Motivating factors for high rates of influenza vaccination among healthcare workers

Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, United States.
Vaccine (Impact Factor: 3.62). 06/2011; 29(35):5963-9. DOI: 10.1016/j.vaccine.2011.06.041
Source: PubMed


Recent guidance from related regulatory agencies and medical societies supports mandatory vaccination of healthcare workers (HCW) against influenza. At St. Jude Children's Research Hospital, a pediatric oncology referral center, more than 90% of HCWs receive vaccine each year without a policy mandating immunization. Factors associated with HCW uptake of influenza vaccines have not previously been evaluated in a high compliance rate setting.
A structured, anonymous, electronic questionnaire was distributed in August 2010 to employees (HCW and non-HCW). Demographics, prior receipt of influenza vaccines, reasons for acceptance or refusal of seasonal and 2009 H1N1 pandemic vaccine, and attitudes on mandatory vaccination were assessed.
95.0% of 925 HCWs and 63.1% of all 3227 qualifying employees responded to the survey. 93.8% and 75.2% of HCW reported receiving seasonal and 2009 H1N1 influenza vaccines, respectively, in the 2009-2010 season. Benefits to self and/or patients were cited as the most frequent reasons for accepting seasonal (83.5% and 78.3%, respectively) and 2009 H1N1 (85.9% and 81.1%, respectively) vaccination. 36.6% of HCWs opposed mandating influenza vaccination; 88.2% and 59.9% of whom reported receiving the seasonal and 2009 H1N1 influenza vaccines, respectively. Violation of freedom of choice and personal autonomy were the most frequently reported reasons for opposition.
In this cohort of HCWs with a high influenza vaccination rate, realistic assessments of the potential benefits of vaccination appear to have driven the choice to accept immunization. Despite this, mandating vaccination was viewed unfavorably by a significant minority of vaccinated individuals. Employee concerns over autonomy should be addressed as institutions transition to mandatory vaccination policies.

