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Systematic Review
This report presents the findings from: (1) a synthesis of evidence about seasonal flu vaccination interventions: content and components, processes, and implementation; and (2) a systematic review of qualitative studies investigating HCWs’ views, attitudes and perceptions about seasonal flu vaccination.
The authors state:
"We identified 60 studies evaluating interventions to promote seasonal flu vaccination among HCWs. Of these, only 13 used a randomised controlled trial (RCT) design. The types of strategy, number of studies, strength of evidence and likely effectiveness are presented in the summary table.
Most of the RCTs focused on increasing awareness, or on education. Few RCTs evaluated strategies to increase access, or incentives, and none assessed mandatory vaccination programmes. Most interventions combined several different elements and this is likely to be the most promising approach, as components are likely to work in different ways, and for different people.
Most RCTs were conducted either in hospitals or in long-term care (e.g., nursing homes). Three studies were conducted in the UK (two RCTs), mainly focusing on increasing awareness or education. Most interventions appear not to have been based on any clear theoretical framework, or on any formative research or substantive engagement with HCWs themselves.
Most non-mandatory interventions focused on individual beliefs, rather than on the social or institutional factors which may affect vaccination uptake.
Data on implementation indicate that it is important to ensure adequate resources and management support; to address HCWs’ beliefs about vaccination; and to collect accurate data on vaccination coverage.
We synthesised the findings from 25 qualitative studies. The data indicated a number of personal beliefs which may be barriers to vaccination, including perceived low risk of influenza, fear of side-effects of the vaccine, and scepticism about vaccine effectiveness. There were serious barriers to the acceptability of some interventions, particularly coercive mandatory policies, but also some educational or awareness-raising strategies. Bringing together the findings from the quantitative and qualitative studies, it appears that HCWs have clear views about their needs and priorities in relation to seasonal flu vaccination, which were mostly not addressed by the evaluated interventions."
Key messages:
Promising interventions combine several components, including individual, social and environmental elements.
Education alone is probably ineffective, but broader awareness-raising strategies appear promising.
Increasing access to vaccination may be effective, but the evidence is weak with few RCTs.
Both “soft” and “hard” mandates appear promising, but have yet to be evaluated using robust study designs, and may have limited acceptability.
Interventions should ideally target everyone working in a healthcare context, but this may be practically difficult.
The culture and context of the organisation(s), within which interventions are implemented, may have an important influence on outcomes. Evaluators should seek to understand interventions within an organisational system.
Very few interventions engaged with HCWs to understand their needs and priorities. Intervention developers/implementers should engage with HCWs to understand their views, conduct formative research and pilot interventions before full-scale evaluation.
Mixed-methods research to understand the context, in which an intervention will be implemented, and HCWs’ likely responses to an intervention, may be valuable.