–
–
–
Materialist/Structuralist Theory
Psychosocial Theory
Social Production Theory
Eco-Social Theory
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6. Social Determinant Conceptual Framework
World Health Organization (2010) A Conceptual Framework for Action on the Social Determinants of Health.
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7. Social Determinants
• Findings from HPV, Influenza, HepB Vaccination
– HPV: School-based programs achieved high coverage for
adolescent girls, but missed those who don’t attend
school. Major cost and price barriers (3 papers)
– Influenza: Vaccination associated with education,
accessibility of care, and social support. Racial/ethnic
divides in vaccination rates (4 Papers)
– HepB: Minimal vaccination programs are in place; trying
to target the high-risk groups, because they tend to have
little access to health care (1 Paper)
• Lack of fully-funded programs for adult
vaccinations
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8. Behavioral Determinants
• Theory of Planned Behavior (6 Papers): intention to
engage in a health behavior is based on:
– Subjective Norms (3)
– Attitude (2)
– Perceived Behavioral Control (3)
• Health Belief Model (5 papers): engagement in a
health behavior depends on
–
–
–
–
Perceived Susceptibility (2)
Perceived Severity (1)
Perceived Effectiveness/Benefits (3)
Perceived Barriers (3)
• Overlap with Social Determinants
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9. Behavioral Determinants
• Liao, et al. (2011) Factors Affecting Intention to
Receive and Self Report 2009 Pandemic (H1N1)
Vaccine in Hong Kong: A Longitudinal Study. PLoS
One
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10. Summary
• Social determinants:
– Barriers to access for adult vaccinations include: a lack
of funded and targeted programs for vaccination;
minimal access to health care; lack of education
– In high income countries, certain racial/ethnic groups
have lower vaccination rates (Black & Hispanic vs. White
populations)
• Behavioral determinants:
– Theory of Planned Behavior and Health Belief Models
are strong predictors of vaccination behavior
– Most significant factors: Perceived behavioral control,
social norms, perceived barriers, perceived benefits
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11. Gaps in Research
• Social determinants of adult vaccination
– Frequently do not consider social determinants of
vaccination
– WHO states that the causal mechanisms of the Social
Determinants of Health are mostly unknown
• Behavioral determinants of adult vaccination
– Very few articles focus on low and middle income
countries  Are findings from high income countries
applicable to low- and middle-income countries, or is
more research necessary?
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12. Thank You.

13. References: Relevant Social Determinant
Articles
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Bonnefoy J, et al. (2007) Constructing the evidence base on social determinants of health: A guide. World Health Organization.
Chiatti C, et al. (2011) Influenza vaccine uptake among community-dwelling Italian elderly: results from a large cross-sectional study. BMC Public Health 11:207
Fernandez ME, et al. (2010) Integrating Clinical, Community, and Policy Perspectives on HPV Vaccination. Annu Rev Public Health. 31: 235-252.
Fiscella K, et al. (2002) Disparities in Health Care by Race, Ethnicity, and Language Among the Insured. Medical Care. 40(1) 52-59.
Harris KM, et al. (2012) A Blueprint for Improving the Promotion and Delivery of Adult Vaccination in the United States. RAND Corporation.
High KP, et al. (2010) Workshop on Immunizations in Older Adults: Identifying Future Research Agendas. J Am Geriatri Soc. 58: 765-776
Kelly MP, et al. (2007) The social determinants of health: Developing an evidence base for political action. Measurement and Evidence Knowledge Network.
LaMontagne DS, et al. (2011). Human papillomavirus vaccine delivery strategies that achieved high coverage in low- and middle-income countries. Bull World Health
Organ. 89: 821-830.
Lee JH & Sadana R. (eds.) (2011) Improving Equity in Health by Addressing Social Determinants. World Health Organization
Mouy B & Barr E. (2006) The social determinants of health: is there a role for health promotion foundations? Health Promotion Journal of Australia, 17(3); 189-196
Nagata JM, et al. (2013) Social determinants of health and seasonal influenza vaccination in adults over 65 years: a systematic review of qualitative and quantitative
data. BMC Public Health 13: 388.
National Foundation for Infectious Disease. (2002) A Report on Reaching Underserved Ethnic and Minority Populations to Improve Adolescent and Adult
Immunization Rates.
