H1N1 Flu: Communicating Risk of Complications to Populations with Chronic Medical Conditions

Background:  People living with chronic medical conditions such as asthma, emphysema, chronic bronchitis, metabolic disorders, or weakened immune systems are at higher risk for complications from infectious diseases, including influenza. The rapid spread of the 2009 H1N1 influenza virus created an urgent need for this and other priority populations to get immunized when the vaccine became available.

Program background: People with underlying medical conditions have been a priority audience for messages about seasonal flu vaccine, however, new communication challenges were presented by the need for a separate vaccine for H1N1. AED and Michael’s Opinion Research conducted formative research on behalf of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention (CDC) to guide development of effective communication to people with underlying chronic diseases about  immunization against both H1N1 and seasonal influenza.

Evaluation Methods and Results: Online surveys and focus groups were conducted with adults between the ages of 25-64 years with conditions including asthma, diabetes, and weakened immune systems between August and October in 2009. The research collected information on risk perception, knowledge and beliefs about the H1N1 vaccine, and reactions to draft messages and advertisements.  Participants tended to differentiate between a high risk associated with contracting 2009 H1N1 influenza and the risk of suffering serious complications if they did get infected.  Many with chronic medical conditions were unreceptive to the message that they were at higher risk for life-threatening complications from H1N1 and opted out of heightened concern about the virus.  In the absence of explicit descriptions of specific chronic medical conditions that might increase the risk of serious consequences from the H1N1 virus, “at risk” populations also tended to reject messages aimed at them. Using examples of tested messages and imagery, the presentation will discuss findings of the CDC’s H1N1 immunization communications research and explore confusion about the risk of acquiring the virus, which target populations may accept, and the risk from consequences of the virus, which they may reject. 

Conclusions:  Findings from formative research with people living with chronic medical conditions illustrate how barriers to effective communication about the benefits of immunization are often subtle and can lead to unexpected resistance to intended messages. Targeting communication to specific medical conditions and providing sufficient information on why they are at risk increases the likelihood of the acceptance of the message.

Implications for research and/or practice: Findings from this research can provide guidance to other health communication campaigns targeting people with chronic conditions.  Perceived risk is a construct common to several theories of behavior change, including Health Belief Model, Theory of Reasoned Action, and Social Learning Theory, and responses from this audience emphasize that it is often multi-dimensional. The subtle nuances of perceived risk suggest that materials should be carefully pre-tested with this audience.