Correlation between family physician’s direct advice and pneumococcal vaccination intention and behavior among the elderly in Japan: a cross-sectional study

Mariko Higuchi, Keiichiro Narumoto, Takahiro Goto, Machiko Inoue

Vaccination is an important element of health maintenance in family medicine. The 23-valent pneumococcal polysaccharide vaccine (PPSV23) is highly recommended for the elderly, but its uptake is low in Japan. Primary care system remains under development and preventive services tend to be neglected in the Japanese medical practice. The study aims to investigate the association between family physician's recommendations for PPSV23 during outpatient care and PPSV23 vaccination intention and behavior in the elderly. We conducted a cross-sectional study with a questionnaire at a family medicine clinic in a rural area in Japan. The participants were over the age of 65 without dementia who had maintained a continuity with the clinic. The questionnaire inquired PPSV23 vaccination status, family physician's advice for PPSV23, socio-demographics, and the constructs in the Health Belief Model. We defined those who had had vaccination intention and behavior as "PPSV23 vaccinated group" and those who had no vaccination and uncertainty about being or no intention to be vaccinated in the future as "PPSV23 unvaccinated group." We used chi-square test for correlation between physician's advice and PPSV23 vaccination/intention, univariate and multivariate logistic regression analysis for factors related to the vaccination/intention, and descriptive analysis for reasons for reluctance to the vaccination. We analyzed 209 valid responses. There were 142 participants in the PPSV23 vaccinated group and 67 in the PPSV23 unvaccinated group. The PPSV23 vaccination group was more likely to have had their physician's advice (80.2% vs 21.3%, p < 0.001). Multivariate logistic regression analysis showed a significant association between PPSV23 vaccination and their physician's recommendation (OR 8.50, 95%CI 2.8-26.0), awareness of PPSV23 (OR 8.52, 95%CI 2.1-35.0), and the perceived effectiveness of PPSV23 (OR 4.10, 95%CI 1.2-13.9). The reasons for reluctance to get vaccinated included lack of understanding of PPSV23, lack of physician's recommendations, and concerns about side effects of PPSV23. Family physician's recommendation was positively correlated with PPSV23 vaccination intention and behavior in the elderly. This reinforces the importance of providing preventive services during time-constrained outpatient care, even in medical systems where it is undervalued.