Use of Health Belief Model to Explain Uptake Patterns of Recommended Vaccines among British Pilgrims to the Hajj 2015 (Thesis Proposal Sample)

Use of Health Belief Model to Explain Uptake Patterns of Recommended Vaccines among British Pilgrims to the Hajj 2015
Name
Institution
Abstract
The Hajj pilgrimage to Mecca, Saudi Arabia, is a deeply spiritual journey undertaken by all physically and financially capable Muslims at least once in a lifetime. Hajj brings more that 1.5 million pilgrims from more than 180 countries and territories into a confined place. Consequently, public health authorities worldwide consider the Hajj as serious challenge to public health. Respiratory viruses have been a threat to public health during the Hajj. In some cases, outbreaks of respiratory infections with high mortalities have been reported just before the Hajj. To prevent the spread of respiratory infections, Saudi government requires that all pilgrims receive a set of mandatory vaccines, and recommends another set. Despite their potential to prevent developing the infections, recommended vaccines have low uptake among pilgrims, with the rates going as low as 0.7% among study populations. To date, there has been no study that has examined the uptake of recommended vaccines, including reasons for refusal, among British pilgrims using a mixed methods approach and the health belief model. The proposed study, therefore, is intended to examine, using both surveys and interviews, the dynamics involved in the uptake of recommended vaccines. The aim is to find out the role of health beliefs (perceived susceptibility, perceived severity, perceived benefits, and perceived benefits), modifying factors, and cues to action in the uptake of recommended vaccines. Health beliefs will be examined in relation in to two relatively recent fatal outbreaks, the pandemic H1N1 and MERS-CoV. It is also noted that when there are outbreaks of severe and fatal respiratory infections such the pandemic H1N1 and MERS-CoV, Saudi public health officials advice at-risk pilgrims to voluntarily postpone performing the Hajj. However, few heed this advice. The study will, therefore, as a secondary objective, investigate the reasons why at-risk pilgrims do not postpone the Hajj.
Table of Contents
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Abstract  PAGEREF _Toc412178646 \h
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Introduction  PAGEREF _Toc412178647 \h
1
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Background  PAGEREF _Toc412178648 \h
1
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Statement of the Research Problem  PAGEREF _Toc412178649 \h
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Study Aims and Objectives  PAGEREF _Toc412178650 \h
2
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Study Questions  PAGEREF _Toc412178651 \h
3
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Brief Literature Review  PAGEREF _Toc412178652 \h
4
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Uptake Rates of Recommended Vaccines  PAGEREF _Toc412178653 \h
4
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Factors Affecting Uptake of Recommended Vaccines  PAGEREF _Toc412178654 \h
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Gender and Age  PAGEREF _Toc412178655 \h
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Safety Concerns  PAGEREF _Toc412178656 \h
5
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Perceptions of Severity and Vulnerability  PAGEREF _Toc412178657 \h
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Health Status  PAGEREF _Toc412178658 \h
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Availability and Accessibility of Vaccines  PAGEREF _Toc412178659 \h
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Role of the Media and Hajj Handlers  PAGEREF _Toc412178660 \h
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Knowledge of the Disease  PAGEREF _Toc412178661 \h
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Proposed Work  PAGEREF _Toc412178662 \h
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Study Design  PAGEREF _Toc412178663 \h
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Methods  PAGEREF _Toc412178664 \h
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Quantitative Phase  PAGEREF _Toc412178665 \h
9
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Qualitative Phase  PAGEREF _Toc412178666 \h
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Setting  PAGEREF _Toc412178667 \h
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Population and Sample  PAGEREF _Toc412178668 \h
10
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Data Collection  PAGEREF _Toc412178669 \h
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Data Analysis  PAGEREF _Toc412178670 \h
11
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Ethical Considerations  PAGEREF _Toc412178671 \h
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Theoretical/Conceptual Model  PAGEREF _Toc412178672 \h
12

Introduction
Background
The Hajj pilgrimage to Mecca, Saudi Arabia, is a deeply spiritual journey undertaken by all physically and financially capable Muslims at least once in a lifetime (Ebrahim et al., 2009). It is the largest mass gathering in the world which draws millions of Muslims from around the world (Shuman, 2013). A total of 1,496,531 pilgrims (1,379,531foreign; a decrease of 21% from 2012) arrived for the 2013 Hajj from 188 countries (Royal Embassy of Saudi Arabia, 2013). Intense crowding at the Hajj sites, shared accommodation, and polluted environment provide ecology for transmission of MERS-CoV (Gautret et al., 2009; Khan et al., 2013; Memish et al., 2013; Omrani et al., 2013; Rashid et al., 2013). Public health authorities in Saudi Arabia and elsewhere in the world consider Hajj as a global public health security challenge, especially for pilgrims at risk of infections (Al-Tawfiq & Memish, 2014; Ebrahim et al., 2009; Gautret et al., 2009). People at risk normally include elderly people aged over 65 years of age, people with chronic diseases such as heart, kidney, and respiratory diseases, and diabetes (Ebrahim et al., 2009; Mangtani, Mak, & Pfeifer, 2009). Others at risk are pregnant women, children under 12 years old, and people with underlying immunosuppressive disorders (Guery et al., 2013; Mangtani et al., 2009). Hajj-related exportation of communicable diseases by returning pilgrims could bring about outbreak of infections worldwide (Ebrahim et al., 2009; Khan et al., 2009; Khan et al., 2013). Resource-limited countries are mainly vulnerable because they have limited capabilities to develop effective surveillance systems for returning pilgrims and respond to disease outbreak (Khan et al., 2009).
