Planning and process evaluation of a multi-faceted influenza vaccination implementation strategy for health care workers in acute health care settings

Abstract

BackgroundInfluenza transmitted by health care workers (HCWs) is a potential threat to frail patients in acute health care settings. Therefore, immunizing HCWs against influenza should receive high priority. Despite recommendations of the World Health Organization, vaccine coverage of HCWs remains low in all European countries. This study explores the use of intervention strategies and methods to improve influenza vaccination rates among HCWs in an acute care setting.MethodsThe Intervention Mapping (IM) method was used to systematically develop and implement an intervention strategy aimed at changing influenza vaccination behaviour among HCWs in Dutch University Medical Centres (UMCs). Carried out during the influenza seasons 2009/2010 and 2010/2011, the interventions were then qualitatively and quantitatively evaluated by way of feedback from participating UMCs and the completion of a web-based staff questionnaire in the following spring of each season.ResultsThe IM method resulted in the development of a transparent influenza vaccination intervention implementation strategy. The intervention strategy was offered to six Dutch UMCs in a randomized in a clustered Randomized Controlled Trial (RCT), where three UMCs were chosen for intervention, and three UMCs acted as controls. A further two UMCs elected to have the intervention. The qualitative process evaluation showed that HCWs at four of the five intervention UMCs were responsive to the majority of the 11 relevant behavioural determinants resulting from the needs assessment in their intervention strategy compared with only one of three control UMCs. The quantitative evaluation among a sample of HCWs revealed that of all the developed communication materials, HCWs reported the posters as the most noticeable.ConclusionsOur study demonstrates that it is possible to develop a structured implementation strategy for increasing the rate of influenza vaccination by HCWs in acute health care settings. The evaluation also showed that it is impossible to expose all HCWs to all intervention methods (which would have been the best case scenario). Further study is needed to (1) improve HCW exposure to intervention methods; (2) determine the effect of such interventions on vaccine uptake among HCWs; and (3) assess the impact on clinical outcomes among patients when such interventions are enacted.

Hospital-based cluster randomised controlled trial to assess effects of a multi-faceted programme on influenza vaccine coverage among hospital healthcare workers and nosocomial influenza in the Netherlands, 2009 to 2011

“…The intervention and external group were allowed to make their own choices and decisions regarding the implementation of programme elements. An evaluation of the process showed that intervention and external UMCs targeted most of the behavioural determinants and choose to implement a variety of the developed methods, whereas the control UMCs targeted less determinants [18], Figure. However, actual exposure of HCWs to these methods was variable and in 2009 largely affected by the pandemic preparedness plans. Lead contacts from the control group did not receive the developed methods and were encouraged to follow their usual influenza vaccination policy.…”

“…An 11-item prediction model with nine behavioural and two demographic predictors could be developed that was highly accurate in discriminating vaccinated from non-vaccinated staff in approximately 95% of the study population. Subsequently, we used the Intervention Mapping (IM) method to thoroughly plan, develop and evaluate a programme that was directed at HCWs in order to influence their behaviour towards immunisation [15,18]. This IM method is a theoretical framework to systematically develop health education interventions and can be used as part of the dynamic process of planning intervention strategies in health education.…”

Le protocole de l’intervention mapping : un processus méthodique pour élaborer, implanter et évaluer des programmes en promotion de la santé

“…D'autres programmes ont visé la prévention des déficits auditifs chez les agriculteurs [70], la promotion de l'activité physique et de la relaxation en entreprise [71], ou la promotion de la vaccination contre la grippe chez les professionnels de santé [72]. Ce protocole a été utilisé dans des populations adultes, des populations d'enfants, d'adolescents et d'étudiants, des populations gériatriques, ou encore des populations défavori-sées sur le plan socioéconomique ou de la santé mentale.…”

The potential economic value of influenza vaccination for healthcare workers in The Netherlands

“…For acute care settings, which treat patients during epidemics, the number of trials is limited. As these settings were not applicable to acute care settings, Riphagen et al performed a trial in acute care settings in the Netherlands …”

“…As these settings were not applicable to acute care settings, Riphagen et al performed a trial in acute care settings in the Netherlands. 7,23 Moreover, while influenza immunization is safe and relatively cheap, evidence on the economic benefits is not widely available for various healthcare settings, but this is an important aspect for hospital managers and policymakers to support such a program. 24 To get a better understanding of the health economic benefits of a vaccination program for healthcare workers, we performed a modeling study using as much input as possible from a clinical trial and complemented information with additional data not provided by the trial.…”