An examination of attitudes, beliefs and behaviors related to vaccination and testing practices for seasonal influenza and viral hepatitis B & C in Native American populations residing in Indiana

Background  Two areas noted in Native American health disparities identified by Healthy People 2020 are vaccine preventable illness and screening for hepatitis.  The Indiana Minority Health Coalition in collaboration with American Indian Center of Indiana and Dr. Juanita Ebert Brand/ Ball State University completed a one-year qualitative study examining  attitudes/beliefs related to vaccination and testing practices for influenza and hepatitis B & C in NA peoples residing in Indiana.  Although there are tribal claims to historical lands, there are no Federally recognized tribes with tribal lands in Indiana.  With no  Federally recognized tribes, there are no Indian Health Service Clinics within Indiana. 

Methods  Purposeful sampling was conducted—59 men and women, self-identified as Native American, were recruited from Pow wows held in Indiana from 9/21/13 to 1/4/14.  Open-ended interviews were conducted, along with demographic & vaccination survey. Interviews were audio recorded. Important areas explored: identity and cultural influences and health; understanding of influenza and hepatitis B vaccination, and Hepatitis C testing;  & confidence in healthcare. 

Results   Fifty nine individuals were enrolled in study (male=23, female 30, two spirit =6).  Participants  ages were 19-75 years. Participants reported 20 different tribal affiliations.  Participants reported 42% (25) receiving flu vaccination within 12 months.  This number is similar to national 2011-2012 influenza vaccination rate for NA.  Chi square tests conducted for gender found no difference between males and females in influenza vaccination, Hepatitis B vaccination or Hepatitis C testing. 

Three major themes emerged: Community as part of health; perceptions of trust-vs-mistrust in healthcare; knowledge deficits regarding hepatitis B & C.  With analysis of interview findings 75% of participants voiced the Native American community as important to life and health.  The impact of trust vs mistrust of healthcare vaccination practices & providers was a 2^nd   major theme with 35% relating statements of mistrust of health care services. The third major theme noted was lack of knowledge and understanding about Hepatitis B & C. A significant proportion expressed lack of understanding or knowledge regarding CDC initiative to initiate Hepatitis C testing.

Conclusions  Despite public information related to safety and efficacy of seasonal influenza & Hepatitis B vaccination, mistrust still exists. A significant proportion of participants interviewed had little knowledge about Hepatitis C testing. Providers should be aware of the possibility of trust and access issues with members of Native American community related to health care & utilize an approach that demonstrates respect for Native American beliefs.