Seasonal influenza vaccination of healthcare workers: systematic review of qualitative evidence

Abstract

BackgroundMost countries recommend that healthcare workers (HCWs) are vaccinated seasonally against influenza in order to protect themselves and patients. However, in many cases coverage remains low. A range of strategies have been implemented to increase uptake. Qualitative evidence can help in understanding the context of interventions, including why interventions may fail to achieve the desired effect. This study aimed to synthesise evidence on HCWs’ perceptions and experiences of vaccination for seasonal influenza.MethodsSystematic review of qualitative evidence. We searched MEDLINE, EMBASE and CINAHL and included English-language studies which reported substantive qualitative data on the vaccination of HCWs for seasonal influenza. Findings were synthesised thematically.ResultsTwenty-five studies were included in the review. HCWs may be motivated to accept vaccination to protect themselves and their patients against infection. However, a range of beliefs may act as barriers to vaccine uptake, including concerns about side-effects, scepticism about vaccine effectiveness, and the belief that influenza is not a serious illness. HCWs value their autonomy and professional responsibility in making decisions about vaccination. The implementation of interventions to promote vaccination uptake may face barriers both from HCWs’ personal beliefs and from the relationships between management and employees within the targeted organisations.ConclusionsHCWs’ vaccination behaviour needs to be understood in the context of HCWs’ relationships with each other, with management and with patients. Interventions to promote vaccination should take into account both the individual beliefs of targeted HCWs and the organisational context within which they are implemented.Electronic supplementary materialThe online version of this article (10.1186/s12913-017-2703-4) contains supplementary material, which is available to authorized users.

Factors associated with influenza vaccination among healthcare workers in acute care hospitals in Canada

“…Similarly, increased knowledge levels and beliefs that influenza is a serious illness and that vaccinations are safe were associated with higher uptake among nurses . Although targeted educational strategies may be needed to resolve misconceptions, immunization programs focusing solely on education result in only minimal increases in coverage rates . Evaluations of programs targeting nurses suggest that multipronged approaches are necessary to address the myriad reasons for vaccine hesitancy and refusal in this occupational group …”

“…31 Although targeted educational strategies may be needed to resolve misconceptions 22 , immunization programs focusing solely on education result in only minimal increases in coverage rates. 34,35 Evaluations of programs targeting nurses suggest that multipronged approaches are necessary [36][37][38][39] to address the myriad reasons for vaccine hesitancy and refusal in this occupational group. 24,40 Lastly, in our study population, people identifying as Black had lower odds of being vaccinated against influenza compared with those with European heritage.…”

Ethical Approaches to Mandating Influenza Vaccinations for Local Health Department Workforce in Georgia

“…Two theories were sited to influence health care worker tendency to become vaccinated against influenza each year: theory of reasoned action/theory of planned behavior (TRA/TBP) and health belief model (HMB) (Slaunwhite, 2016;Marcu, 2015;Elias, 2017;Lorenc, 2017;Nowrouzi-Kia & McGeer, 2014;Sydnor & Perl, 2014). Articles that cited TBP/TRA state that is important to consider the individual factors that will assist in lessening the resistance associated with health care worker influenza vaccination policies (Slaunwhite, 2016;Marcu, 2015).…”

“…Four authors cited HBM as a promising tool to impact behavioral change resulting in an increase in influenza vaccination coverage among HCW (Elias, 2017;Lorenc, 2017;Nowrouzi-Kia & McGeer, 2014, Sydnor & Perl, 2014. Barriers to health care provider influenza vaccination are more complicated than other vaccines as influenza vaccination is required annually requiring HCW to make the decision each year.…”

“…HCW vaccination behavior needs to be understood in the context of HCW relationships amongst each other and with management and their patient population. Interventions to promote vaccination should take into account both the individual beliefs of targeted HCW and the organizational context within which they are implemented (Lorenc et al, 2017).…”