URJHS Volume 7

URC

College Students’ Perceptions of Meningitis Prevention

Liz Schulte
Mary Paradise
Julie Hasken
Megan Temme
Ann Bruno

Truman State University


Abstract

The results of this study indicated that most respondents perceived that they were at-risk for meningitis as college students, felt more susceptible than their non-college counterparts, and the majority perceived the disease as a serious health threat. Although many perceived that they were not well educated about the disease before they came to college, they did feel that the college provided adequate information about the disease and the vaccine. Because the four conditions for taking preventive health action according to the Health Belief Model were met, the study may explain why almost 90 percent of the respondents received the vaccine at some point.

Introduction:

Meningitis is a serious disease that can result in an epidemic and devastate the health of a specific population. Meningitis can either be bacterial or viral but is mainly caused by types of bacteria such as the Neisseria meningitides. The severity of this problem is increased among groups of individuals who live in close proximity with one another because of the easier transmission of respiratory droplets or throat secretions. The actual disease is caused by an infection in the thin lining surrounding the brain and spinal cord. The swelling can result in nerve damage, learning disabilities, or death. The World Health Organization found that even when diagnosed early, 5-10% of infected individuals die within 24-48 hours of diagnosis (World Health Organization, 2003).

College residence halls with their close living conditions are principle sites for a meningitis epidemic (Harrison, 1999). Meningitis is more prevalent among college subgroups such as those living in residence halls. Among 590,000 freshmen that reside in dormitories, the rate of meningitis infection was 4.6 per 100,000; higher than any age group, disregarding children younger than two years of age (Advisory Committee on Immunization Practices, 2000). In addition, college students who lived on campus had a 3.24 per 100,000 rate of contracting meningitis compared to 0.96 among non-resident students (Harrison, 1999). Therefore, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices recommended that all college freshmen living in dormitories be vaccinated against the meningococcal disease. This came on the heels of a newly developed vaccine that may provide longer protection and help college health educators provide protection for students attending college (American College Health Association, 2005). Economically, the meningitis vaccination provides benefits for colleges. For example, for freshmen in dormitories, approximately 300,000-500,000 doses of the vaccine would prevent between 15 and 30 meningitis cases and one to three deaths. This would result in cost-per-case prevention of around $600,000-$1.8 million and cost of death prevented at $22-$48 million. The American College Health Association determined that colleges should be more effective in communicating the dangers of meningitis and should advocate for the vaccination program (Advisory Committee on Immunization Practices, 2000).

The Health Belief Model (HBM) describes the cognitive behaviors that may reduce the risk of contracting a disease: (a) a person feels that his or her health is at risk, (b) the person perceives the severity of the condition and its consequences, (c) the person has perceived the benefits of taking action and realizes that these benefits will outweigh the consequences of not acting, and (d) the person is called to action by the receipt of information or by feeling the need to act (Green, 2007). Therefore, the purpose of this study is to determine college students’ perceptions of the effectiveness of the Health Belief Model in meningitis prevention.

Method

Sample

Two hundred sixty-four college students enrolled at a small midwestern university during fall 2006 were surveyed about their perceptions regarding the meningitis vaccine and meningitis prevention. The respondents were 264 males and females between the ages of 18-22. Most (37.4%, n=99) respondents were freshmen, followed by sophomores (24.9%, n=66), juniors (21.1%, n=6), and seniors (15.1%, n=40) with only three (1.1%) not reporting their class standing. Although racial/ethnic characteristics were not asked, over half (58.1%, n=153) of the respondents described their hometown as suburban, followed by rural (31.3%, n=83), urban (7.9%, n=21), and other (2.3%, n=6) with only one not answering the question (0.4%).

Procedure

After IRB approval, an online survey was electronically mailed to each respondent with a link to the survey site. The survey consisted of three questions about whether they received their meningitis vaccine before or after coming to campus or if they signed the waiver not to receive the vaccine. In addition, using a Likert scale, nine questions about the participants’ perceptions of the meningitis vaccine and meningitis prevention were asked. All those who received a survey completed and electronically returned it.

Data Analysis

Descriptive statistics were used to report participants’ perceptions about meningitis prevention.

Results

When asked if respondents received their meningitis vaccines before coming to campus in the fall, the majority (79.9%, n=211) reported they had, but 20.1% (n=53) reported that they did not. Of the 53 respondents who reported that they did not receive their meningitis vaccine before coming to campus in the fall, most (56.6%, n=3) reported that they signed the waiver not to receive the vaccine and understood the risk. Only 23 (43.4%) respondents reported that they did receive the vaccine after they came to campus.

Respondents were then asked to rate their perceptions to nine statements about the meningitis vaccine and meningitis prevention as either strongly disagree, disagree, neutral, agree, or strongly agree (Table 1). Most (57.9%, n=153) respondents agreed or strongly agreed that they had a small chance of contracting meningitis in college, and over 90% (92.4%, n=244) of respondents also either agreed or strongly agreed that meningitis is a serious, life-threatening disease. In addition, a little over 70% (71.6%, n=189) of respondents agreed or strongly agreed that they were more susceptible to the disease than their non-college counterparts. Almost 30% (29.4%, n=78) of respondents disagreed with the statement that the vaccine was expensive, though, followed closely by 26.0% (n=69) who were neutral to that statement. Only 34.8% (n=92) agreed or strongly agreed that they knew the warning signs and symptoms of meningitis, and only 30.3% (n=80) agreed or strongly agreed that they had recently learned any information about meningitis. Although most (43.2%, n=114) disagreed or strongly disagreed that they were well-educated about the disease before coming to college, most (42.0%, n=11) either agreed or strongly agreed that the college provided adequate information about the disease and the vaccine.

