Identifying implementation strategies to address barriers of implementing a school-located influenza vaccination program in Beijing

Abstract

Background The school-located influenza vaccinations (SLIV) can increase influenza vaccination and reduce influenza infections among school-aged children. However, the vaccination rate has remained low and varied widely among schools in Beijing, China. This study aimed to ascertain barriers and facilitators of implementing SLIV and to identify implementation strategies for SLIV quality improvement programs in this context. Methods Semi-structured interviews were conducted with diverse stakeholders (i.e., representatives of both the Department of Health and the Department of Education, school physicians, class headteachers, and parents) involved in SLIV implementation. Participants were identified by purposive and snowball sampling. The Consolidated Framework for Implementation Research was adopted to facilitate data collection and analysis. Themes and subthemes regarding barriers and facilitators were generated using deductive and inductive approaches. Based on the Consolidated Framework for Implementation Research—Expert Recommendations for Implementing Change (CFIR-ERIC) matching tool, practical implementation strategies were proposed to address the identified barriers of SLIV delivery. Results Twenty-four participants were interviewed. Facilitators included easy access to SLIV, clear responsibilities and close collaboration among government sectors, top-down authority, integrating SLIV into the routine of schools, and priority given to SLIV. The main barriers were parents’ misconception, inefficient coordination for vaccine supply and vaccination dates, the lack of planning, and inadequate access to knowledge and information about the SLIV. CFIR-ERIC Matching tool suggested implementation strategies at the system (i.e., developing an implementation blueprint, and promoting network weaving), school (i.e., training and educating school implementers), and consumer (i.e., engaging students and parents) levels to improve SLIV implementation. Conclusions There were substantial barriers to the delivery of the SLIV program. Theory-driven implementation strategies developed in this pre-implementation study should be considered to address those identified determinants for successful SLIV implementation.

Effectiveness of Multifaceted Strategies to Increase Influenza Vaccination Uptake

“…Intervention schools delivered multifaceted E-SLIV strategies from September 2022 to November 2022. The E-SLIV strategies were developed based on the Consolidated Framework for Implementation Research (CFIR)—Expert Recommendations for Implementing Change Matching tool in response to identified barriers under the CFIR . The barriers included lack of planning and cosmopolitanism, inadequate access to knowledge and information about the SLIV among school implementers, and misconceptions and unmet needs among parents regarding influenza-related information .…”

“…The E-SLIV strategies were developed based on the Consolidated Framework for Implementation Research (CFIR)—Expert Recommendations for Implementing Change Matching tool 40 , 41 , 42 in response to identified barriers under the CFIR. 13 The barriers included lack of planning and cosmopolitanism, inadequate access to knowledge and information about the SLIV among school implementers, and misconceptions and unmet needs among parents regarding influenza-related information. 13 The corresponding E-SLIV implementation strategies included planning and coordination at the system level, training and educating school administrators and clinicians at the school level, and educating and reminding students and parents at the individual level ( Table 1 ).…”

“… 13 The barriers included lack of planning and cosmopolitanism, inadequate access to knowledge and information about the SLIV among school implementers, and misconceptions and unmet needs among parents regarding influenza-related information. 13 The corresponding E-SLIV implementation strategies included planning and coordination at the system level, training and educating school administrators and clinicians at the school level, and educating and reminding students and parents at the individual level ( Table 1 ). Quality control methods to improve fidelity and retention included top-down supervision; a shared, real-time school doctor checklist; and class headteacher prompts.…”

“…School-located influenza vaccination (SLIV) is a cost-effective approach to expand vaccination coverage and has been adopted by countries including Canada, the UK, Australia, and the US. Since 2007, the Department of Health and the Department of Education of Beijing, China have collaborated to administer free influenza vaccinations in primary and middle schools, and details have been published elsewhere . However, influenza vaccination coverage remains low.…”

“…Since 2007, the Department of Health and the Department of Education of Beijing, China have collaborated to administer free influenza vaccinations in primary and middle schools, and details have been published elsewhere. 13 However, influenza vaccination coverage remains low. For example, the rates among primary and middle school students were 46.8% during the 2017 to 2018 season.…”