Health Promotion, Health Literacy and Vaccine Hesitancy: The Role of Humanoid Robots

The use of humanoid robot technologies within global healthcare settings is rapidly evolving; however, the potential of robots in health promotion and health education is not established. The aim of this study was to explore the impact of a social humanoid robot on individuals' knowledge of influenza (flu) prevention and attitudes towards influenza vaccination. A multi-methods approach involving pre and post-test questions and interviews was used. The study was undertaken in a publicly funded tertiary level hospital in northern Queensland, Australia. Of the 995 participants, the majority were visitors (53.07%). The mean age of the participants was 42.25 (SD=19.54) years. Based on the three knowledge questions that were posed at the two-point interactions of participants with the humanoid robot 'Pepper', the results showed that there was a significant difference in the correct responses pre- and post-test regarding the best way to avoid getting the flu (Exact McNemar significance probability <.0001), how long the flu virus can live outside the human body (p <.0001) and the length of time for handwashing to be effective against spreading germs (p <.0001). The results also showed that there was a significant difference in attitudes associated with influenza vaccination when pre-test was compared to post-test (p=.0019). Interaction of the participants with the humanoid robot demonstrated immediate knowledge gains and attitudinal change that suggests that humanoid robots may be an important intervention for health promotion in prevention of influenza and other respiratory viruses.

Influenza vaccination in the COVID-19 era

Influenza spreads globally annually with significant paediatric and adult attack rates and considerable morbidity, mortality and the exacerbation of extant chronic disease. In the northern and southern hemispheres, outbreaks occur mainly in the respective winter seasons. Influenza vaccination is available but only partially effective. In the absence of a vaccine, in winter, novel coronavirus COVID-19 will also circulate in parallel with seasonal influenza. Thus far it appears that with the current strains of these two viruses, the clinical outcome of co-infection is not significantly worse than infection with COVID-19 alone. However, several strains of influenza circulate, including strains still to come. Similarly, COVID-19 has several strains, with probably more to come. This paper discusses these issues and estimates ideal minimum influenza vaccination coverage based on an estimated influenza Basic Reproduction Number (R0) of 0.9-2.1 so as to obtain herd immunity or approach it. There is a strong argument for attempting near universal population coverage with the annual influenza vaccine leading up to next winter.

Attitudes of Nursing Home Staff Towards Influenza Vaccination: Opinions and Factors Influencing Hesitancy

Seasonal influenza is recognized to be a significant public health problem and a cause of death, especially in fragile persons. In nursing homes (NHs), vaccination for both residents and staff is the best preventive strategy. However, professionals' immunization rates are far from reaching the international recommended values. This study aims to describe the adherence and attitudes of NH staff towards flu vaccination and to explore staff hesitancy. A questionnaire was developed based on a literature review and on the 3Cs (confidence, complacency, convenience) of the WHO framework and administered among the staff of four NHs of a province in the northeast of Italy. Results demonstrated a low adherence towards annual vaccination (i.e., only 3% declared getting the flu vaccination each year). Complacency, confidence and convenience all showed a significant impact on the attitude towards vaccination both in univariate and multivariable analysis, with complacency being the most strongly associated area. The area of confidence resulted in strongly challenging factors. Only 24.8% of interviewees appeared trustful towards the efficacy of receiving immunization and 34% declared safety issues. Insights from the study can support the implementation of effective interventions to improve vaccination adherence in NHs. Specifically, increasing complacency by raising awareness related to the risks of influenza appears to be an essential strategy to effectively promote vaccination uptake.

Barriers and beliefs among health-care workers regarding seasonal influenza vaccine in Al-Qassim region, Saudi Arabia