Discussion

The results of this study indicted that most respondents perceived that they were at-risk for meningitis as college students, felt more susceptible than their non-college counterparts, and the majority perceived the disease as a serious health threat. Although many perceived that they were not well educated about the disease before they came to college, they did feel that the college provided adequate information about the disease and the vaccine. Because the four conditions for taking preventive health action according to the HBM were met, the study may explain why almost 90% of the respondents did receive the vaccine at some point.

Most respondents agreed that there was a small chance of contracting the disease while in college, but they felt that they were more susceptible to it than those not in a college setting. Although it is true that only 4.6 per 100,000 college students become infected each year, their perceptions were in line with the fact that their demographic has the highest infection rate over any other populations excluding children under two (Advisory Committee on Immunization Practices, 2000). The majority also perceived the disease as a serious condition that is an accurate perception according to the World Health Organization. A little over half, though, felt neutral or disagreed that the vaccine was expensive. Cost of the vaccine and administration (range: $54-$88), costs per hospitalization ($10,924-$24,030), value of premature death based on lifetime productivity ($1.3-$4.8 million), and cost of side effects of vaccine per case ($3,500-$12,270 per one million doses) suggest a positive cost-benefit. Possibly because not many felt that they knew someone with meningitis, they did not perceive themselves as knowledgeable of the warning signs and symptoms of the disease. Because the symptoms may be very similar to the flu, it is important for students to be able to recognize this and be aware that if their symptoms persist they should seek medical attention immediately. Without timely treatment, meningitis could result in serious, permanent medical complications or death.

A limitation of this study was its reliance on self-report measures, specifically reliance on respondent memory of obtaining the vaccination, what was learned about meningitis in the previous six months before college, as well as what was read in information given to them by the college prior to their first week on campus. The volunteer nature of the sample may also suggest that those who participated in the study were somehow different than those who did not. In addition, although there were respondents in each of the classes (freshman, sophomore, junior, senior); the small sample size of the study did not provide enough variance to more than describe responses or provide a reasonable number to generalize to a larger population. Given the small sample size, it is recommended that a more in-depth study be conducted as a follow-up.

Most also felt that they were not previously well read about the disease, however, they perceived that the college did provide them with enough information about the disease and the vaccine. Although the college does provide several informational letters prior to students arriving on campus, it is recommended that they continue their meningitis awareness campaign, possibly during freshmen orientation, in order to encourage continued precautions and knowledge of the disease and the vaccine. This recommendation to continue the information campaign relates well with the American College Health Association recommendation that encourages colleges to communicate the dangers of meningitis and promote the vaccination program (Advisory Committee on Immunization Practices, 2000). In addition, health educators and health care providers should follow the Health Belief Model in their meningitis prevention programming in order to continue to encourage positive health behavior.

References

Advisory Committee on Immunization Practices (2000). Morbidity and Mortality Weekly Report, CDC June 30, 200049(RR07), 11-20. Retrieved September 2007 from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4907a2.htm

American College Health Association (2005). Meningitis on Campus, Retrieved September 2007 from http://www.acha.org/projects_programs/meningitis/disease_info.cfm

Green, L.W. (2007). Health Belief Model. Retrieved December 3, 2007, from http://www.enotes.com/public-health-encyclopedia/health-belief-model.

Harrison, L. H. (1999). Risk of Meningococcal Infection in College Students. Journal of the American Medical Association, 281(20). Retrieved September 2007 from EBSCOhost.

Morbidity and Mortality Weekly Report (2000). Meningococcal disease and college students. Center for Disease Control. Retrieved February 2008 from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4907a2.htm

World Health Organization. (2003). Meningococcal meningitis, Media centre. Retrieved September 2007 from http://www.who.int/mediacentre/factsheets/fs141/en/

Table 1

Respondents’ Perceptions About Meningitis and Meningitis Perception N=264

Statement

(all in reference to meningitis)

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Small chance of contracting meningitis in college

10.9%

10.6%

19.6%

41.9%

15.8%

Meningitis is a serious life-threatening disease

0.0%

0.8%

5.7%

28.7%

63.8%

You are more susceptible than a non-college student

3.4%

10.9%

13.2%

41.9%

29.4%

Meningitis vaccine is expensive

13.2%

29.4%

26.0%

19.6%

10.6%

Know the warning signs/symptoms of meningitis

14.3%

36.6%

13.2%

28.3%

6.4%

Know someone who has contracted meningitis

41.9%

30.2%

4.5%

28.3%

6.4%

Read or learned about meningitis in the last 6 months

21.2%

24.7%

12.5%

23.0%

7.2%

Felt well educated before coming to college

14.3%

28.7%

20.0%

27.2%

8.3%

College provided you with adequate information about meningitis and the vaccine

7.9%

23.8%

25.3%

34.4%

7.5%

 


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