Facilitators and barriers to the seasonal influenza vaccination among nurses: A sequential explanatory mixed methods study
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Seasonal influenza is a public health concern that contributes to a significant increase in mortality and morbidity among high-risk patients annually. Influenza is a vaccine preventable disease with international and national recommendations supporting annual vaccination for high-risk patients and healthcare workers (HCWs). Despite recommendation, variations in vaccine uptake rates are evident among the different categories of HCWs, with nurses having one of the lowest vaccine uptake rates. HCWs constitute a large heterogeneous workforce and the reasons why they accept or reject the influenza vaccine is complex. Nurses in particular, are known to have different attitudes about influenza compared to physicians and it is also known that the various categories of HCWs respond to vaccination campaigns in different ways. It is therefore essential to identify and understand the reasons why nurses working in the acute hospital sector are not availing of a freely accessible, safe and effective vaccine in order to inform and develop future influenza campaigns to target the vaccination gap. Aim The overall aim of this study is to understand the facilitators of, and the barriers to, the uptake of seasonal influenza vaccination among nurses. Objectives 1. To examine nurses’ knowledge, risk perceptions, health beliefs and seasonal influenza vaccination behaviours. 2. To explore in depth the barriers and facilitating factors associated with vaccinated and unvaccinated nurses. 3. To identify nurses’ views in relation to mandatory vaccination policy for seasonal influenza. 4. To conduct a systematic review of the literature on interventions to improve seasonal influenza vaccination rates among nurses. 5. To provide information for the planning and implementation of interventions and campaigns to promote the uptake of the influenza vaccine among nurses. Methods The Health Belief Model (HBM) was the theoretical framework underpinning this research. A sequential explanatory mixed methods study was undertaken to identify the barriers and facilitators to seasonal influenza vaccination among nurses (chapter 4). Phase one of this sequential explanatory mixed method study consisted of a cross sectional survey using the King’s Nurses Influenza Vaccination Questionnaire (KNIVQ), to examine the relationship between nurses’ knowledge, risk perception, health belief and influenza vaccination practices. This was followed by focus group discussions (phase two) which was informed by the findings from the survey in phase one. The aim of phase two was to elaborate, and further explain in depth the findings from the survey, and also explore the barriers and facilitating factors associated with vaccinated and unvaccinated nurses. The quantitative data were analysed statistically and thematic analysis was used to analyse the qualitative data. The results from phase one and phase two were integrated using the pillar integration process (PIP). A systematic review was also undertaken to review the evidence on the effectiveness of interventions to improve the seasonal influenza vaccination among nurses (chapter 6). Results The results found that in the absence of mandatory vaccination policy for seasonal influenza, there are multiple factors that act as facilitators of, and barriers to nurses’ vaccination practices. Male nurses, those with higher knowledge about influenza and the vaccine and higher perceived risk were associated with vaccination uptake in the previous 12 months and future vaccine intentions. Nurses who believed they were in control of their own health (internal subscale) were also more likely to have been vaccinated while the subscale powerful others was associated with nurses’ future vaccine intentions. Nurses were also strongly influenced by the information they receive from flu experts within the hospital. Conclusions Although vaccinating nurses against seasonal influenza is an important public health initiative, achieving high vaccine uptake rates among nurses remains a challenge annually. It is important to recognise the needs of the different categories of HCWs when developing and tailoring influenza intervention programmes. Multi-faceted influenza campaigns targeting nurses based on the Health Belief Model should be prioritised. The current study makes an original contribution to knowledge by advancing understanding about the barriers of, and facilitating factors to nurses’ vaccination practices. Recommendations include to improve knowledge and awareness through mandatory training. There is a need for a more targeted approach to influenza campaigns with the personal benefits of vaccination incorporated into future campaigns.