This week I am taking a break from discussing teaching Latino culture to medical professionals to discuss something more pertinent this time of year: flu vaccines. Each year, Latino patients are less likely to receive the flu vaccine than any other population. Studies suggest that the average number of flu-related deaths each yearis 36,000 (between 3,300 and 49,000 depending on the year). While these numbers are debatable, I still believe it is an important topic of discussion. In this post, I will describe some possible reasons for why the Latino population has a lower vaccination rate and how we can equip our students to communicate with these patients in such a way that alleviates this disparity.
In the United States, only 40.6% of Latinos receive the flu shot each year while non-Latino whites are vaccinated at a rate of 52.7%. These statistics are even more surprising when we take into consideration the incidences of pre-existing conditions among each population. Some pre-existing conditions, such as asthma diabetes and heart disease, can either be made worse by the flu or can make the effects of the flu more harmful, possibly even deadly. For this reason, people who have these conditions are strongly recommended to receive the flu vaccine each year and, therefore, tend to have a higher follow through rates with receiving it. However, even though the Latino population has more incidences of these pre-existing conditions than the white non-Latino population, the statistics reveal that fewer Latinos receive the vaccine. These lower vaccination rates are even more confusing when we add in the fact that Latinos tend to be more accepting of vaccines in general than their white counterparts. For example, they are less resistant to childhood vaccines. So why is the flu vaccine suddenly an issue?
A few of the current theories point to a variety of culprits including language and cultural barriers, fear of problems due to immigration status, difficulties due to transportation and frequent mobility, and the lack of communication with their medical providers. In terms of language barriers, I have explained in previous posts the tendency of native-English speaking doctors to not explain all of the side effects of medications to Spanish-speaking patients and the resulting non-compliance. The same holds true for vaccines. When not all of the side effects are explained, patients do not understand how to interpret what they experience after taking the medicine or receiving the vaccine. For example, some patients, due to this lack of information, believe they got the flu from receiving the vaccine and consequently refuse to receive the vaccine in the future. In terms of cultural barriers, these can range from machismo (real men do not get sick) to lack of knowledge of the healthcare system. Many patients are unclear on why to get vaccine, where to go and when. Fear of immigration status plays a role among undocumented Latinos health practices. Some fears I heard while working in the clinic setting included fears that: their name would be registered when they received the vaccine and, as a consequence, they would be deported or the fear that, by receiving assistance (such as a free vaccine), their child would owe money in the future or their child would become property of the government or their own paperwork process for becoming a legal citizen would be affected. Transportation can also be a barrier for those living in rural areas or places without a good public transit system. Frequent mobility refers to the tendency to move often. This affects flu shot rates because each time they move to a new area, they must become familiar with the resources available in terms of care and transportation. Finally, a big factor here is the lack of communication with the medical professional. The best time to encourage patients to get flu vaccines is when they are already in clinic. This can be while the doctor is discussing their condition (such as diabetes) or at a sick visit near the flu season time. In either case, it is important that the provider expresses the necessity of the flu vaccine as well as when and where they can get it.
In Spanish for healthcare professionals courses, the students know better than the instructor what the patient needs to know about the vaccine. However, they do need help knowing how to pass this knowledge to the patient as well as how to communicate with the patient on the topic inter-culturally. As instructors, we need to explain that due to beliefs such as personalismo (which I will explain in a later post) and a possible lack of literacy, it is not enough to give a patient a handout in Spanish on the flu vaccine that answers the most commonly asked questions. Instead, the provider should consider doing the following:
- Take the time to explain the flu vaccine to Latino patients either during appointments where complicating conditions are the topic or during appointments near or during flu season
- Encourage patients that immigration status is not affected or taken into consideration
- Let patients know where and then they can get the flu vaccines
- Be familiar with which clinics offer the vaccine least expensively, even if that happens to not be at the clinic where the professional is working
- Know what public transit can be used to get to places where the flu vaccine is offered
- Be sure to explain any and all side effects, encouraging the patient that the side effects are better than the flu itself
- Appeal to the patient as a provider and caretaker of the family rather than only as a high risk patient. Realizing the financial impact of a week off from work or the possibility of infecting their children or family members is more motivating to many Latino patients than the possible risks to their own health.
Arellano, Ana (2012): “Latinos most in need but reluctant to get flu shots”. CT Latino News, URL: http://ctlatinonews.com/blog/2012/10/25/latinos-most-in-need-but-most-reluctant-to-get-flu-shots/
Deruy, Emily (2013): Latinos less likely to get a flu shot than any other ethnic groups”. ABC News, URL: http://abcnews.go.com/ABC_Univision/Politics/flu-vaccines-latinos-ethnic-groups/story?id=18193016 [06/10/2013]
Neel, Joe (2010): “How many people die from flu each year? Depends how you slice the data.” NPR. URL: http://www.npr.org/blogs/health/2010/08/26/129456941/annual-flu-death-average-fluctuates-depending-on-how-you-slice-it
US Department of Health and Human Services Office of Minority Health (2012): “Immunizations and Hispanic Americans”. URL: http://minorityhealth.hhs.gov/templates/content.aspx?ID=3328 [06/10/2013]