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Alsaif F, Twigg M, Scott S, Blyth A, Wright D, Patel A. A systematic review of barriers and enablers associated with uptake of influenza vaccine among care home staff. Vaccine 2023; 41:6156-6173. [PMID: 37673716 DOI: 10.1016/j.vaccine.2023.08.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/08/2023]
Abstract
Barriers and enablers to vaccination of care home (CH) staff should be identified in order to develop interventions to address them that increase uptake and protect residents. We aimed to synthesis the evidence describing the barriers and enablers that affect the influenza vaccination uptake of care home (CH) staff. METHOD We searched PubMed, MEDLINE, EMBASE, CINAHL, PsycINFO, AMED, IBSS, SCOPUS to identify quantitative, qualitative or mixed-method studies. Data related to health or social care workers in CHs reported barriers or enablers were extracted and mapped to the Theoretical Domains Framework (TDF); the data within each domain were grouped and categorized into key factors affecting influenza vaccine uptake among CH staff. RESULTS We screened 4025 studies; 42 studies met our inclusion criteria. Thirty-four (81 %) were surveys. Five theoretical domains were frequently reported as mediators of influenza vaccine uptake: Beliefs about consequences (32 studies), Environmental context and resources (30 studies), Emotions (26 studies), Social influences (25 studies), Knowledge (22 studies). The low acceptance rate of the influenza vaccine among CH staff can be attributed to multiple factors, including insufficient understanding of the vaccine, its efficacy, or misconceptions about the vaccine (knowledge), perceiving the vaccine as ineffective and unsafe (beliefs about consequences), fear of influenza vaccine and its side effects (emotions), and experiencing limited accessibility to the vaccine (environmental context and resources). CONCLUSION Interventions aimed at increasing influenza vaccine uptake among CH staff should focus on addressing the barriers identified in this review. These interventions should include components such as enhancing knowledge by providing accurate information about vaccine benefits and safety, addressing negative beliefs by challenging misconceptions, managing concerns and fears through open communication, and improving accessibility to the vaccine through convenient on-site options. This review provides a foundation for the development of tailored Interventions to improve influenza vaccine uptake among CH staff.
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Affiliation(s)
- Faisal Alsaif
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
| | - Michael Twigg
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
| | - Sion Scott
- School of Healthcare, University of Leicester, University Road, Leicester LE1 7RH, UK.
| | - Annie Blyth
- School of Economics, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK.
| | - David Wright
- School of Healthcare, University of Leicester, University Road, Leicester LE1 7RH, UK.
| | - Amrish Patel
- School of Economics, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK.
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Patel A, Sims E, Blacklock J, Birt L, Bion V, Clark A, Griffiths A, Guillard C, Hammond A, Holland R, Jones A, Jones L, Katangwe-Chigamba T, Pitcher J, Ruby P, Scott S, Wagner AP, Ahmed S, Baqir W, Cook L, Dean T, Wright D. Cluster randomised control trial protocol for estimating the effectiveness and cost-effectiveness of a complex intervention to increase care home staff influenza vaccination rates compared to usual practice (FLUCARE). Trials 2022; 23:989. [PMID: 36494824 PMCID: PMC9733011 DOI: 10.1186/s13063-022-06925-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/12/2022] [Indexed: 12/13/2022] Open
Abstract
The care home staff influenza vaccination rate in England is significantly lower than the 75% World Health Organisation recommendation. This represents a substantial potential for resident harm. Barriers to staff vaccination stem from individual and organisational levels. Existing interventions address some but not all barriers and are not underpinned by behavioural science theory. This study aims to estimate the effectiveness and cost-effectiveness of a theory-informed intervention to improve care home staff vaccination rates compared to routine practice.Set in care homes with both nursing and residential focus, and a range of ownership status, only homes providing long stay care to older people with a staff vaccination rate below 40% are eligible to participate. Participation expressions of interest will be sought using a variety of approaches prior to seeking consent.The primary outcome measure is the proportion of staff vaccinated at 6 months, with secondary outcome measures being proportion vaccinated at 3 months, numbers of staff sick days, general practitioner and nurse visits to care home, care home resident hospitalisations and mortality.Based on the assumptions that the mean cluster (care home) size is 54 staff, a coefficient of variation of 0.48, control vaccination rate is 55%, intervention 75%, intra-cluster correlation coefficient of 0.2 and with 90% power, and 20% attrition, we require 39 care homes per arm.Blocked randomisation will be at the level of care home, stratified by the proportion of non-white care home staff, and implemented by Norwich Clinical Trials Unit.The intervention comprises co-designed information videos and posters, provision of in-house staff vaccination clinics, and incentive scheme and monthly data collection on trial outcomes. Beyond usual practice, the control arm will additionally contribute monthly data.Data will be collected at the start, monthly and at 6 months, and analysis will be blind to allocation. Statistical analysis will use the intention-to-treat principle with the difference in vaccination rates between groups compared using a random effect logistic regression model at the staff-level.This will be the first study to use a theory-informed intervention designed to comprehensively address identified barriers to care home staff influenza vaccination.Trial registration: ISRCTN ISRCTN22729870 . Registered on 24 August 22. Secondary identifiers: R209939, IRAS 316820, CPMS 53812.
