Susceptibility, Severity Contribute to Pneumococcal Vaccine Uptake in Black Adults With T2D

Non-Hispanic Black adults with type 2 diabetes (T2D) face barriers to accessing pneumococcal vaccines despite being at increased risk of infections and related complications, according to an article in The Science of Diabetes Self-Management and Care.¹

The results from a cross-sectional, web-based survey lists contributing factors to the low vaccination rates among this subset of patients with T2D, including perceived susceptibility, perceived severity, geographical location, and influenza vaccine history.¹

The results pose significant implications for pharmacists, who are trustworthy health care professionals and often counsel, facilitate, and treat patients in convenient community settings. As one of the most visible promoters of vaccination—and, for many in minority communities, the most accessible—pharmacists should use these insights to tailor their patient counseling and education strategies towards individuals at highest risk of severe pneumococcal disease and those least likely to seek out a pneumococcal vaccine.¹

Pneumococcal Vaccination in Minority Populations

As one of the most prevalent chronic conditions worldwide, T2D, characterized by impaired glucose retention and insulin resistance, is disproportionately observed in ethnic and racial minority groups, including non-Hispanic Black adults. These patients face an estimated 12.1% rate of T2D, while for White patients, their incidence is much lower, at 6.9%.Concerningly, Black adults are at increased risk for serious vascular complications compared with other populations; this includes a heightened susceptibility to infectious diseases and worsened outcomes, including pneumococcal disease.^2-4

Pneumococcal vaccination is deemed highly effective and is recommended for individuals with T2D. Based on a series of factors, multiple doses may be recommended throughout a lifetime. Unfortunately, vaccination rates in non-Hispanic Black individuals lack compared with other racial groups, with multiple factors—including lack of knowledge regarding vaccine recommendations, mistrust, limited access to health care, and social determinants of health—reported in past research as having an impact. For Black adults with T2D, it is especially critical for investigators to determine the factors behind low pneumococcal vaccine uptake while seeking solutions to increase coverage.⁵

Survey Considerations

Using the health belief model (HBM), which is a framework used to understand health-related behaviors by analyzing beliefs regarding health conditions and preventive actions, the current investigators sought to describe factors related to pneumococcal vaccination among non-Hispanic Black adults with T2D. The authors aimed to explore pneumococcal vaccination status and HBM constructs while evaluating associations between HBM constructs and pneumococcal vaccination.¹

The HBM features key constructs, including perceived susceptibility; perceived severity; perceived benefits; perceived barriers; self-efficacy; cutes to action; and modifying factors. The survey comprised 57 items cross 6 sections, including knowledge of pneumococcal disease and vaccines; HBM beliefs constructs; perceived mistrust in health care settings; diabetes-related characteristics; sociodemographic characteristics; and negative and positive factors affecting pneumococcal vaccination. The survey content was validated by 5 experts and piloted in 6 non-Hispanic adults with T2D.¹

Responses Showcase Aspects Influencing Pneumococcal Vaccination

A total of 330 participants completed the questionnaire. Patients most often reported having a diabetes diagnosis of more than 5 years (46.4%), 1-to-2 diabetes-related complications (54.6%), treatment with oral medications (40.9%), moderate diabetes control (49.7%), and at least 1 annual health visit (97.0%). Regarding structural variables, knowledge of pneumococcal disease and vaccines was above the medium knowledge rating. However, general vaccine beliefs reflected a slightly favorable score for vaccines.¹

The authors reported that perceived susceptibility, severity, and cues to action had above medium rating scores; however, perceived barriers had medium rating scores. Furthermore, there were slightly high scores reported for perceived benefits and self-efficacy.¹

Regarding specific, bivariate associations between HBM constructs and pneumococcal vaccination, the investigators found that individuals reporting diabetes-related complications, use of oral medication, annual health visits, and a history of influenza vaccination had significant associations with pneumococcal vaccination. Perceived susceptibility, benefits, self-efficacy, and cues to action demonstrated a significant positive association with pneumococcal vaccination, indicating that a patient’s perceived risk of serious disease is a major motivating factor towards vaccination.¹

In their responses, participants reported multiple aspects that could influence their willingness to receive a pneumococcal vaccination. Some respondents expressed the need for more evidence of vaccine benefits, while others noted that accessibility improvements—such as free vaccination at local pharmacies—were motivators. Patients reported that increased information about vaccines from trusted health professionals was essential. These responses demonstrate the gaps currently visible in equitable pneumococcal vaccination strategies, and present aspects for pharmacists and other providers to improve on in the future to increase pneumococcal vaccine coverage.¹

REFERENCES

1. Okoh CM, Moczygemba LR, Rush S, et al. Factors Impacting Pneumococcal Vaccination Among Non-Hispanic Black Adults With Type 2 Diabetes: A Nationwide Cross-Sectional Study. Sci Diabet Self-Man Care. 2025;0(0). doi:10.1177/26350106251371085

2. CDC. Appendix A: detailed tables. Table 3. Age-adjusted prevalence of diagnosed diabetes by race and ethnicity, education level, family income level, metropolitan residence, and sex among adults aged 18 years or older, United States, 2019–2021. Published May 15, 2024. Accessed September 30, 2025. https://www.cdc.gov/diabetes/php/data-research/appendix.html#cdc_report_pub_study_section_2-table-2

3. Gregg EW, Hora I, Benoit SR. Resurgence in diabetes-related complications. JAMA. 2019;321(19):1867-1868. doi:10.1001/jama.2019.3471

4. Kim EJ, Ha KH, Kim DJ, Choi YH. Diabetes and the risk of infection: A national cohort study. Diabetes Metab J. 2019;43(6):804-814. doi:10.4093/dmj.2019.0071

5. AdultVaxView—Vaccination coverage among adults in the United States, National Health Interview Survey, 2022. CDC. Published October 4, 2024. Accessed September 30, 2025. https://www.cdc.gov/adultvaxview/publications-resources/adult-vaccination-coverage-2022.html