Project Goals | V.I.P. Committee | Individual Resident Level Outcomes | Conclusion
V.I.P.: Vaccinate for Influenza Prevention, was a multi-level peer-led empowerment intervention with older minority adults living in public senior housing in Hartford, CT. It addressed known and persistent inequities in influenza vaccination among African American and Latino older adults, and associated infections, hospitalizations and mortality. The intervention brought together a group of social scientists, vaccine researchers, geriatricians, public health nurses, elder services providers and advocates (the Influenza Strategic Alliance or ISA) in collaboration with senior housing management and an activist resident committee (the V.I.P. Committee). Two buildings of equal size (approximately 175 residential units) and similar ethnic composition (African American, Latino, West Indian/Caribbean and White) were randomized as intervention and control buildings. Pre- and post-intervention surveys were conducted in both buildings, measuring influenza knowledge, attitudes and peer norms. Processes and outcomes were documented at four levels: Influenza Strategic Alliance (macro and exo levels), building management (meso level), building resident committee (meso level) and individual residents. This article will report on the processes and outcomes at the building resident and individual resident levels.
PROJECT GOALS
The primary goals of the V.I.P. program were: 1) to create a regional support and advocacy committee, the Influenza Strategic Alliance, consisting of public and gerontological health providers, researchers, and representatives from agencies advocating for and providing services and information to older adults that could provide ongoing support for resident activities and advocate for improvements in communication and vaccination availability; 2) to engage building administrators to act in concert with residents to support influenza vaccination clinics and other public health activities; 3) to organize, inform through engaged inquiry, and assist the V.I.P. Committee, a formalized group of senior housing residents, to promote vaccination practices in their buildings using a peer-leadership and communications model; 4) to enable building residents to make informed decisions about obtaining influenza vaccinations by providing them with information, and the opportunity to integrate their own knowledge with others’ through questioning, in a supportive pro-vaccination environment; and 5) to increase vaccination rates to 70% thus providing building level immunity. Finally an important emergent goal of the intervention was to promote sustainability through increasing interaction across intervention levels, and encouraging independent pro-vaccination advocacy in the year following the completion of the intervention.
V.I.P. COMMITTEE:
Recruitment, Training, Activities & Outcomes
After obtaining support from the building managers, the ICR study team reviewed the project with the Tenants' Associations in both buildings. The project was then presented to building residents who were invited to join the V.I.P. Committee in the intervention building, and to participate in pre- and post-intervention surveys (intervention and control buildings). Nine residents joined the V.I.P. Committee, some of them members of the Tenants' Association. Participation in the V.I.P. Committee included regular attendance at twice weekly meetings for two months, followed by the development and implementation of a flu campaign. Committee goals were to learn about influenza and vaccination so as to be able to instruct others and answer their questions, to recruit for and conduct two pro-vaccination flu fairs with associated vaccination clinics, and to understand member responsibilities, thus building internal capacity to implement flu vaccination activities with less support the following year.
Committee members demonstrated high commitment to the project. Most members attended all sessions and played a role in the vaccination campaign by creating flu education and pro-vaccination messages for posters and flyers, creating the script and images for a flu prevention movie, and recruiting other building residents to campaign events and flu clinics. They were able to speak about the causes and consequences of influenza and to provide strong arguments to the building public in favor of vaccination. The Committee also created interactive activities such as a flu game, poster contest and 'ask the expert' session to allow building residents to learn about flu and vaccination for themselves and how to better improve their own health.
Resident attendance at each campaign event exceeded average attendance rates at most previously observed voluntary health-related building activities. More than 85 residents attended each of the flu fairs, as well as building staff and a few family members. In the intervention building thirty-three residents obtained flu vaccinations during intervention-related clinics, approximately 35% of the building population 62 and over. This increased the overall rate of vaccination in the building making it significantly higher than the control building. In addition, two residents also requested pneumococcal vaccinations.
The V.I.P. Committee's ability to sustain its activities and to plan for future flu campaigns was assessed and documented during the following year. Committee members continued to meet and planned and implemented a resident vaccination campaign with building management support and minimal assistance from project staff (mainly facilitation at meetings), using materials taken from the study curriculum and their pro-vaccination film. The group's capacity to organize and carry out additional activities with limited staff support suggests that this intervention has potential for sustainability.
INDIVIDUAL RESIDENT LEVEL OUTCOMES
Intervention outcomes at the individual level were evaluated by conducting pre/post cross-sectional surveys in both Intervention and Control buildings (At baseline, Intervention N 107; Comparison =73; At Post-Test Intervention N=103; Comparison N=86). The pre-test was conducted in both buildings during the pre-flu season period (October to December 31). The post-test was conducted in both buildings after the flu season came to an end (May through July 31).
Evaluation results showed that the intervention significantly increased levels of pro-vaccination knowledge and beliefs
(B =.13; P =.063) and social influence (B =.27; P =<.001). It reduced fears of vaccination among peer implementers and participating residents (B =-.19; P =.009), and it improved the vaccination rate in the intervention building from 30.4% to 71%. A test of difference between proportions showed a significant difference between the increase in vaccination in the control building (18%) and the Intervention building (41%), (P =.010).
CONCLUSION
These results and the those of the ISA and building management levels (not reported here) show that a multilevel pilot empowerment intervention conducted with older low income and minority adults in subsidized senior housing can result in sustainable systemic support for vaccination acceptance in a vulnerable population. The approach fills a gap in intervention design utilizing peer education and capacity building approaches with older adults. It has shown that it has the potential to increase and sustain influenza vaccination rates and, at the same time, to create the infrastructure for the acceptance of other vaccines and public health measures that could sustain the independent living situation of older low income adults who also suffer from barriers to quality health care.
Published Article
V.I.P. Project
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