Article Text

Patient Education Strategies to Improve Pneumococcal Vaccination Rates: Randomized Trial
  1. Donna M. Thomas,
  2. Susan M. Ray,
  3. Felicia J. Morton,
  4. Jennifers Drew,
  5. Gardiner Offutt,
  6. Cynthia G. Whitney,
  7. Terry A. Jacobson
  1. From the Department of Medicine (D.M.T., S.M.R., T.A.J.), Emory University School of Medicine; The Office of Health Promotion and Disease Prevention (F.J.M., T.A.J.), Grady Health System; The Atlanta Veterans Affairs Medical Center (J.S.D., G.O.) and the Georgia Emerging Infections Program (D.M.T., S.M.R.,J.S.D., G.O.); Centers for Disease Control and Prevention (C.G.W.), Atlanta, GA.
  1. Supported in part by a grant from the National Vaccine Program and the CDC Emerging Infections Program. Also supported in part by Indigent Care Trust Funds from the State of Georgia to the Office of Health Promotion and Disease Prevention at Grady Health System.
  2. Presented in part at the 34th National Immunization Conference in Washington, DC, July 2000.
  3. Address correspondence to: Dr. Susan M. Ray, Department of Medicine 69 Butler St, SE, Atlanta, GA 30303. Tel: 404-616-6139; fax: 404-880-9305; e-mail: sray02{at}


Background The pneumococcal vaccine is widely underused. Patient education is one mechanism not widely explored for increasing vaccination rates.

Objective To evaluate the effects of a culturally appropriate patient education videotape on pneumococcal vaccination rates among the clinic population of an inner-city public hospital.

Methods Randomized, controlled trial comparing (1) a videotapebrochure group who both viewed the videotape and received a lowliteracy brochure, (2) a videotape only group, and (3) a control group.

Results Of 2,962 charts reviewed, 558 patients were randomized. The study population was 94% black, 73% female, and elderly (mean age 63.0 years) and 64% had less than a high school education. Patients in the videotape-brochure group were 2.5 (1.8, 3.5 95% CI) times more likely to discuss the vaccine with their physician (p < .001) and 3.5 (1.9, 6.5 95% CI) times more likely to receive the vaccine (p < .001) than the control group. The videotape-brochure group was 1.6 (1.2, 2.1 95% CI) times more likely to discuss the vaccine (p < .001) and 2.3 (1.4, 3.8 95% CI) times more likely to receive the vaccine (p = .002) than the video only group. Patients in the video only group were 1.6 (1.1, 2.3 95% CI) times more likely to discuss the vaccine with their physician than the control group (p = .041) but were not more likely to receive the vaccine.

Conclusion A culturally appropriate videotape along with a lowliteracy brochure significantly increased pneumococcal vaccination rates and physician-patient discussion about the vaccine. These significant outcomes were not observed with use of videotape alone and were likely attributable to the effect of the brochure. We recommend that patient education initiatives to increase vaccination rates not focus solely on audiovisual media.

Key Words
  • pneumococcal vaccination
  • patient education
  • audiovisual
  • low literacy
  • adult immunization

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