Nowalk MP, et al. (2006) Determinants of adult vaccination at inner-city health centers: A descriptive study. BMC Family Practice 7(2).
Rangel MC, et al. (2005) Racial and ethnic disparities in influenza vaccination among elderly. J Gen Intern Med. 20: 426-431.
Shepard CW, et al. (2006) Hepatitis B Virus Infection: Epidemiology and Vaccination. Epidemiol Rev 28: 112-125.
Soeung SC, et al. (2012) The social determinants of health and health service access: an in depth study in four poor communities in Phnom Penh Cambodia.
International Journal for Equity in Health. 11(46)
Uddin M, et al. (2010) Demographic and socioeconomic determinants of influenza vaccination disparities among university students. J Epidemiol Community Health
64: 808-813.
World Health Organization (2001) Universities and the health of the disadvantaged.
World Health Organization (2007) Addressing sex and gender in epidemic-prone infectious diseases
World Health Organization (2008) Challenges to Implementing the Social Determinants for Health Equity Agenda in Countries.
World Health Organization (2008) Human Papillomavirus Vaccine Background Paper. September 2008.
World Health Organization (2010) A Conceptual Framework for Action on the Social Determinants of Health.
World Health Organization (2011) Report of the ad-hoc Consultation on Ageing and Immunization.
World Health Organization (2013) Global Vaccine Action Plan, 2011-2020
Zimmerman RK, et al. (2005) Predictors of pneumococcal polysaccharide vaccination among patients at three inner-city neighborhood health centers. American
Journal of Geriatric Pharmacotherapy. 3(3); 149-159
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14. References: Relevant Behavioral
Determinant Articles
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Baars J, et al. (2008) Drug Users' Participation in a Free Hepatitis B Vaccination Program: Demographic, Behavioral, and SocialCognitive Determinants. Substance Use and Misuse. 43(14); 2145-2162
Chapman GB & Coups EJ. (1999) Predictors of Influenza Vaccine Acceptance among Health Adults. Preventive Medicine 29L
249-262.
Chi R-C & Neuzil KM. (2004). The Association of Sociodemographic Factors and Patient Attitudes on Influenza Vaccination
Rates in Older Persons. Am J Med Soc. 327(3): 113-117
de Wit JBF, et al. (2005) Social-cognitive determinants of vaccination behavior against hepatitis B: An assessment among men
who have sex with men. Preventive Medicine 40: 795-802
Gagnon MP & Godin G. (2000) Young Adults and HIV vaccine: Determinants of intention of getting immunized. Canadian
Journal of Public Health. 91(6); 432-434
Gallagher S & Povey R. (2006) Determinants of older adults’ intention to vaccinate against influenza: a theoretical approach.
Journal of Public Health 28(2); 139-144.
Gerend MA, Shepherd MA, & Shepherd JE. (2013) The Multidimensional Nature of Perceived Barriers: Global Versus Practical
Barriers to HPV Vaccination. Health Psychology 32(4); 361-369.
Liao Q, et al. (2011) Factors Affecting Intention to Receive and Self-Reported Receipt of 2009 Pandemic (H1N1) Vaccine in
Hong Kong: A Longitudinal Study. PLoS ONE 6(3): e17713
Looijmans-van den Akker I, et al. (2007) No intention to comply with influenza and pneumococcal vaccination: Behavioral
determinants of smokers and non-smokers. Preventive Medicine. 45; 380-385
Myers LB & Goodwin R. (2011) Determinants of adult’s intention to vaccinate against pandemic swine flu. BMC Public Health
11:15
Reiter PL, et al. (2009) Parents’ health beliefs and HPV vaccination of their adolescent daughters. Social Science & Medicine.
doi:10.1016/j.socscimed.2009.05.024.
Schutten M, de Wit JBF, van Steenbergen JE. (2002) Why do gay men want to be vaccinated against Hepatitis B? An
assessment of psychosocial determinants of vaccination intention. International Journal of STD & AIDS. 13(2) 86-90
Van Keulen HM, et al (2013) Determinants of HPV vaccination intentions among Dutch girls and their mothers: a crosssectional study. BMC Public Health 13:111
Zijtregtop EAM, et al. (2010) Which factors are important in adult uptake of a (pre)pandemic influenza vaccine? Vaccine 28;
207-227.
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