A Mixed-Methods Study to Evaluate Elementary School Staff's Acceptability, Delivery Challenges, and Communication Regarding the Implementation of School-Located Influenza Vaccination Program in Hong Kong.

Qiuyan Liao,Wendy Wing Tak Lam,Hau Chi So,Meihong Dong,Benjamin J Cowling,Dennis Kai Ming Ip,Jiehu Yuan

doi:10.3390/vaccines9101175

Qiuyan Liao, Wendy Wing Tak Lam + Show 5 more

Open Access

https://doi.org/10.3390/vaccines9101175

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Abstract

This was a mixed-methods study comprising a questionnaire-based survey, a qualitative study, and analysis of school newsletters to evaluate elementary school staff’s acceptability, delivery challenges and communication about school-located influenza vaccination program (SIVP) in Hong Kong. We found that school staff with lower intention to implement SIVP perceived greater logistical difficulties in arranging SIVP. Challenges regarding program delivery included schools’ limited infrastructure, the burden of paperwork, the fear of being overwhelmed by multiple school-based vaccination schedules, lacking confidence in communicating with parents about influenza vaccines, and the difficulties in managing vaccination-related anxiety among children with intellectual disability. School staff were generally passive in communicating with parents and students about influenza vaccines. We also found that schools may use the school newsletters as a substitute of the formal informed consent forms. Good partnerships among government, service providers and schools should be established to minimize the burden of paperwork for school staff, facilitate early planning of SIVP, and support schools with limited infrastructure and the vaccination of children with intellectual disabilities. Training is needed to enhance school staff’s confidence in communicating with parents and students about influenza vaccines and improve information delivery to support parents’ informed decisions for children’s vaccination.

Highlights

Seasonal influenza attacks children, with an annual attack rate of ~20% among unvaccinated children [1], and was associated with 16.4% of the hospitalizations among children aged 5–17 years [2]
In the United States, the school nurses were responsible for checking the consent forms and screening for students’ health eligibility to vaccination [22], while in Hong Kong, this may become the responsibility of school staff without the support of a school nurse, which may be perceived as a burden to school staff
Non-return of parental consent forms was identified to be an important challenge of implementing school-located influenza vaccination program (SIVP) in the United States, which was linked to context-based communication and the consent process [8,9,22], but how SIVP was communicated with parents and students via schools and the consent process in the context of an Asian city remained unexplored

Summary

Introduction

Seasonal influenza attacks children, with an annual attack rate of ~20% among unvaccinated children [1], and was associated with 16.4% of the hospitalizations among children aged 5–17 years [2]. School-located influenza vaccination program (SIVP) was evidenced to be efficient for promoting vaccination uptake rates among schoolaged children elsewhere [3,4,6,7] and acceptable for elementary schools and parents in the context of the United States [8,9,10]. The contexts of mainly providing IIV for school-aged children and having school staff instead of school nurses for the coordination of the school-located immunization programs in Hong Kong were similar to those in other Asian countries such as Japan and Korea [28,29,30]. Learning elementary schools’ experience with SIVP in Hong Kong may help to generalize the findings to other Asian cities with similar contexts

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