Of 1573 patients initially sampled, practice nurses noted that 67 had died, 121 had moved, and 142 were too ill to be contacted. Responses to the mailed questionnaire identified a further 10 who had since died, 24 who had moved or had wrong addresses and 3 who were too ill to reply. This left a total of 1206 eligible patients of whom 113 refused and 174 did not reply after a second mailing. Information on vaccine status in 2000 was missing in another 35 patients and a further 40 had not completed the prior full assessment. The effective response rate was therefore 75% (844/(1206-35-40)).
Of the 844 responders, 85% of 329 men and 75% of 515 women were vaccinated against influenza in 2000 according to GP records. This percentage was higher than in the whole sample (responders and non-responders) where it was 69.8% and 60.5% in men and women respectively. However, the age and sex patterns of the responders' recorded uptake were similar to that of the full sample[15
]. Vaccine recipients were more likely to be male than female (RR 1.12, 95% CI 1.03–1.22) with a non-significant tendency for those aged 80–84 to be more likely to be vaccinated that those below the age of 80 years (1.04, 95% CI 0.9–1.2).
Over 93% of those who stated that they had had influenza vaccination in the last 12 months also had a GP record of this. Of those who had a GP record of vaccination last year, 92% recalled that they had been vaccinated, 4% thought it was more than a year ago, 2% were not sure and 1% thought the last time they had had influenza vaccine was a few years ago.
Recall of an invitation or being in a practice that actively recruited patients (latter information obtained from the practices) was high for both vaccinated and unvaccinated patients but was not significantly associated with vaccination in over 74 year olds in this sample. There was also no significant association with self-perceived health or inactivity (Table ).
Characteristics of patients by vaccination status
Reasons given for influenza vaccine receipt
Most vaccinated patients indicated that a reason for being vaccinated was a recommendation from a health care worker (Table ). Recommendation by a health care worker was defined to include opportunistic offers, face to face, letter or telephone contacts. A much smaller percentage reported recommendation from a friend or relative. Nearly all those who had had influenza vaccination agreed either with the statement that prevention was better than cure or that they were aware of the benefits, a quarter perceived themselves at high risk and an even smaller percentage noted that they had had a bad experience with influenza in the past
Patients' reasons for having or not having influenza vaccination
Reasons given for influenza vaccine non-receipt
Of the pre-coded options given the most popular reason for non receipt of vaccine was that they did not get ill, followed by the perception that the vaccine makes them ill or they lacked interest in influenza vaccination (Table ). Fewer than one in ten did not like injections or thought the vaccine did not work. Perceived allergies to vaccination were not important.
Of those who had not had the vaccine last year, a substantial percentage reported that they had never had the vaccine (30%). A small percentage appeared to lack knowledge that they needed it each year (6.5%) or did not know they could have the vaccine (5.3%). A few also volunteered that they thought they were too old for the vaccine (5.3%). Information given about influenza, the vaccine and how effective it is (figure ) was noted to be useful in 80% (95%CI 76–84%) of those who had had the vaccine last year and 45% (35–55%) who had not. Of those who had not had the vaccine last year, 29% (95% CI 20–40%) said they would have it next season. Of these, 96% said the information was useful compared to 27% of those who would not have the vaccine next year. Of the 71% who said they would not have the vaccine next year, the order of importance of attitudes associated with not having vaccination next year was similar to the whole group of not vaccinated.
In this sample few reported physical barriers such as lack of transport, and only one person gave reasons of unsuitable surgery times or that the surgery was too far away.
Characteristics of people with particular reasons against vaccination
The crude association between the two main reasons against influenza vaccination and socio-economic status as well as underlying health were explored (table ). A statement that they were generally healthy was associated with living in owner occupied housing with central heating, not living in urban areas and not having a history of past influenza. There was also a non significant association with being non-smokers. People who reported that they did not have the vaccine because it might make them ill were less likely to be currently married, and less likely to live in comfortable neighbourhoods.
Characteristics of people with the two most common reasons for not having influenza vaccine