BACKGROUND:
A patient's decision to accept or reject a provider's recommendation to receive a vaccination is the culmination of a complex set of interactions that include individual beliefs and health experience, family and community influences, work sites and health center support, and the provider-patient relationship. To understand a patient's decision to be vaccinated requires appreciating the complexity of these interactions. The Behavioral Ecological Model (BEM) has been developed to accommodate and explain these circles of influence as a set of hierarchical contingencies that influence health decisions. This model assumes that hierarchical and interacting contingencies of reinforcement must be engineered to compensate for natural contingencies that result in risk practices or the failure to practice prevention activities, including delivery of vaccinations.

OBJECTIVE:
To describe the application of the BEM model in understanding patient decisions to be vaccinated for influenza in five primary care settings in San Diego.

METHOD:
200 high risk (diabetes, COPD, renal failure) adults, 20-50 years old, who had not yet received the flu shot, were interviewed at the time of presentation to outpatient visits. Exit interviews were obtained on all participants, irrespective of immunization receipt.

RESULT:
We will present results on the relationship between immunization receipt and ecological contingencies.

CONCLUSION:
This study will help target interventions to improve immunization compliance.

LEARNING OBJECTIVES:
Use of BEM to contextualize patient decision-making.