Family physicians beliefs and attitudes regarding adult pneumococcal and influenza immunization in Lebanon

Background. Influenza and pneumococcal diseases are responsible for more deaths than all other vaccine-preventable diseases combined. Despite all efforts, the vaccination rate is below target. Objectives. To assess knowledge and beliefs of family physicians in Lebanon regarding influenza and pneumococcal vaccines, to identify adult immunization barriers, to assess physicians' use of evidence-based strategies to improve adult immunization and identify barriers to implementation of such strategies. Methods. All 52 Lebanese family physicians attending the annual family medicine conference in Beirut in November 2009 were asked to fill a self-administered questionnaire that included items inquiring about knowledge, beliefs, attitudes, barriers to these vaccines and their opinions regarding strategies to improve immunization rate. Results. Response rate was 82.7%. Accurate knowledge of influenza and pneumococcal vaccination guidelines was 58.1% and 53.5%, respectively. Thirty-eight physicians (88.4%) believe that influenza and pneumococcal vaccines are important, while 36 (83.7%) recommend influenza vaccine and 33 (76.7%) pneumococcal vaccine. Barriers for recommending vaccines were reported by 14 participants (32.5%). Concerning the influenza vaccine, the most commonly reported barriers were patient's refusal and non-availability of the vaccine, followed by physicians' concerns about efficacy and safety. As for the pneumococcal vaccine, the most frequently reported barriers were patient's refusal, cost and physicians concerns about efficacy. Insufficient time and unknown immunization status were reported to be barriers of lesser importance. Twenty-six physicians (61%) reported physicians' reminders as the most important intervention to promote adult immunization, followed by patient education (48%). Lack of time and availability of electronic medical record were cited as important strategies to increase adult immunization rate. Conclusions. Education and intervention efforts are needed to overcome barriers faced by practitioners and to define the most effective strategies to overcoming these barriers.