Elsevier

Vaccine

Volume 29, Issue 46, 26 October 2011, Pages 8357-8363
Vaccine

Behavioral change with influenza vaccination: Factors influencing increased uptake of the pandemic H1N1 versus seasonal influenza vaccine in health care personnel

https://doi.org/10.1016/j.vaccine.2011.08.084Get rights and content

Abstract

Background

Many health care personnel (HCP) choose not to get vaccinated against influenza despite recommendations to do so. The pH1N1 epidemic gave a unique opportunity to evaluate the attitudes to influenza vaccination of a group of HCP who routinely choose not to get vaccinated, but accepted the pH1N1 vaccine.

Methods

HCP employed at a tertiary care hospital in Winnipeg, Canada who received the pH1N1 vaccine were invited to participate in an online survey asking about attitudes and experiences regarding seasonal and pH1N1 influenza and vaccination. Those eligible included primarily nurses, other clinical staff, and support staff, as few physicians work as employees.

Results

Of the 684 respondents (29% return rate), 504 reported routinely getting vaccinated (RV) for seasonal influenza and 180 reported routinely not getting vaccinated (NRV). These two groups had different attitude towards the two strains of influenza, with markedly lower level of concern about seasonal influenza than pH1N1 for the NRV group. The contrast was especially notable regarding the NRV's view of the seriousness of the illness, their sense of exposure risk, and their confidence in the vaccine effectiveness (for all, seasonal < pH1N1, p < 0.001). The most common motivators for getting vaccinated for both NRV and RV groups related to concerns about personal or family safety, while the choice to decline seasonal vaccination related primarily to lack concern about the illness and concerns about vaccine effectiveness and safety. Coworkers were influential in the decision to get the pH1N1 vaccine for the NRV group.

Conclusion

For HCP who do not routinely get the seasonal vaccination, perception of risk outweighing side effect concerns appeared to be a major influence in going ahead with the pH1N1 vaccine. Educational campaigns that focus on personal benefit, engage peer champions, and address concerns about the vaccine may improve influenza vaccine uptake among health care personnel.

Highlights

► We compared attitudes to influenza vaccination among two groups of health care personnel (HCP) who received the pH1N1 vaccine: those who did (RV) or did not (NRV) routinely get the seasonal vaccine. ► For the NRV group the major influence in their decision to get the pH1N1 vaccine appeared to be that their perception of risk outweighed their concerns about the vaccine. ► The NRV group was much less concerned about seasonal influenza than pH1N1 influenza.

Introduction

Influenza causes annual outbreaks of disease, with the highest rates of serious illness and death among adults aged ≥65 years, children under 2 years old, and those with particular medical conditions that place them at increased risk for complications [1]. Influenza vaccination has been recommended for health care personnel (HCP) by public health authorities to limit influenza transmission to susceptible patient populations [1], [2]. Despite this, uptake of vaccination by HCP has remained low in many jurisdictions [1], [2], with rates commonly reported to be under 50% [3]. Mandatory vaccination has been recommended as a way to increase HCP vaccination rates [4]. Although this approach has been successful in some United States health care facilities [5], [6], it has often been met with substantial resistance and court challenges [5]. In Canada, a successful legal challenge resulted in the abandonment of a mandatory vaccination program for paramedics in one province [7]. Some jurisdictions may be reluctant to pursue mandatory campaigns due to potential conflicts between administration and HCP [8], and questions about the efficacy of vaccination programs in limiting influenza transmission from HCP to patients [9]. Nevertheless, HCP continue to be identified as an important focus for vaccination campaigns in order to decrease the risk for vulnerable patients, and efforts to improve uptake through a voluntary process remain of interest.

HCP who choose to get influenza vaccines often do so to protect their own health [10], [11]. Barriers to uptake include misconceptions or lack of knowledge about influenza infection, and also a lack of convenient access to the vaccine [10], [12]. Those vaccination campaigns which have been more successful usually build on HCP education, availability, measurement, facility policies, and role modeling [3].

In the wake of the H1N1 pandemic in 2009–2010, there were a number of studies investigating uptake of the pH1N1 vaccine amongst HCP [12], [13], [14], [15], [16], [17], [18], [19]. An important factor associated with uptake of pH1N1 vaccine was having previously received the seasonal vaccine [11], [13], [16], [17], [18], [19], with other relevant factors including occupation [13], [16], [18], [19], perceptions of vaccine safety [18], older age [13], [16], and a sense of professional responsibility [18]. However, little information is available on what may have influenced a HCP subgroup of particular interest: those who have not typically had the seasonal vaccination in the past, but chose to be vaccinated with the pH1N1 influenza vaccine.

The Health Sciences Center (HSC) is the largest tertiary care hospital in Manitoba, a province in central Canada. The hospital offers free, convenient, on-site influenza vaccination for hospital staff. Seasonal staff influenza vaccination rates typically approximate 25%. In 2009, the pH1N1 vaccine had a significantly higher uptake, with approximately 46% or almost 3000 of the staff within the institution being vaccinated. While there has been much speculation about the reasons for the higher rates, including fear of the disease and a high profile in the media, there has been little systematic investigation. This change in behavior provided a unique opportunity to more closely examine the factors that may have been influential in opting to get the vaccination, in order to provide guidance for future voluntary vaccination approaches.

The main purpose of this study was to explore the reasons for pH1N1 vaccination among HCP, comparing those who routinely obtain the seasonal influenza vaccine and those who do not, in order to identify personal, social, and environment influences on the decision-making. This information could then be utilized to guide more effective strategies to facilitate acceptance of the seasonal influenza vaccine among HCP.

Section snippets

Material and methods

The Occupational and Environmental Safety & Health Unit (OESH) at the HSC maintains employee records of vaccinations, including influenza vaccination. Those HCP who received the pH1N1 vaccine on-site during the 2009–2010 influenza season, and who were employed at the center for at least 2 years prior (to allow for an opportunity to be routinely offered seasonal influenza vaccine in the hospital), were eligible to take part (n = 2376) in the study. All those who had electronic addresses on file

Results

A total of 700 individuals responded to the survey, with 684 (29% of employees) providing usable questionnaires. The average age of respondents was 48.1 ± 9 years; 83% were female. Thirty-three percent of the respondents were nurses, 36% had other types of clinical positions such as physiotherapist, dietician, or health care aid and 31% worked in non-clinical fields such as housekeeping, maintenance, and administrative support. These proportions were reasonably comparable to the proportions of

Discussion

The purpose of this study was to identify reasons that a group of HCP who routinely do not get the seasonal influenza vaccine chose to get the pH1N1 vaccine. The study identified a number of factors which appeared to be relevant for this group in making a pro-vaccine decision, and provided some insight into their considerations for typically declining the vaccine. These HCP appeared to have quite different attitudes toward the two strains of influenza. They had markedly lower levels of concern

Conflict of interest statement

No author reports any potential conflict of interest regarding the information contained in this publication.

Acknowledgements

Funding for this project was provided by a grant from Manitoba Health. The data collection, analysis and interpretation as well as the preparation of the manuscript were done independently of the funding body. The results and conclusions presented are those of the authors. No official endorsement by Manitoba Health is intended or should be inferred.

Author contributions: AK, LG, DM contributed to the conception and design of the study, acquisition of data. AK performed the analysis, AK, LG, DM

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