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Affiliation(s)
- Amrish Patel
- grid.8273.e0000 0001 1092 7967School of Economics, University of East Anglia, Norwich, UK
| | - Erika Sims
- grid.8273.e0000 0001 1092 7967Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Jeanette Blacklock
- grid.9918.90000 0004 1936 8411School of Healthcare, University of Leicester, Leicester, UK
| | - Linda Birt
- grid.9918.90000 0004 1936 8411LOROS Associate Professor in Palliative Care and Frailty, University of Leicester, Leicester, UK
| | - Veronica Bion
- grid.8273.e0000 0001 1092 7967Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Allan Clark
- grid.8273.e0000 0001 1092 7967School of Medicine, University of East Anglia, Norwich, UK
| | - Alys Griffiths
- grid.10025.360000 0004 1936 8470Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Cecile Guillard
- grid.8273.e0000 0001 1092 7967Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Amber Hammond
- grid.8273.e0000 0001 1092 7967Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Richard Holland
- grid.9918.90000 0004 1936 8411Leicester Medical School, University of Leicester, Leicester, UK
| | - Andy Jones
- grid.8273.e0000 0001 1092 7967School of Medicine, University of East Anglia, Norwich, UK
| | - Liz Jones
- grid.10025.360000 0004 1936 8470Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Thando Katangwe-Chigamba
- grid.8273.e0000 0001 1092 7967Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Jennifer Pitcher
- grid.8273.e0000 0001 1092 7967School of Economics, University of East Anglia, Norwich, UK
| | - Po Ruby
- grid.8273.e0000 0001 1092 7967Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Sion Scott
- grid.9918.90000 0004 1936 8411School of Healthcare, University of Leicester, Leicester, UK
| | - Adam P. Wagner
- grid.8273.e0000 0001 1092 7967Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK ,grid.451056.30000 0001 2116 3923National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) East of England (EoE), Cambridge, UK
| | - Saiqa Ahmed
- Patient and Public Involvement Representative, NIHR Applied Research Collaboration North West Coast (ARC NWC), Liverpool, UK
| | - Wasim Baqir
- grid.451052.70000 0004 0581 2008Pharmacy Integration Programme, NHS England and Improvement, London, UK
| | - Luke Cook
- Askham Village Community, Doddington, UK
| | - Tony Dean
- Norfolk Local Pharmaceutical Committee, Great Bircham, UK
| | - David Wright
- grid.9918.90000 0004 1936 8411School of Healthcare, University of Leicester, Leicester, UK
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Hall CM, Northam H, Webster A, Strickland K. Determinants of seasonal influenza vaccination hesitancy among healthcare personnel: An integrative review. J Clin Nurs 2021; 31:2112-2124. [PMID: 34716635 DOI: 10.1111/jocn.16103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/23/2021] [Accepted: 10/04/2021] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore the determinants of and behaviour change models for seasonal influenza vaccination compliance among healthcare personnel. BACKGROUND COVID-19 vaccine hesitancy among healthcare personnel may be better understood by exploring determinants of seasonal influenza vaccine hesitancy. DESIGN Integrative literature review. METHODS A systematic search was conducted in accordance with PRISMA guidelines. Six thousand and forty-eight articles were screened. Seventy-eight met inclusion criteria. Due to the heterogeneity of included articles, a narrative synthesis was conducted utilising a conceptual matrix to identify thematic categories. RESULTS Six thematic categories were identified as influencing HCP SIV compliance: 'perceived vulnerability', 'trust', 'past behaviour', 'professional duty', 'access and convenience' and 'knowledge and experience'. The Health Belief Model (HBM) was the most commonly utilised health behaviour change model within the seasonal influenza vaccination context. Few studies have examined seasonal influenza vaccine acceptance and uptake within the Australian HCP context, particularly involving community care and aged care. CONCLUSIONS Factors that appear to relate to influenza vaccination compliance among HCP can be grouped according to several thematic categories, and they also appear influential in COVID-19 vaccine uptake. In particular, an emerging focus on 'trust' or the more emotive considerations of decision-making around health-protective behaviours requires further exploration in the context of a pandemic. Efforts to influence these domains to increase compliance, however, are likely to be impeded by a lack of a well-developed and tested behaviour change model. RELEVANCE TO CLINICAL PRACTICE Healthcare personnel (HCP) face high levels of occupational exposure to seasonal influenza every year. An emerging focus on 'trust' and the more emotive considerations of decision-making around health-protective behaviours requires further exploration in the context of a pandemic.
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Affiliation(s)
- Caroline M Hall
- Faculty of Health, School of Nursing, Midwifery & Public Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Holly Northam
- Faculty of Health, School of Nursing, Midwifery & Public Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Adrian Webster
- Faculty of Health, School of Nursing, Midwifery & Public Health, University of Canberra, Canberra, Australian Capital Territory, Australia.,Health Systems Group, Australian Institute of Health and Welfare, Canberra, Australian Capital Territory, Australia
| | - Karen Strickland
- Faculty of Health, School of Nursing, Midwifery & Public Health, University of Canberra, Canberra, Australian Capital Territory, Australia.,Faculty of Health and Environmental Sciences, School of Clinical Sciences, AUT, Auckland, New Zealand.,Robert Gordon University, Aberdeen, Scotland
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