Understanding Black Patients' Refusal of Pneumococcal Vaccination

J Racial Ethn Health Disparities. 2017 Feb;4(1):1-8. doi: 10.1007/s40615-015-0193-9. Epub 2015 Dec 22.


Objective: Racial disparities in rates of pneumococcal vaccine (PPSV23) exist. In one practice, 3.1 % of white patients refused PPSV23 following doctor recommendation, whereas 11.2 % of black patients refused vaccination. Our objective was to understand reasons black patients refused PPSV23.

Methods: Mixed-method telephone survey in 2012 of black patients aged ≥65 with a documented refusal of PPSV23. The survey assessed beliefs about PPSV23; reasons for non-receipt of PPSV23; receipt of other vaccinations; and comparative perceptions of adult vs. childhood vaccines. Participants responded to items on a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree).

Results: Participants' (N = 40) mean age was 73 years; 95 % were female. Participants recognized pneumonia could be deadly (M = 4.3, SD = 1.0), but reported low levels of personal susceptibility (M = 2.8, SD = 1.4). Participants perceived childhood vaccines to be safer (M = 4.2, SD = 1.2) than adult vaccines (M = 3.4, SD = 1.4; p < 0.01). Qualitative analyses to understand reasons for refusal of vaccine both reinforced identified low perceptions of personal susceptibility as well as identified numerous additional barriers to receipt of PPSV23 (e.g., fear, side effects, and mistrust).

Conclusions: Black patients in our sample who refused PPSV23 may not perceive themselves susceptible to the disease, suggesting that strategies to improve PPSV23 rates among these patients may need to emphasize susceptibility to pneumonia. Further, given the discrepancies in perceptions toward childhood versus adult vaccinations, focusing on vaccination across the lifespan may be a promising vaccine promotion strategy.

Keywords: Disparities; Qualitative research; Vaccinations.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • African Americans / psychology*
  • African Americans / statistics & numerical data
  • Aged
  • Chicago
  • Female
  • Health Knowledge, Attitudes, Practice / ethnology
  • Healthcare Disparities / ethnology*
  • Humans
  • Male
  • Pneumococcal Infections / ethnology*
  • Pneumococcal Infections / prevention & control
  • Pneumococcal Vaccines / administration & dosage*
  • Qualitative Research
  • Surveys and Questionnaires
  • Treatment Refusal / ethnology*


  • 23-valent pneumococcal capsular polysaccharide vaccine
  • Pneumococcal Vaccines