Title: Multilevel Barriers to Adult Vaccination in an Underserved
Community Clinic: A Quality Improvement Study
Author: Sumalatha Khatroth, MD
Family Medicine, PGY-3
Jackson Park Hospital
Background: Adult vaccination rates remain below national benchmarks, particularly in
underserved communities. Barriers exist at both patient and provider levels, contributing to
suboptimal uptake. Identifying these barriers is critical to improving coverage.
Objective: To evaluate patient knowledge, attitudes, and perceived barriers toward
recommended adult vaccines and assess resident physicians -reported challenges in
vaccine counseling. A secondary objective was to measure the impact of a targeted
educational intervention on patient understanding and vaccination intent.
Methods:A two-phase quality improvement study was conducted at Jackson Park Clinic.
Phase 1 surveyed 80 adult patients on awareness, vaccination history, and barriers for
Influenza, COVID-19, Tdap, Shingles, and PCV-20. Phase 2 surveyed 15 resident
physicians on counseling practices, confidence, and systemic challenges. Patients received
a structured educational intervention, followed by post-intervention assessment of
understanding, confidence, and vaccination intent. Descriptive statistics were applied.
Results: Patient awareness was highest for COVID-19 (95%) and Influenza (92%), followed
by Tdap (65%), Shingles (58%), and PCV20 (55%). Reported barriers included perceived
lack of necessity (40%), fear of side effects (30%), lack of provider recommendation (20%),
and cost (10%), with 65% requesting more information. Among residents, 53.8% routinely
counseled patients and felt confident, while patient hesitancy (100%) and limited time
(46.2%) were major challenges. Post-intervention, 95% of patients showed improved
understanding, and 90% expressed intent to vaccinate within six months.
Conclusions: Adult vaccination remains low due to patient misconceptions and provider
barriers. Targeted education improves knowledge and short-term willingness to vaccinate.
Sustained gains require standardized education, consistent provider recommendations, and
workflow integration.