Data to Action Success Story: Washington

Tribe-driven development of flu vaccination outreach materials for American Indian and Alaska Native women in Washington State

Problem Overview

Pregnant and postpartum women and infants are at increased risk of severe complications from both seasonal and H1N1 influenza.  Recent work through the development of the Tribal Maternal and Infant Health Strategic Plan for Washington state identified deaths due to infectious disease as an important cause of American Indian/Alaska Native (AI/AN) maternal or infant mortality in Washington. Of particular concern were death rates due to influenza and pneumonia, which were 7 times higher among AI/AN infants than among other infants in the state.

Program Activity Description

Washington’s Pregnancy Risk Assessment Monitoring System (PRAMS) received supplemental funding from CDC in 2011–2013 for enhanced outreach to raise awareness about PRAMS among tribes, encourage participation in PRAMS, and disseminate results from PRAMS to tribal communities.  One of the first project activities was to conduct analyses that examined uptake of seasonal influenza vaccination, H1N1 vaccination, and reasons for not receiving vaccinations among AI/AN women for the 2009–2010 and 2010–2011 flu seasons.

For the 2009–2010 flu season, 64% of AI/AN women received the H1N1 flu vaccine during pregnancy or very shortly after giving birth, and approximately 54% received the seasonal flu vaccine.  For the 2010–2011 flu season, the flu vaccine changed to include one shot that provided protection against both seasonal and H1N1 flu.  During 2010–2011, 63% of all AI/AN women received the vaccine around the time of pregnancy.  AI/AN women offered the vaccine by a healthcare provider were almost four times more likely to get vaccinated compared with AI/AN women who were not offered the vaccine.  AI/AN women commonly reported that they don’t normally get the seasonal flu shot, and this was the primary reason for not getting the shot during pregnancy.

Program Activity Outcomes

On the basis of findings from PRAMS flu data and other available resources, the PRAMS Tribal Flu Steering Committee developed two products about flu vaccination for targeted outreach to AI/AN pregnant women.  The goal of the materials was to encourage AI/AN pregnant women to get the flu vaccination and to educate family and friends to support their decision. The first item was an oversized postcard designed to empower a pregnant woman to talk to her health care provider, which had a message on the back to inform the provider about the need for flu vaccination.  The second item was a poster for health clinics; Women, Infants, and Children (WIC) clinics; and tribal health centers. 

The message for these materials was, “I am Native. I am pregnant and I don’t usually get the flu shot. Today is different. Today I protect my baby.” It was developed based on the results from PRAMS analysis showing the most common reason for not getting the flu shot was that women “didn’t normally get a flu shot.”  The Steering Committee provided extensive input and review to ensure the materials were culturally appropriate, and the Steering Committee approved the final versions.  The review process also ensured that the reading level was appropriate.  The design, messaging, color scheme, and photos were reviewed with a group of new mothers who are members of the Shoalwater Bay Tribe before the materials were disseminated.

In April 2013, 500 posters and 20,000 postcards were printed.  The final materials were presented and distributed to the American Indian Health Commission (AIHC) at an AIHC meeting in 2013.  The AIHC comprises delegates from the 29 tribes and 2 urban Indian organizations in Washington that work together on common healthcare concerns.  The posters and postcards continue to be distributed to various Washington stakeholders and venues (health care clinics, WIC clinics, tribes, and other public venues).  Washington PRAMS also has shared the materials with tribes in other states.  Familiarity with PRAMS among AIHC committee members, Washington tribal health directors, and other tribal health leaders increased from about 5% to 100% over the course of the project.