Health education and factors influencing acceptance of and willingness to pay for influenza vaccination among older adults

BMC Geriatr. 2015 Oct 26;15:136. doi: 10.1186/s12877-015-0137-6.


Background: The influenza vaccine is recommended in older population. However the immunization coverage varies globally. It has been reported as low as 10-20 % in some countries. This study explored the acceptance of and willingness to pay for influenza vaccination, comparing acceptance and willingness to pay before and after health education.

Methods: The study was conducted with 2693 older people in Bangkok, Thailand. Participants were divided into an education group (n = 1402) and a control group (n = 1291). A validated questionnaire measuring acceptance of and willingness to pay for vaccination was administered during semi-structured interviews before and after education. Data on factors influencing acceptance were analyzed.

Results: Participants' mean age was 69.5 years, 80 % were women and 82.1 % had at least one co-morbidity. Of the participants, 43.5 % had previously received vaccination more than once, although 92.8 % expressed acceptance of vaccination. Acceptance was associated with a positive attitude toward vaccination (OR 2.1, 95 % CI 1.5-2.9) and a history of receiving vaccination (OR 4.1, 95 % CI 2.8-6.1). At baseline, there were no differences between the education and control groups in terms of work status (p = 0.457), co-morbidities (p = 0.07), medical status (p = 0.243), and previous vaccination (p = 0.62), except for educational background (p = 0.004). Acceptance of vaccination increased to 95.8 % (p < 0.001) after education and willingness to pay increased to 82.1 % (p < 0.001). Education significantly affected those with primary school-level education and no previous vaccination history, with acceptance increasing from 83.3 to 92.6 % (p < 0.001); more than twice as high as the control group (OR 2.4, 95 % CI 1.2-4.7). Viewing an educational video increased the proportion of participants with a high level of knowledge from 29.2 to 49.2 % (p < 0.001), and increased the proportion of participants with a positive attitude from 52.4 to 70.7 % (p <0.001). No significant difference was found in any parameter between the first and second assessment in the control group.

Conclusions: The strategies to increase positive attitudes may enhance the acceptance of vaccination. Health education using an educational video demonstrated a significant impact on acceptance, willingness to pay, knowledge and attitude in older people. This may lead to increased sustainability of the immunization program in older people.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Fees, Pharmaceutical
  • Female
  • Humans
  • Influenza Vaccines* / economics
  • Influenza Vaccines* / therapeutic use
  • Influenza, Human / prevention & control*
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Patient Compliance* / psychology
  • Patient Compliance* / statistics & numerical data
  • Patient Education as Topic / methods*
  • Surveys and Questionnaires
  • Thailand
  • Vaccination* / economics
  • Vaccination* / methods
  • Vaccination* / psychology


  • Influenza Vaccines