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    • "Belgian, Dutch and German immunizers all reported self-protection, patient protection, and protection of family members as most important reasons to get vaccinated against influenza. It has been suggested before, that the realistic assessment of potential benefits of influenza vaccination for especially the self, but also for others are crucial motivating factors for HCP to get vaccinated [25,26]. In contrast to that, Belgian, Dutch and German non-immunizers’ reasons to not get vaccinated against influenza can be clustered into six categories: 1) fear of side effects or illness caused by the vaccine, 2) a low risk-perception, 3) the disbelief in the effectiveness of influenza vaccination, 4) organizational barriers, 5) misconceptions/lack of knowledge, and 6) undefined negative emotions or fear resulting from the decision whether to get vaccinated. "
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    ABSTRACT: Health Authorities recommend influenza vaccination of healthcare personnel (HCP) to decrease the transmission of influenza to vulnerable patients. Recent studies have almost exclusively used quantitative questionnaires in order to identify determinants of vaccination behaviour. Interviews enable HCP to express freely why they think they are (not) willing to get vaccinated against influenza. By means of semi-structured one-on-one interviews with 123 Belgian, Dutch and German HCP, reasons for and against vaccination, experiences with influenza vaccination, intention to get vaccinated and possible barriers, as well as willingness to advice influenza vaccination to patients were investigated. Data were processed with QSR NVivo 8.0 and analysed using a combination of a deductive and a general inductive approach. Across countries, self-protection, patient protection, and protection of family members were reported as most important reasons to get vaccinated against influenza. Reasons to not get vaccinated against influenza were fear of side effects caused by the vaccine, a low risk-perception, the disbelief in the effectiveness of influenza vaccination, organizational barriers, misconceptions, and undefined negative emotions. The social cognitive variables underlying the decision of HCP to get vaccinated against influenza (or not) seem to be similar in Belgium, Germany, and the Netherlands, even though some differences surfaced. A quantitative investigation of those social cognitive variables is needed in order to determine the importance of the social cognitive variables in explaining the intention to get vaccinated and the importance of the similarities and differences between countries that have been found in this study.
    Full-text · Article · Apr 2014 · BMC Public Health
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    • "Indeed, in a sample of HCWs in a governmental hospital located in Turkey a total of 23.1% received the pandemic influenza A/H1N1 vaccine [22]. In a pediatric oncology referral center in the United States 75.2% of HCWs reported receiving 2009 H1N1 influenza vaccine [30]. The uptake rates for monovalent 2009 pandemic H1N1 vaccine among hospital-based doctors, nurses, and allied HCWs in Singapore and United Kingdom were 36.2% and 41.3%, respectively [29]. "
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    ABSTRACT: To assess the knowledge, the attitudes, and the behaviour towards influenza A/H1N1 and the vaccination among health-care workers (HCWs). A sample of HCWs was selected from a random sample of non-teaching public hospitals, located in the cities of Naples and Avellino (Italy), received a self-administered anonymous questionnaire including questions about socio-demographic characteristics, knowledge on modes of transmission and preventative measures, attitudes and behaviour relating to influenza A/H1N1. Only 36.1% correctly knew the main modes of transmission, and that HCWs are a risk category and this level of knowledge was significantly higher in HCWs having received information through scientific journals. A higher perceived risk of contracting influenza A/H1N1 has been observed in the HCWs more knowledgeable, in those considering influenza A/H1N1 a serious disease, and in those working in surgical wards. Only 16.7% have received the influenza A/H1N1 vaccination and HCWs with more fear of contracting influenza A/H1N1, those considering vaccine more useful and less dangerous were more likely to receive vaccine. Education and communication strategies for improving the level of knowledge and for the immunization uptake regarding influenza A/H1N1 HCWs are strongly needed.
    Full-text · Article · Apr 2014 · BMC Infectious Diseases
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    • "Facilitating factors that have been noted include interest in self-protection, concern for patients' well-being, belief in the vaccine's effectiveness, reduction in sick leave, and trust in employee health service's recom- mendations. 15 There is limited information regarding barriers and facilitators to influenza vaccination in the context of a pandemic outbreak, although a few studies including 1 US study (Hakim et al 2011) 18 on pH1N1 vaccination uptake in HCWs have been pub- lished. 16 Information on uptake rates and factors associated with pH1N1 in a medical center might be informative in terms of future pandemic preparedness planning. "
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    ABSTRACT: Background: Information on the rates and factors associated with influenza vaccinations, although limited, is important because it can inform the development of effective vaccination campaigns in a university medical center setting. Methods: A study was conducted in 2011 to identify individual and organizational level barriers and facilitators to influenza vaccination among clinical and nonclinical personnel (N = 428) from a major university medical center. Results: Seventy-one percent of clinical personnel (n = 170) reported pandemic H1N1 vaccination compared with 27% of nonclinical personnel (n = 258), even though vaccine was made widely available to all personnel at no cost. Similarly, disparate rates between clinical and nonclinical personnel were noted for the 2009/2010 seasonal influenza vaccine (82% vs 42%, respectively) and 2010/2011 combination (pandemic plus seasonal) influenza vaccine (73% vs 28%, respectively). Factors associated with pandemic vaccination in nonclinical personnel included the following: high level of influenza-related knowledge, concern regarding influenza contagion, history of previous influenza vaccinations or influenza illness, participation in vaccine-related training, and awareness of the institution's written pandemic plan. For clinicians, past history of seasonal influenza vaccination was associated with pandemic vaccination. For all participants, taking any 1 or more of the 3 influenza vaccines available in 2009 to 2011 was associated with intent to take a hypothetical future novel pandemic vaccine (odds ratio, 6.7; 95% confidence interval: 4.32-10.44; P < .001). Conclusion: Most of the risk factors associated with lack of vaccination uptake are amenable to organizational strategies.
    Full-text · Article · Feb 2013 · American journal of infection control
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