Do Declination Statements Increase Health Care Worker Influenza Vaccination Rates?

Departments of Medicine and Preventive Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Clinical Infectious Diseases (Impact Factor: 8.89). 10/2009; 49(5):773-9. DOI: 10.1086/605554
Source: PubMed


In response to health care worker influenza vaccination rates that are below desired targets, strategies designed to stimulate
vaccination have been proposed, including the use of declination statements for those refusing vaccination. The impact of
these statements has not been thoroughly investigated and may be affected by their specific language and context. This review
examines the available data on the use and impact of declination statements to increase health care worker vaccination rates
and notes some potential pitfalls and issues that may arise with their use.

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    • "What has been established is that the use of declination forms is associated with increased resources to track compliance (as noted by a number of our participants), the risk of negatively affecting the employer–employee relationship, and the need for institutions to determine the punitive consequences for HCWs who refuse to sign the document. In the concluding statement of a recent review examining the use and impact of declination statements the authors emphasised that there may be increases in vaccination coverage, and a decrease in staff misconceptions about the influenza vaccine, if the declination statements were bundled with other measures that emphasised the rationale for and importance of vaccination, and decreased barriers to receipt of the vaccine [17]. "
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    ABSTRACT: Background In Australia, whether to provide free influenza vaccine to health care workers (HCWs) is a policy decision for each hospital or jurisdiction, and is therefore not uniform across the country. This study explored hospital policies and practices regarding occupational influenza vaccination of HCWs in Australia. Methods A study using qualitative methodology, which included semi-structured interviews, was undertaken with hospital staff involved with the delivery of occupational influenza vaccination from three states in Australia. Results The 29 participants were responsible for vaccinating staff in 82 hospitals. Major themes in the responses were the lack of resources and the difficulties participants faced in procuring any additional support or funding from their institutions. All study sites provided vaccine free of charge to employees via on-site clinics or mobile carts, and used multiple strategies to inform and educate their staff. In some instances, declination forms had been adopted, however their use was associated with resourcing issues, animosity, and other problems. Participants who were responsible for multiple sites were more likely to recount lower vaccination coverage figures at their hospitals. Conclusions From these interviews, it is clear that hospitals are implementing multiple strategies to educate, promote, and deliver the vaccine to staff. However, resources and support are not always available to assist with the vaccination campaign. The reality for many hospitals is that there is limited capacity to implement the vaccination campaigns at the levels high enough to raise compliance rates. Further research needs to be conducted to quantify the factors contributing to higher uptake in the Australian hospital setting.
    Full-text · Article · Sep 2012 · BMC Health Services Research
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    • "Low influenza vaccination rate in the HCWs is a global problem. Studies regarding how to increase vaccination rates suggest that i)free of charge vaccines ii)vaccination in 24 h open vaccination centres iii)mobile vaccination cards iv)administrative emphasis and support, v)education vi)signed declination forms vii)use of media campaigns or non-profit organizations that might push politicians and physicians to take further action viii)mandatory vaccination may be suitable interventions [5,23-25]. In spite of the fact that free of charge vaccines and administrative emphasis and support were already present in our sample, attitudes were considerably negative. "
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    ABSTRACT: Health care workers' (HCWs) influenza vaccination attitude is known to be negative. The H1N1 epidemic had started in mid 2009 and made a peak in October-November in Turkey. A national vaccination campaign began on November 2nd, 2009. Despite the diligent efforts of the Ministry of Health and NGOs, the attitudes of the media and politicians were mostly negative. The aim of this study was to evaluate whether HCWs' vaccination attitudes improved during the pandemic and to assess the related factors. This cross-sectional survey was carried out at the largest university hospital of the Aegean Region-Turkey. A self-administered questionnaire with 12 structured questions was applied to 807 HCWs (sample coverage 91.3%) before the onset of the vaccination programme. Their final vaccination status was tracked one week afterwards, using immunization records. Factors influencing vaccination rates were analyzed using ANOVA, t-test, chi-square test and logistic regression. Among 807 participants, 363 (45.3%) were doctors and 293 (36.6%) nurses. A total of 153 (19.0%) had been vaccinated against seasonal influenza in the 2008-2009 season. Regarding H1N1 vaccination, 143 (17.7%) were willing to be vaccinated vs. 357 (44.2%) unwilling. The number of indecisive HCWs was 307 (38.0%) one week prior to vaccination. Only 53 (11.1%) stated that they would vaccinate their children. Possible side effects (78%, n = 519) and lack of comprehensive field evaluation before marketing (77%, n = 508) were the most common reasons underlying unwillingness or hesitation.Among the 749 staff whose vaccination status could be tracked, 228 (30.4%) actually received the H1N1 vaccine. Some of the 'decided' staff members had changed their mind one week later. Only 82 (60%) of those willing, 108 (37%) of those indecisive and 38 (12%) of those unwilling were vaccinated.Indecisive HCWs were significantly younger (p = 0.017). Females, nurses, and HCWs working in surgical departments were more likely to reject vaccination (p < 0.05). Doctors, HCWs working in medical departments, and HCWs previously vaccinated against seasonal influenza were more likely to accept vaccination (p < 0.05). Being younger than 50 and having been vaccinated in the previous season were important predictors of attitude towards pandemic influenza vaccination. Vaccination rates increased substantially in comparison to the previous influenza season. However, vaccination rates could have been even higher since hesitation to be vaccinated increased dramatically within one week (only 60% of those willing and the minority of those indecisive were finally vaccinated). We speculate that this may be connected with negative media at the time.
    Full-text · Article · Apr 2011 · BMC Infectious Diseases
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