A human coronavirus, Middle East Respiratory Syndrome coronavirus (MERS-CoV) was first reported in September 2012 (Al-Tawfiq & Memish, 2014; Memish, Al-Tawfiq, & Al-Rabeeah, 2013; Rabiah, 2013). MERS-CoV belongs to the coronavirus family, Coronaviridae family. This is a group of large, enveloped single-stranded RNA viruses associated with several infections in mammal and avian population (Rabiah, 2013). There were 90 laboratory confirmed cases of MERS-CoV as of July 12, 2013 worldwide, but almost 80% of the cases were in Saudi Arabia (Assiri et al., 2013; Khan et al., 2013). As of June 3, 2014, there were reported 688 MERS-COV infection and 282 mortalities (Gardner & MacIntyre, 2014). As a result of the high mortality rates associated with MERS-CoV in the Middle East and Europe, development of effective vaccines was considered as crucial (Ma et al., 2014). Vaccines were considered as essential in preventing the spread of MERS-COV and possible future pandemic. Researchers have reported promising results on the possibility of developing MERS-CoV vaccine (Ma et al., 2014).
Respiratory viruses are increasingly becoming a threat to public health security worldwide and have been associated with substantial morbidity, mortality, and economic consequences (Guery et al., 2013; Khan et al., 2013; Omrani et al., 2013; Rabiah, 2013). As a result, vaccines have been developed to prevent the spread of infections during mass gatherings such as the Hajj. In some circumstances, the Saudi public health authorities advice at risk individuals to postpone performing the Hajj. For instance, in light of the potential for the 2013 Hajj to facilitate transmission of MERS-CoV cases, the Saudi Ministry of Health (MOH) advised potential pilgrims at risk of MERS-CoV to voluntarily postpone doing the Hajj (Memish et al., 2013; Memish, Zuma, & Al-Tawfiq, 2013). Most of at risk pilgrims from Western Europe did not heed to the advice by Saudi MOH (Gautret et al., 2013). Similarly, prior to the 2009 Hajj, there was an outbreak of H1N1 influenza and to mitigate the spread, the Saudi MOH, in consultation with global public authorities, advised at risk individuals to voluntarily refrain from doing the 2009 Hajj (Memish et al., 2009), but they did not heed the advice (Ebrahim et al., 2009; Gautret et al., 2010; Gautret et al., 2011).
Researchers have investigated the uptake of recommended vaccines within their study populations. Study populations in Hajj-related research studies have been either Hajj pilgrims or Saudi health care professionals engaged during the Hajj. Previous studies on the uptake of vaccines have focused on influenza vaccine, pneumocaccal, diphtheria and bacillus Calmette-Guerin vaccines (Alqahtani et al., 2014). Most studies on the rate of vaccine uptake have been conducted on influenza vaccines. The rates of vaccine uptake are greatly different among different populations. Alqahtani and colleagues found that 29 of the 42 studies they reviewed reported uptake of influenza vaccines among Hajj pilgrims (Alqahtani et al., 2014). They found that rate of seasonal influenza uptake among study populations ranged between 0.7% and 100%, with the rates being higher among at risk patients (Alqahtani et al., 2014). Few studies have investigated the reasons behind the low uptake rates from the perspective from prevention.
Statement of the Research Problem
The uptake rate of recommended vaccines is low among Hajj pilgrims, including British Hajj pilgrims (Rashid et al., 2008). For instance, influenza vaccination rate for t...