Names of patients were randomly selected from each category using computer-generated random numbers. A letter was first sent to the patient's GP requesting permission to contact the patient for interview. Upon confirmation, the GP was asked to forward a study information pack to the patient. The research nurse contacted patients as soon as they returned the consent form to arrange an interview. Replacements were sought if GP permission was not obtained, the patient failed to respond to the invitation, declined interview, or immunisation status had changed. Recruitment of refusers and defaulters was particularly difficult. Consequently, several general practices participating in a parallel study of health worker attitudes to influenza immunisation were approached and asked to assist by identifying older patients who had never had influenza vaccine. They recruited these patients either by issuing study packs during consultation or by an invitation letter.
How this fits in
The main barriers to influenza immunisation in older people appear to be negative patient perceptions and the lack of an organised approach in GP surgeries. Most previous studies have used a quantitative approach that does not allow in-depth exploration of the values and beliefs that shape patient attitudes. This qualitative study shows that health education messages about influenza immunisation need to challenge the perception that influenza carries no risk for healthy older people, but to avoid undermining older people's self image of being fit, strong, and healthy. Health professionals should also make greater use of personalised prompts and reminders in strategies to promote influenza vaccine uptake.
