The impact of pharmacist-led educational intervention on pneumococcal vaccine awareness and acceptance among elderly in Jordan

Figures & data

Figure 1. Flowchart of participant enrollment, data collection, educational interview, and follow-up. KAP; knowledge, attitude, and practice

Table 1. Sociodemographic characteristics of the participants and their association with the outcome measure “A physician consultation regarding pneumococcal vaccines”

	%^a(n)	%^b(n)	P-value^c
Age (median ± IQR)^d	70.0 ± 7	70.0 ± 7	0.188
Gender^e
Male	19.3% (177)	21.2% (145)	0.007*
Female	80.7% (739)	78.8% (538)
Cognitive impairment^e
Impairment likely	7.9% (n = 72)	7.8% (53)	0.786
Impairment less likely	92.1% (n = 844)	92.2% (630)
Educational level^e
≤High school	72.6% (665)	71.7% (490)	0.027*
≥College or higher	27.4% (251)	28.3% (193)
Income^e
≤500 JD	83.1% (761)	83% (567)	0.005*
>500 JD	16.9% (155)	17% (116)
Employment^e
Full or part time	3.2% (29)	4% (28)	0.001*
Unemployed	96.8% (887)	96% (655)
Working in the medical field^e
Yes	2.8% (26)	2.8% (19)	0.296
No	97.2% (890)	97.2% (664)
Marital status^e
Married	62.6% (573)	65.9% (450)	0.393
Others (widow, divorced, single)	37.4% (343)	34.1% (233)
Number of sons^e
≤ 3	14.2% (130)	14.1% (96)	0.089
>3	85.8% (786)	85.9% (587)
Medical insurance^e
Yes	94.2% (863)	94% (642)	0.000*
No	5.8% (53)	6% (41)
Smoking status^e
Yes	5.5% (50)	6.1% (42)	0.171
No	94.5% (866)	93.9% (641)
Self-described health status^e
Excellent	4.4% (40)	5% (34)	0.955
Very good	12.6% (115)	12.7% (87)
Good	66.2% (606)	67.4% (460)
Poor	15.3% (140)	14.2% (97)
Very poor	1.6% (15)	0.7% (5)
Medical provider visits during the past 6 months^e
≤ 3	54.5% (499)	55.9% (382)	0.385
>3	45.5% (417)	44.1% (301)
Having care giver at home^e
Yes	48.9% (448)	47.6% (325)	0.343
No	51.1% (468)	52.4% (358)
Having ever heard about pneumococcal pneumonia and its vaccine^e
Yes	3.9% (36)	4% (27)	0.01*
No	96.1% (880)	96% (656)
Seasonal influenza vaccine uptake^e
Yes	23.0% (211)	23.7% (162)	0.044*
No or not sure	77% (705)	76.3% (521)

IQR: interquartile range; JD: Jordanian Dinar.

^avalid percent of the whole study population (N = 916).

^bvalid percent of the participants who completed the study (n = 683)

^cA Pvalue of less than 0.05 indicate a significant association of the covariate with a high likelihood of a physician consultation among the participants who completed the study (n = 683)

^dEta test, Eta coefficient is presented.

^ePearson’s chi-square test.

Table 2. Risk factors for invasive pneumococcal disease and pneumococcal carriage (N = 916)

Factor	%^a(n)
Risk factors for invasive pneumococcal disease
Chronic kidney disease	4.4% (40)
Nephrotic syndrome	0.1%(1)
leukemia	0.3% (3)
lymphoma	0.3% (3)
Cerebrovascular disease	2.7% (25)
Liver disease	0.9%(8)
Drug- or radiation- induced immunosuppression	3.8% (35)
Solid organ transplant	0.1% (1)
Sickle cell disease and hemoglobinopathies	0.2% (2)
Myocardial Infarction	13.1% (120)
Coronary artery disease	17.4% (159)
Peripheral vascular disease	1.6% (15)
Asthma	7.0%(64)
COPD	0.4% (4)
Diabetes	52.2% (478)
Risk factors for pneumococcal carriage
Contact with children aged <2 at least once a month.	62.6% (573)
Contact with children aged 2–12 at least once a month.	87.2% (799)
Sharing bedroom with other family members.	34.2% (313)
Antibiotic use within the past 6 months.	47.8% (438)

^aValid percent.

