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Innovative Approaches for Understanding Seasonal Influenza Vaccine Declination in Healthcare Personnel Support Development of New Campaign Strategies

Published online by Cambridge University Press:  02 January 2015

Tamara M. Schult ,
Ebi R. Awosika ,
Michael J. Hodgson ,
Pamela R. Hirsch ,
Kristin L. Nichol ,
Sue R. Dyrenforth  and
Scott C. Moore
Tamara M. Schult*
Affiliation:
Office of Public Health, Veterans Health Administration, Washington, DC
Ebi R. Awosika
Affiliation:
Office of Public Health, Veterans Health Administration, Washington, DC University of Minnesota Medical School, Minneapolis, Minnesota
Michael J. Hodgson
Affiliation:
Office of Public Health, Veterans Health Administration, Washington, DC
Pamela R. Hirsch
Affiliation:
Office of Public Health, Veterans Health Administration, Washington, DC
Kristin L. Nichol
Affiliation:
University of Minnesota Medical School, Minneapolis, Minnesota Minneapolis VA Health Care System, Minneapolis, Minnesota
Sue R. Dyrenforth
Affiliation:
National Center for Organizational Development, Veterans Health Administration, Cincinnati, Ohio
Scott C. Moore
Affiliation:
National Center for Organizational Development, Veterans Health Administration, Cincinnati, Ohio
*
One Veterans Drive (V68), Minneapolis, MN 55417 ([email protected])
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Abstract

Objective.

The main objectives of our study were to explore reasons for seasonal influenza vaccine acceptance and declination in employees of a large integrated healthcare system and to identify underlying constructs that influence acceptance versus declination. Secondary objectives were to determine whether vaccine acceptance varied by hospital location and to identify facility-level measures that explained variability.

Design.

A national health promotion survey of employees was conducted that included items on vaccination in the 2009-2010 influenza season. The survey was administered with two other institutional surveys in a stratified fashion: approximately 40% of participating employees were randomly assigned to complete the health promotion survey.

Setting.

National single-payer healthcare system with 152 hospitals.

Participants.

Employees of the healthcare system in 2010 who responded to the survey.

Methods.

Factor analysis was used to identify underlying constructs that influenced vaccine acceptance versus declination. Mean factor scores were examined in relation to demographic characteristics and occupation. Multilevel logistic regression models were used to determine whether vaccine acceptance varied by location and to identify facility-level measures that explained variability.

Results.

Four factors were identified related to vaccine declination and were labeled as (1) “don't care,” (2) “don't want,” (3) “don't believe,” and (4) “don't know.” Significant differences in mean factor scores existed by demographic characteristics and occupation. Vaccine acceptance varied by location, and vaccination rates in the previous year were an important facility-level predictor.

Conclusions.

Results should guide interventions that tailor messages on the basis of particular reasons for declination. Occupation-specific and culturally appropriate messaging should be considered. Continued efforts will be taken to better understand how workplace context influences vaccine acceptance.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 9 , September 2012 , pp. 924 - 931
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012 