This study aimed to assess the seasonal influenza vaccine (SIV) coverage rate, and to assess knowledge, attitudes, and practice of health-care workers (HCWs) concerning the SIV. In this multicenter cross-sectional study conducted in Qassim region, Saudi Arabia, a validated questionnaire was distributed randomly among HCWs. Of 523 responses from HCWs across different institutions, 282 (53.9%) respondents were females and most respondents were aged between 30 and 39 years. Overall, 48.6% of participants had been regularly vaccinated with the SIV, and 70% were willing to be vaccinated in the coming season. Reasons for HCWs' non-adherence to the SIV included their having previously had influenza, which was not severe (20.7%), and that they were young and healthy (19.2%). Belief in the effectiveness of the SIV (72.3%) and knowledge that the SIV should be administered yearly (86.6%) was high among respondents. Less than 50% of respondents believed that vaccine safety concern is the main barrier preventing health-care institutions from providing the SIV to patients. Our study results showed suboptimal SIV coverage among HCWs in Qassim region. Educational programs and campaigns regarding the risk of influenza infection, as well as the provision of adequate information, and highlighting the importance of HCWs being vaccinated are essential. Easy access to and availability of the SIV in each region is crucial for improved vaccine coverage. Health-care institutions need to more actively encourage staff to undergo influenza vaccinations on a regular basis, especially during the influenza season.

The views of key stakeholders around mandatory influenza vaccination of hospital and aged care staff: Examining the current climate in Australia

BACKGROUND

Healthcare worker (HCW) vaccination against seasonal influenza is considered a key preventative measure within hospitals and aged-care facilities (ACFs) to reduce the risk of transmission and related disease. Despite this, many facilities experience persistently low vaccination coverage rates and mandatory vaccination has been explored as a potential strategy to improve coverage. This study explored the current climate around staff vaccination in Australia from the perspective of opinion leaders and key stakeholders.

METHODS

Qualitative semi-structured interviews were conducted between April and July 2018 with 22 individuals involved in vaccination policy and program development and implementation from a range of organisations including state health departments, hospitals and ACFs across Australia. In addition, interviews were undertaken with individuals from aged care and nursing peak bodies/colleges. Interviews were transcribed, and thematic analysis was undertaken using NVivo 12 software.

RESULTS

Major themes emerging from the interviews included a sense that attitudes around staff vaccination are changing; the persistence of administrative and resource barriers; the importance of positive workplace culture towards influenza vaccination; and the need for individualised and personal communication strategies. Perspectives were diverse on the necessity of introducing stronger policies, with participants divided in their support mandatory influenza vaccinations. Some advocated that key performance indicators should be used as an alternative to vaccine mandates.

CONCLUSIONS

This study provides policy makers with useful insights into the current Australian context around occupational vaccination policies, to inform acceptable and effective strategies to improve influenza vaccination uptake among Australian hospital and aged care staff.

A systematic review and meta-analysis of the direct epidemiological and economic effects of seasonal influenza vaccination on healthcare workers

BACKGROUND

Influenza vaccination is a commonly used intervention to prevent influenza infection in healthcare workers (HCWs) and onward transmission to other staff and patients. We undertook a systematic review to synthesize the latest evidence of the direct epidemiological and economic effectiveness of seasonal influenza vaccination among HCW.

METHODS

We conducted a systematic search of MEDLINE/PubMed, Scopus, and Cochrane Central Register of Controlled Trials from 1980 through January 2018. All studies comparing vaccinated and non-vaccinated (i.e. placebo or non-intervention) groups of HCWs were included. Research articles that focused on only patient-related outcomes or monovalent A(H1N1)pdm09 vaccines were excluded. Two reviewers independently selected articles and extracted data. Pooled-analyses were conducted on morbidity outcomes including laboratory-confirmed influenza, influenza-like illnesses (ILI), and absenteeism. Economic studies were summarized for the characteristics of methods and findings.

RESULTS

Thirteen articles met eligibility criteria: three articles were randomized controlled studies and ten were cohort studies. Pooled results showed a significant effect on laboratory-confirmed influenza incidence but not ILI. While the overall incidence of absenteeism was not changed by vaccine, ILI absenteeism was significantly reduced. The duration of absenteeism was also shortened by vaccination. All published economic evaluations consistently found that the immunization of HCW was cost saving based on crude estimates of avoided absenteeism by vaccination. No studies, however, comprehensively evaluated both health outcomes and costs of vaccination programs to examine cost-effectiveness.

DISCUSSION

Our findings reinforced the influenza vaccine effects in reducing infection incidence and length of absenteeism. A better understanding of the incidence of absenteeism and comprehensive economic program evaluations are required to ensure the best possible management of ill HCWs and the investment in HCW immunization in increasingly constrained financial environments. These steps are fundamental to establish sustainability and cost-effectiveness of vaccination programs and underpin HCW immunization policy.