Table 3. Knowledge of participants who have heard about pneumococcal disease and its vaccine and the obstacles and determinants of vaccine uptake (n = 36)

Knowledge about pneumococcal infection	%^a(n)
Pneumococcal infection is the principal causative agent of bacterial pneumonia, otitis media, sinusitis, meningitis and septicemia.	55.6% (20)
Children younger than 2 years old are at high risk of these infection.	77.8% (28)
Elderly aged ≥65 years are at risk of invasive pneumococcal disease.	80.6% (29)
Pneumococcal bacteria can spread from person to person by direct contact with respiratory secretions, like saliva or mucus.	94.4% (34)
Effective vaccine is available to prevent invasive pneumococcal disease in elderly.	55.6% (20)
Washing hands with soap and water after coughing/sneezing can prevent the spread of the disease.	97.2% (35)
Reasons for not getting vaccinated (as specified by those who have not had the vaccine before)
Unaware of its importance.	19.4% (7)
Healthy people do not need it.	16.7% (6)
Do not think that the vaccine is effective.	5.6% (2)
Fear of contracting illness.	8.3% (3)
Unaware of vaccine availability.	47.2% (17)
Concerns of the side effects of the vaccine.	16.7% (6)
Do not consider pneumococcal illness as a threat.	2.8% (1)
Cost of the vaccine.	8.3% (3)
Factors that would encourage the participants to get vaccinated in the future (as specified by all the participants regardless of vaccination status)
If it is provided by the government for free.	86.1% (31)
If the vaccine was tested more thoroughly for safety and efficacy.	94.4% (34)
If it is recommended by a physician.	97.2% (35)
If it is cheaper.	83.3% (30)

^aValid percent.

Table 4. Obstacles against pneumococcal vaccine uptake (n = 683)

Factor	%^a(n)
Do not think the vaccine is important for their health.	45.5% (311)
The physician had not recommended it	25.6% (175)
Concern of side effects.	23.1% (158)
Price.	22.3% (152)
Fear of contracting illness.	13.8% (94)
Time limitation.	8.8% (55)
Not convinced of its efficacy.	4.4% (30)
Availability of the vaccine.	1.6% (11)
Do not consider pneumococcal disease as a threat.	1.5% (10)

Table 5. Multiple logistic regression results for the covariates associated with a high likelihood of a physician consultation regarding pneumococcal vaccine among the participants who completed the study

	B	S.E	Pvalue	OR	95% C.I.
Gender Male female^a	−0.077	0.249	.756	0.926	0.568–1.509
Level of education High school or lower College or higher^a	0.203	0.230	.378	1.225	0.781–1.922
Income ≤500 JD >500 JD^a	−0.347	0.249	.164	0.707	0.434–1.152
Employment Full or part time unemployed^a	1.252	0.484	.010	3.497	1.355–9.029
Insurance Yes No^a	1.564	0.562	.005	4.780	1.590–14.368
Having ever heard about pneumococcal pneumonia and its vaccine Yes No^a	0.308	0.439	.484	1.360	0.575¬-3.218
The perception of pneumococcal disease as a health threat Yes No or Not sure^a	0.386	0.205	.059	1.471	0.985¬-2.196
The belief in the health benefits of the vaccine (educational interview) Yes No or Not sure^a	0.134	0.184	.466	1.143	0.798–1.639
The belief in the health benefits of the vaccine (two-months follow-up) Yes No or Not sure^a	1.192	0.195	.000	3.294	2.247–4.827
Reading the booklet Yes No^a	0.666	0.186	.000	1.947	1.351–2.806
Constant	−2.883	0.645	.000	0.056

OR; odds ratio.

^aReference category.

*Significant at P value < 0.05.