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Seasonal influenza vaccination of health care workers: evidence synthesis

What do we want to know?

This review addresses the following questions:

  • What are the views and experiences of healthcare workers (HCWs) regarding vaccination for seasonal influenza?
  • What is known about the implementation and context of interventions to promote vaccination for seasonal influenza among HCWs?

Who wants to know and why?

This systematic review provides policy-makers and people involved in delivering vaccination promotion interventions with an overview of what is known about HCWs’ perceptions and attitudes. The focus on qualitative evidence and contextual data from intervention studies can help us to understand what problems may be encountered in implementing interventions, and also to gain a broader and more critical understanding of the contexts of vaccination promotion.

What did we find?

Some HCWs said that the risk of influenza is low, that influenza is not a serious illness, or that they were worried about the potential side-effects of the vaccine: these factors may make them less likely to accept vaccination. Some were sceptical about the effectiveness of vaccination in reducing disease among patients, and suggested that there is a lack of robust scientific evidence.

In contrast, many HCWs reported positive reasons to accept vaccination, including the protection of their own health and that of their patients. Some saw vaccination as an ethical imperative for healthcare professionals.

For some HCWs, individual freedom of choice in deciding whether to be vaccinated is important. They suggested that organisational policies imposing mandatory vaccination would compromise individual autonomy, and could be counter-productive in terms of HCWs’ broader relationships with organisations and with patients.

HCWs’ experiences of vaccination programmes were mixed. Some felt that management were strongly supportive of vaccination, while others reported ambivalence from managers. Programmes to promote vaccination, such as requiring HCWs to sign declination forms, were found to have logistical challenges. HCWs prefer information which is tailored to their needs and provides a balanced view of vaccination.

Contextual data from intervention studies confirms the importance of social and organisational factors, such as leadership and peer relationships among HCWs.

What are the implications?

HCWs value their autonomy and professional responsibility in making decisions about vaccination. Programmes which are imposed in a top-down way may be counter-productive.

Successful implementation of interventions to promote vaccination uptake may be affected by HCWs’ personal beliefs and from the relationships between management and employees within the targeted organisations. Intervention providers should aim to gain an understanding of the organisational context before delivering vaccination programmes, ideally through formative research or consultation. Identification of the different barriers to vaccination uptake among HCWs is important as appropriate interventions can then be selected and implemented. This approach is likely to increase the reach and acceptability of interventions.

How did we get these results?

We conducted a systematic review of qualitative studies which reported data on HCWs’ perceptions of seasonal influenza vaccination. Twenty-five studies were included in the review and the data from these studies were  synthesised thematically.

In addition, we retrieved studies included in a previous review evaluating the effectiveness of interventions to increase the uptake of influenza vaccination and extracted data on the context of the interventions (e.g. setting, population, intervention content) and on the process of implementation. We synthesised the data thematically by type of intervention.

This report should be cited as:

Lorenc T, Marshall D, Wright K, Sutcliffe K, Sowden A (2018). Seasonal influenza vaccination of healthcare workers: evidence synthesis. London: EPPI Centre, Social Science Research Unit, UCL Institute of Education, University College London ISBN- 978-1-911605-05-8

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