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Health Literacy and Correlates to Influenza Vaccination in Underserved African American Populations 1 Cook 1 Olaoluwa Fayanju, MD, MSc; 1 Debbie Donelson, MD; 2 Karen Tate, MPH; 3 Amy Luke, Ph. D County-Loyola-Provident Family Medicine Residency Program, 2 Loyola University Medical Center, 3 Loyola University Chicago, Stritch School of Medicine Maywood, IL PURPOSE SURVEY TOOL RESULTS African American populations have lower rates of influenza vaccination compared to other racial/ethnic groups in the United States. This study aims to establish whether health literacy explains the low rates of vaccination among African-American patients in a Chicago family medicine clinic. This survey was developed from the Health Literacy Skills Instrument (HLSI) which was used with the permission of RTI International of Durham, NC. High health literacy was defined as having a score of 3, 4, or 5 on the 5 -point scale. Added by investigators were questions on whether the influenza vaccination was received in the 2014 -2015 flu season or in prior years. • More than 20% of respondents did not get a flu shot this season or in past seasons because they thought a flu shot would given them the flu or that a vaccination would not work. BACKGROUND Study participants were asked if they had: hypertension, COPD, HIV/AIDS, or depression. • Using Chi-square analysis, health literacy was not significantly associated with acceptance or non-acceptance of the flu shot. HSLI Survey Questions While good hygiene, an absence of chronic disease and good health habits can reduce the risk of contracting the influenza virus, vaccination is the most effective means of preventing infection. As a result of the expansion of health insurance coverage through the Affordable Care Act, 100, 000 people were enrolled in County. Care, the new managed-care Medicaid program launched in 2013. This population of newly insured patients is notable for the high prevalence of chronic diseases such as heart disease, diabetes, obesity, and asthma; frequent hospitalization and ED visits; and chronic inability to acquire needed medications. Keeping this population healthy through preventive measures such as annual influenza vaccines, will be essential to controlling costs and providing affordable care. 2013 -2014 marked the fifth year of recommended universal vaccination coverage, yet coverage rates nationally have consistently been less than 50%. Illinois, with an overall vaccination rate of 43. 1% in 2013, lagged behind both the nation (45%) and the region (43. 5%). Among African-Americans, state (40. 9%), regional (39. 7%), and national (41. 3%) vaccination coverage was below that of all other reported races and ethnicities. • 64% of respondents (total n=98) were female with an average of 53. 54. 1% of participants demonstrated low health literacy ; 45. 9% high health literacy. • Logistic regression, adjusted for age and sex showed that increasing age was associated with vaccine uptake (p-value =0. 048, OR =1. 03 [1. 00 -1. 07], 95% CI). • Most co-morbid conditions were not associated with uptake of the vaccine; arthritis, diabetes and high cholesterol were positively correlated with uptake. • Past flu shot acceptance was strongly associated with flu shot use in the 2014 -2015 season. Survey performance FLU VACCINE RATES 70% % of Repondents that scored 58. 2% 60% 0 out of 5 If a person is at high risk for heart disease, which of the following levels of low density lipoprotein (LDL) cholesterol is best? A. 102 B. 86 C. 129 D. 155 E. Not sure 8% 1 out of 5 17% How many grams of fiber are in two servings? A. 2 B. 3 C. 4 D. 5 E. 50% 10% 40% 21% 20% 48% 2 out of 5 30% 3 out of 5 20% 4 out of 5 10% 5 out of 5 0% 22% % Receiving Immunization, 2014 -2015 % Receiving Prior Immunization Not sure Medical Conditions as Reported by Respondents Insurance Coverage by Respondents Major Depression % with no data on insurance status Tobacco Use Understanding disparities in influenza vaccination among African-Americans has particular relevance to clinicians in practice in Chicago and for those who serve patients in the Cook County Health and Hospitals System. 1. 0% Thyroid Dysfunction % Uninsured Obesity 10. 2% HTN Public Insurance (e. g. Carelink, SCHIP) HIV/AIDS 1. 0% Hyperlipidemia Commercial Insurance Emphysema OBJECTIVES 1. Identify the state of health literacy within significant demographic served by the Englewood Health Center 2. Establish whether high levels of health literacy are associated with higher vaccination rates and lower levels of health literacy are associated with lower vaccination rates 3. Develop conclusions as to how to improve vaccination rates METHODS • Survey conducted at Englewood Health Center of Cook County Health & Hospitals System • Surveys were conducted in April 2015 at conclusion of 2014 -2015 flu “season” • Eligible participants were African-American patients of the Englewood Health Center aged 18 year and older • Exclusion criteria included any known intellectual, psychological or physical limitations that might prevent completion of the survey 9. 2% DM Medicare CAD 17. 3% CHF Based on the chart above, who is more likely to die of prostate cancer? A. White men B. African American men C. Neither D. Don’t know Medicaid Chronic Bronchitis 25. 5% COPD County. Care Cancer A person is cooking dinner for himself and he wants to include one serving from the meat and beans group. What should he choose? A. 1 ½ ounces of cooked lean beef B. 1 ½ ounces of cooked fish C. 3 boiled eggs D. 1 cup of kidney beans E. Don’t know If John was visiting someone in room 130 and wanted to go to the cafeteria, which of these places would he pass if he took the shortest route? A. Diagnostic Imaging B. Gift shop C. Cardiac center D. Emergency services E. Don’t know Bipolar Disorder 0. 0% 35. 7% 10. 0% 20. 0% 30. 0% 40. 0% Asthma Arthritis Anemia 0. 0% 5. 0% 10. 0% 15. 0% 20. 0% 25. 0% 30. 0% 35. 0% 40. 0% 45. 0% DISCUSSION Health literacy – whether at high or low level -- was not found to be associated with corresponding influenza vaccination rates among the African-American patients at Englewood Health Center. However, with over 20% of respondents believing that flu shots cause the infection or can make them sick, there is a significant amount of misinformation with which physicians must contend. We were able to establish that certain chronic diseases, most notably diabetes and hyperlipidemia, did correlate with a greater likelihood of taking the recommended immunization. We speculate this is because these diseases are associated with more frequent interactions with providers and therefore lead to greater trust and belief in the benefit of the intervention. Other factors such as patient skepticism of medical interventions predicated on historical mistrust could be explored in a qualitative analysis of this population and may yield answers which can better predict patient decision making.