Eloho Ajayi, MD, on Language Barriers to Receiving the Influenza Vaccine

In this podcast, Eloho Ajayi, MD, discusses her team's latest research that explored the rate of acceptance of the influenza vaccine among patients with limited English proficiency, as well as how she plans to use these findings to better understand why patients refuse the vaccine. 

Additional Resource:

Eloho Ajayi, MD, is a clinical instructor at the University of Cincinnati and a fellow in the Infectious Diseases Department at the University of Cincinnati Medical Center.


Amanda Balbi: Hello everyone, and welcome to another installment of Podcasts360—your go-to resource for medical news and clinical updates. I’m your moderator, Amanda Balbi with Consultant360 Specialty Network.

My guest today is the lead author of a study that aimed to determine the rate of acceptance of the influenza vaccine among patients with limited English proficiency who presented for care at their resident-ran out-patient clinic.

Dr Eloho Ajayi is a clinical instructor at the University of Cincinnati and a fellow in the Infectious Diseases Department at the University of Cincinnati Medical Center.

Thank you for joining me today, Dr Ajayi. To start, can you give us a brief overview of your research and how it came about?

Eloho Ajayi: Thanks so much for having me. I decided to look into this topic during my residency. I was privileged to care for a large population of patients with low English proficiency in our primary health care clinic.

There have been some background data that this population tended to be unable to seek out medical care in a timely manner and also were not really good at following medically recommended interventions.

I wanted to run the study in my population and to see if patients who had low English proficiency were more likely or less likely to accept the influenza vaccine, because as we all know, the flu season can cause annually and it's a condition that has been associated with a high degree of morbidity and mortality amongst people who are elderly or have other comorbid conditions.

The main reason I conducted this study was to see what our population—what their attitudes were towards receiving the influenza vaccine.

I think it is important to study because these patient populations are vulnerable because of the communication barrier. And I felt our results for this study will help physicians to be more proactive and to increase the awareness that this population may need more prompting, more reminders to get vaccines or other elements of preventive health.

Basically, I chose to do this study to use the results to generate more awareness amongst practitioners in my clinic and, eventually, the entire medical community to know that this population may need more interventions to help them embrace the influenza vaccination more than other populations as proficient in English language.

Amanda Balbi: Absolutely. And I think you might have touched on—a little bit—the results before, but can you talk a little bit more about what your study found and how those results may impact clinical practice?

Eloho Ajayi: We took data from 3 different influenza seasons. Influenza seasons run from October of a year to early the next year, like March, April. So, we took data from the 2015-2016, 2016-2017, and 2017-2018 influenza seasons.

Unfortunately, our results were not really encouraging. For example, in our population subsets, we had a significant amount of patients that spoke Spanish, Portuguese, Korean. Our total sample size that was analyzed was 390 patients. Out of this patient group, a vast majority consistently said “no” to the influenza vaccine every season that we studied.

Just to give you a good backdrop of what the study found, for example, only 4.2% of Spanish-speaking patients accepted the influenza vaccine all season. For the Portuguese patients, it was even slightly less. And it was 3.6% of all Portuguese-speaking patients who consistently accepted the influenza vaccine all 3 years.

This poor acceptance rate spanned across all language subtypes that we studied—Korean, Chinese, Arabic, a lot of the minor languages. Of all of the patients, none of them received a vaccine all 3 seasons.

I think that shows a huge opportunity for patient education, patient counseling, and also for physicians to be more proactive in offering this valuable preventive measure to this patient population.

Amanda Balbi: Absolutely. And so, what would you say is your overall key take-home message for health care practitioners?

Eloho Ajayi: My take-home message for health care practitioners is, I know that the communication barrier exists for a lot of providers in the US. The clinical encounter with patients who don't speak in English may be longer because we need translators maybe over the phone or in person.

But the results from the study emphasized strongly that we need to take our time to check all the boxes, see these patients as a whole and not neglect offering them counseling on the need for vaccines and other elements of preventive health.

An extension, while in the early part of the influenza season this year, I hope that providers will become more aware of the needs to be more proactive in offering influenza vaccine to this population this season, especially in the face of the COVID-19 epidemic as well.

Unfortunately, there's a pile of evidence that is increasing every day showing that people with low English proficiency suffer from increased morbidity and mortality when affected by medical conditions. Even data from the ongoing pandemic have shown that people who are of Hispanic heritage are more likely to suffer from morbidity and mortality from COVID-19 infection—infection from the SARS-CoV-2 virus.

So I want to encourage clinicians to—when you have an encounter with patients who have a language barrier, I think we should make sure that the patient understands the message we're trying to pass along. And if a patient refuses a recommended medical intervention that’s backed by medical literature, I think physicians, rather than saying, “Okay, yes. The patient said he's not going to go forward.” I think we should take a step back to understand if the patient really gets the risk and benefits of refusing the intervention.

It may be a little dicey going through an interpreter, but I think it is a step we have to take while caring for every single patient who doesn't speak English fluently or has limited English proficiency.

Amanda Balbi: Absolutely. And so now that you have this data from this study, what is the next step in your research? And how do you plan to use the results from the study in the future?

Eloho Ajayi: I think the next step is to answer the “why” question: “Why are the patients in our clinic saying ‘no’ to the influenza vaccine?”

I think the next step for research is to understand, “Why?” Is it that there is a misconception that is widespread in comments about the vaccine? Or is it the way we are offering the patient the vaccine? I want to know why they consistently refuse the influenza vaccine.

After that, the very next step will be to address the “why” we find. So the next step in the study is to find out why the gap exists and also try to implement changes to improve the vaccination acceptance rate among this vulnerable population.

Amanda Balbi: Great, thank you again for speaking with me today and answering all my questions.

Eloho Ajayi: My pleasure. Amanda. It's been a huge opportunity to present my findings on your platform, and I hope it will be able to trigger a change in the medical community.