patient getting a flu vaccine
February 6, 2018

Social norms, those unspoken rules about what is acceptable behavior, tell us what we think others are doing and what others think we should be doing. Social norms influence how we dress, how we greet one another, the words we use, and—new research from Maryland shows—whether we will get an annual flu shot.

Results from a study led by School of Public Health Professor Sandra Quinn indicate that social norms, and specifically subjective social norms, may be important areas to target to increase flu vaccine uptake, especially among African American adults. Their results appear in the article, "The influence of social norms on flu vaccination among African American and White adults", in Health Education Research.

Dr. Quinn, who is senior associate director of the Maryland Center for Health Equity, and her colleagues explored the impact of social norms on flu vaccine acceptance in a novel way. First, their study is one of the only to explore racially specific norms. Further, they are one of the first to examine both descriptive (what others do) and subjective norms (what others think one should do).

Using both qualitative and quantitative approaches, the team examined whether social norms seemed to exist around vaccination, how influential they are and whether social norms could be harnessed to reduce vaccine racial disparities.

In assessing descriptive norms around flu vaccination, both the qualitative and quantitative findings indicated that respondents believed about half the population receives a flu vaccine, which reflects the reality that just under half of all adults receive the vaccine.

The survey results indicated that while subjective norms appeared to be more influential in shaping vaccine behavior among African Americans, subjective norms were a significant influence on both white and African American vaccine behavior. Over 60% of whites and 50% of African Americans who did not get vaccinated reported that few people close to them wanted them to get the vaccine. Conversely, over 40% of whites and over 30% of African Americans who took the vaccine reported that most or nearly all wanted them to get the vaccine. The authors note, “this speaks to the dramatic impact of subjective norms on vaccine behavior.”

The authors conclude with some guidance for public health researchers and health care practitioners to help increase flu vaccine uptake for African American and white adults. “Perceived descriptive norms about flu vaccination are weak, but realistic, reflecting the reality that just under half of all adults receive a flu vaccination, with even lower uptake among African Americans. More importantly, we identified a greater association between subjective norms and vaccination behavior, extending across both races. This finding suggests that increasing communication among loved ones about flu vaccine may be an effective tactic to increase flu vaccination.”

In addition to Sandra Quinn, the research team includes Karen M. Hilyard (FHI 360), Amelia M. Jamison, Ji An, Gregory R. Hancock (all of University of Maryland), Donald Musa (University of Pittsburgh), and Vicki S. Freimuth (University of Georgia).

“The influence of social norms on flu vaccination among African American and White adults” was published in Health Education Research.

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The influence of social norms on flu vaccination among African American and White adults

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Sandra C. Quinn