Behavior Change Theory: The Unlikely Hero in Fighting the Flu

If you haven’t heard yet—the flu is going around. In fact, this flu season has been one of the worst on record—and it’s set to get worse. The flu has spread to almost every state in the country, and recently  the Centers for Disease Control (CDC) reported a total of 63 pediatric flu-related deaths this season.

The other day I was speaking with my close friend, Lucy (name changed to protect her identity), about this year’s flu epidemic. Through our conversation, I discovered that not only had Lucy neglected to get the flu vaccine, but that she also had no intention of getting it. To make matters worse, she revealed that she has NEVER gotten the vaccine. As a public health professional (and someone that spends time with her), I was astonished. Unfortunately, my dear friend isn’t the only one: Despite ongoing messaging that the vaccine is important, studies show that less than half of U.S. adults get the flu vaccine each year.

As flu activity remains high and widespread throughout the U.S., why do Lucy and others not feel pressed to get vaccinated?

When I asked Lucy why she didn’t get her flu shot, she cited many of the common excuses—including that this year’s vaccine “isn’t effective.” It’s true this year’s vaccine is only about 17 percent effective, compared to 40 to 60 percent in a typical year. But studies show that it’s still better to get the vaccine even if it’s less effective than in years past. After all, the CDC recommends annual flu shots because, even with uncertain effectiveness, vaccination still reduces a person’s risk of severe illness and even death.

When faced with a severe flu season and a perceptibly ineffective vaccine, how can we, as health communicators, ramp up our messaging to make sure people get vaccinated?

Let’s take a look at the Health Belief Model: A key behavioral theory that addresses preventive health behaviors. The Health Belief Model suggests that behaviors can be changed if messages successfully target five constructs: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action. Using this model, how might we frame our messaging to push Lucy, a healthy young adult, to get the vaccine?

• Increase Lucy’s perception that she is at risk for the flu. Our communications should emphasize that this year’s flu is affecting nearly every type of person in nearly every community, including those who are generally healthy, like Lucy. Flu is all around her—amongst her fellow grocery shoppers, her niece’s classmates, and her fellow commuters. And not being vaccinated increases her risk of getting the flu from any one of these people. The more direct and personalized the messages are, the more effective they become.
• Increase Lucy’s perception that getting the flu is serious. Lucy may not know or understand the potential severity of contracting the flu. We know that this year more people are being hospitalized, and even dying, than in years past—including healthy children. Increasing her awareness of the potentially serious complications of getting the flu will make her feel like the vaccine is worth it.
• Help Lucy understand the vaccine’s benefits. This year’s vaccine is still recommended despite its lack of effectiveness. Why? The vaccine has clear and significant protective benefits, not just for Lucy herself, but for those around her. Help Lucy understand that even this year’s “less effective” vaccine can still protect her from getting the flu and can reduce the severity of the flu if she contracts it. Messaging should clearly emphasize these benefits, especially during peak flu season.
• Identify and reduce Lucy’s barriers to getting the vaccine. There may be barriers that prevent Lucy from taking the next step to actually going out and getting the shot. Communications should ease Lucy’s concerns about the potential side effects, the cost of the vaccine, and her perceived risk of getting sick from the shot.
• Help Lucy follow through. Messaging should provide cues to help Lucy follow through with getting vaccinated. This can involve providing her with information on how to get the vaccine, promoting awareness of places to get the vaccine, and using appropriate reminder systems to incentivize Lucy to go out and get the vaccine. Promoting these actions through the key communication channels Lucy engages with—such as the internet, grocery stores, or health care providers—will increase the effectiveness of our messages.

Though scientists are moving closer to a universal flu vaccine, we must continue to leverage new strategies to add depth and effectiveness to our messaging. Do it for you, your friends, and your community. Now let’s get out there and #FightFlu!

Laura Koehler, M.P.H., C.H.E.S.
Account Executive