36639 Raw Onions, Grandmothers and Vaccine Uptake: How Cultural Traditions of Home Remedies and Self-Reliance May Contribute to Low Immunization Rates Among Adult African Americans

Karen Hilyard, PhD, asst prof at UGA College of Public Health, Health Promotion and Behavior, University of Georgia, Athens, GA, Sandra Quinn, PhD UMD School of Public Health, Department of Family Science, University of Maryland, College Park, MD, Donald Musa, DrPH, University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, PA, Vicki Freimuth, PhD, Department of Communication Studies and Grady College of Journalism and Mass Communication, University of Georgia, Athens, GA and Amelia Jamison, MA, Department of Epidemiology, University of Maryland, College Park, MD

Theoretical Background and research questions/hypothesis:  Dependence on natural remedies (“naturalism”) to prevent flu may be harmful if it precludes evidence-based behaviors such as vaccination.  Little research has focused on racial differences in adherence to naturalism.  Naturalism among African Americans may be a more culturally-based and racially-based set of beliefs and practices than it is for other groups, with important ties to family, history, and self-efficacy in the face of limited access and resources. Debunking alternative remedies could backfire if perceived as attacking culture or tradition, and must be handled in a culturally sensitive way.     Our investigation pursued the following research questions:

  • RQ1: How do naturalistic beliefs and practices of African Americans differ from Whites?
  • RQ2: What impact do naturalistic beliefs and practices have on lower rates of vaccination among adult African Americans? 
  • RQ3: How can communicators better understand these beliefs and practices in order to promote the more desired behavior – vaccination -- in a culturally competent and respectful way?

Methods: This grounded theory study (n=120) included exploratory interviews (6 White (W), 7 Black (B)), focus groups (9 groups; 27 W, 64 B), and in-depth interviews (8 W, 8 B).  In all data collection, respondents varied by vaccine behavior, education, and income.  All data were transcribed and analyzed with Atlas.ti.

Results:  Reliance on naturalist approaches to healthcare – vitamins, herbs, organic foods, “homeopathics,” natural doctors and home remedies – was popular among respondents and appeared to influence flu vaccine decisions.  Both races expressed concern about “chemical” or “unnatural” vaccines and believed medicine might compromise the body’s natural immunity. Self-reliance was often related to naturalistic practices. African Americans often associated naturalistic practices with family matriarchs. For Whites, naturalism seemed disconnected from family tradition or values, and sometimes was a conscious embrace of new or “Eastern” tradition.  Many Whites rejected the flu shot as part of practices like eating organic or doing yoga. African American respondents cited religious faith and past discrimination or lack of access to medical treatment as reasons for embracing naturalism.  Home remedies varied by race, such as African Americans’ frequent use of raw onions near the bed to prevent flu. 

Conclusions:  Both blacks and whites engage in complementary or alternative beliefs and practices, but sometimes the reasons are different.  For whites, such practices may be a choice, but for African Americans, such practices may be a tradition. 

Implications for research and/or practice:  Increased access to vaccination for insured patients under the Affordable Care Act provides an opening to change traditions related to vaccination. Instead of treating naturalistic beliefs as a deficit or competing behavior that precludes vaccination, practitioners should approach it from a perspective of cultural respect, seeking ways to work with this self-sufficient behavior, not against it.  Flu vaccination campaigns should target African American matriarchs and elders as key influencers of health practices.  Rather than debunking beliefs that are not supported by evidence and suggesting traditional (but harmless) practices be replaced by vaccination, communicators may wish to reposition naturalistic beliefs as complementary or supplemental, emphasizing vaccination as a first line of defense.