Cross-Cultural Household Influence on Vaccination Decisions

Abstract

Uptake of vaccination against seasonal influenza is suboptimal in most countries, and campaigns to promote vaccination may be weakened by clustering of opinions and decisions not to vaccinate. This clustering can occur at myriad interacting levels: within households, social circles, and schools. Given that influenza is more likely to be transmitted to a household contact than any other contact, clustering of vaccination decisions is arguably most problematic at the household level. We conducted an international survey study to determine whether household members across different cultures offered direct advice to each other regarding influenza vaccination and whether this advice was associated with vaccination decisions. The survey revealed that household members across the world advise one another to vaccinate, although to varying degrees, and that advice correlates with an increase in vaccination uptake. In addition, respondents in Japan, China, and the United States were less likely to offer advice to older adults than to the young, despite older adults' being the target age group for vaccination in both Far Eastern countries. Furthermore, advice was not primarily directed to household members within the age groups advised to vaccinate by national health policies. In Japan, advice was offered more to ages outside of the policy guidelines than inside. Harnessing the influence of household members may offer a novel strategy to improve vaccination coverage across cultures worldwide.

Keywords: advice; culture; households; influenza; vaccination.

Figure 1

Average numbers of other household members (excluding the respondent), by relationship type.

Figure 2

Likelihood of respondent advising a household member to vaccinate by country of residence and age of the household member being advised (or not advised). Vertical lines indicate 95% confidence intervals.

Figure 3

(A) Proportion of respondents who vaccinated by their country of residence and whether or not at Least one household member advised them to vaccinate (top). (B) Proportion of respondents who vaccinated because they were advised by a household member, separately per country (bottom). Error bars indicate 95% confidence intervals

Figure 4

For each country, the proportion of household members that a respondent advised to vaccinate and whether they were within (black) or outside (grey) the age group advised to receive influenza vaccination by the national health authorities. Age-specific vaccine recommendations are provided below each country name. Note: South Africa has no current age-specific vaccination policy.

Figure 5

For each country, the Gini Coefficient (left) (26, 27) and Collectivism Index (right) (16) plotted against the mean likelihood of respondents from that country advising a household member to vaccinate.