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References

1. Wortley, PM, Talbot, TR, Rehm, SJ, et al, eds. Providing a safer environment for healthcare personnel and patients through influenza vaccination: strategies from research and practice. The Joint Commission on Accreditation of Healthcare Organizations, 2009. http://vww.jointcommission.0rg/assets/l/l8/Flu_Monograph.pdf. Accessed August 18, 2011.Google Scholar
2. Centers for Disease Control and Prevention. Prevention and control of influenza with vaccines: recommendations of the advisory committee on immunization practices. MMWR Morb Mortal Wkly Rep 2011;59:1–62.Google Scholar
3. Greene, LR, Cain, TA, Dolan, SA, et al. APIC position paper: influenza immunization of healthcare personnel. Association for Professionals in Infection Control and Epidemiology (APIC), 2008. http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Influenza/APIC_Position_Paper_Influenza_ll_7_08final_revised.pdf. Accessed August 18,2011.Google Scholar
4. Talbot, TR, Bradley, SE, Cosgrove, SE, Ruef, C, Siegel, JD, Weber, DJ. Influenza vaccination of healthcare workers and vaccine allocation for healthcare workers during vaccine shortages. Infect Control Hosp Epidemiol 2005;26:882–890.10.1086/502512Google Scholar
5. Borlaug, G, Newman, A, Pfister, J, Davis, JP. Factors that influenced rates of influenza vaccination among employees of Wisconsin acute care hospitals and nursing homes during the 2005-2006 influenza season. Infect Control Hosp Epidemiol 2007;28:1398–1400.Google Scholar
6. Babcock, HM, Gemeinhart, N, Jones, M, Dunagan, WC, Woeltje, KF. Mandatory influenza vaccination of health care workers: translating policy to practice. Clin Infect Dis 2010;50:459–464.10.1086/650752Google Scholar
7. Feemster, KA, Prasad, P, Smith, MJ, et al. Employee designation and health care worker support of an influenza vaccine mandate at a large pediatric tertiary care hospital. Vaccine 2011;29:1762–1769.10.1016/j.vaccine.2010.12.115Google Scholar
8. Rakita, RM, Hagar, BA, Crome, P, Lammert, JK. Mandatory influenza vaccination of healthcare workers: a 5-year study. Infect Control Hosp Epidemiol 2010;31(9):881–888.10.1086/656210Google Scholar
9. Hirsch, P, Hodgson, M, Davey, V. Seasonal influenza vaccination of healthcare employees: results of a 4-year campaign. Infect Control Hosp Epidemiol 2011;32:444–448.Google Scholar
10. Poland, GA. The 2009-2010 influenza pandemic: effects on pandemic and seasonal vaccine uptake and lessons learned for seasonal vaccination campaigns. Vaccine 2010;28S:D3–D13.10.1016/j.vaccine.2010.08.024Google Scholar
11. Tagajdid, MR, El Annaz, H, Belefquih, B, et al. Factors influencing uptake of influenza vaccine amongst healthcare workers in a regional center after the A(H1N1) 2009 pandemic: lessons for improving vaccination rates. Int J Risk SafMed 2011;23:249–254.10.3233/JRS-2011-0544Google Scholar
12. Honda, H, Padival, S, Shimamura, Y, Babcock, HM. Changes in influenza vaccination rates among healthcare workers following a pandemic influenza year at a Japanese tertiary care centre. J Hosp Infect 2012;80:316–320.10.1016/j.jhin.2011.12.014Google Scholar
13. Hofmann, F, Ferracin, C, Marsh, G, Dumas, R. Influenza vaccination of healthcare workers: a literature review of attitudes and beliefs. Infection 2006;34:142–147.10.1007/s15010-006-5109-5Google Scholar
14. Hollmeyer, HG, Hayden, F, Poland, G, Buchholz, U. Influenza vaccination of health care workers in hospitals: a review of studies on attitudes and predictors. Vaccine 2009;27:3935–3944.10.1016/j.vaccine.2009.03.056Google Scholar
15. Hirsch, P, Ledsky, R, Knighton, T, Pritchett, J, Tensuan, L, Durfee, J. Seasonal influenza vaccination in VA health care facilities: messages and approaches for clinical and nonclinical staff. In: Program and abstracts of the 138th Annual Meeting of the American Public Health Association (APHA); November 6-10, 2010; Denver, CO. Abstract 230130.Google Scholar
16. Hodgson, MJ, Reed, R, Craig, T, et al. Violence in healthcare facilities: lessons from the Veterans Health Administration. J Occup Environ Med 2004;46:1158–1165.10.1097/01.jom.0000141658.91805.47Google Scholar
17. Warren, N, Hodgson, M, Craig, T, Dyrenforth, S, Perlin, J, Murphy, F. Employee working conditions and healthcare system performance: the Veterans Health Administration experience. J Occup Environ Med 2007;49:417–429.10.1097/JOM.0b013e31803b94ceGoogle Scholar
18. Nichol, KL, Hauge, M. Influenza vaccination of healthcare workers. Infect Control Hosp Epidemiol 1997;18:189–194.10.2307/30141980Google Scholar
19. Blakely, TA, Woodward, AJ. Ecological effects in multi-level studies. J Epidemiol Community Health 2000;54:367–374.10.1136/jech.54.5.367Google Scholar
20. Goldstein, H. Multilevel statistical models. New York Wiley, 2003.Google Scholar
21. Larsen, K, Petersen, JH, Budtz-Jorgensen, E, Endahl, L. Interpreting parameters in the logistic regression model with random effects. Biometrics 2000;56:909–914.10.1111/j.0006-341X.2000.00909.xGoogle Scholar
22. Larsen, K, Merlo, J. Appropriate assessment of neighborhood effects on individual health: integrating random and fixed effects in multilevel logistic regression. Am J Epidemiol 2005;161:81–88.10.1093/aje/kwi017Google Scholar
23. Merlo, J, Chaix, B, Ohlsson, H, et al. A brief conceptual tutorial of multilevel analysis in social epidemiology: using measures of clustering in multilevel logistic regression to investigate contextual phenomena. J Epidemiol Community Health 2006;60:290–297.10.1136/jech.2004.029454Google Scholar
24. Kussman, MJ. Veterans Healthcare Administration NLB Human Resources Committee, 2008 Facility Complexity Model, http://nlb.vssc.med.va.gov/EDMs/Document%20Library/EDM%20FY08%20Facility%20Complexity%20Level%20Model.pdf. Published September 2008. Accessed June 3, 2011.Google Scholar
25. West, AN, Lee, RE, Shambaugh-Miller, MD, et al. Defining “rural” for veterans' health care planning. J Rural Health 2010;26:301–309.10.1111/j.1748-0361.2010.00298.xGoogle Scholar
26. Schult, TM, Awosika, ER, Hodgson, MJ, Dyrenforth, S. Disparities in health behaviors and chronic conditions in health care providers in the Veterans Health Administration. J Occup Environ Med 2011;53:1134–1145.10.1097/JOM.0b013e31822b8379Google Scholar
27. Healthy People 2020. http://www.healthypeople.gov/2020/default.aspx. Published 2010. Accessed August 25, 2011.Google Scholar
28. Poland, GA. Mandating influenza vaccination for health care workers: putting patients and professional ethics over personal preference. Vaccine 2010;28:5757–5759.10.1016/j.vaccine.2010.07.057Google Scholar