Increasing uptake of Live Attenuated Influenza Vaccination (LAIV) in two-year-olds through appointment times and dates: A pilot intervention in Cwm Taf Morgannwg University Health Board

Abstract

BackgroundThe Live Attenuated Influenza Vaccine (LAIV) protects two-year-old children against influenza and serious illness, however uptake across Wales is sub-optimal and below Welsh Government targets. Awareness of the vaccine and its effectiveness, convenience of appointments/clinics and lack of central appointment provision may influence uptake. We piloted provision of set appointment dates and times to investigate impact on uptake of LAIV amongst two-year-olds and identify potential operational issues in a pragmatic selection of general practices. MethodsParents/guardians of two-year-olds in pilot practices (n=9) were sent a personalised letter using the UK Government Notify System, a scheduled vaccination appointment and an evidence-based Frequently Asked Questions sheet. Children in non-pilot practices (n=37) received a general letter and FAQ sheet, without a scheduled appointment. Intervention practices were selected based on low LAIV uptake amongst two-year-olds in the two previous influenza seasons. A mixed-methods, uncontrolled, evaluation of the pilot included analysis of vaccination practice-level uptake data and qualitative data from baseline and follow-up stakeholder surveys. Further patient-level analysis of the intervention to determine individual effects and impact on deprivation-based health inequalities is planned. FindingsCompared to the previous year, pilot practices saw a median increase in LAIV uptake amongst two-year-olds of 30·4% (IQR 11·7% to 33·6%), whilst non-pilot practices saw a median decrease of 4·7% (IQR 16·0% to 2·2%). Uptake increased for 100% (9/9) of the pilot practices, but for only 35% (13/37) of non-pilot practices, compared to the previous year. Qualitative feedback noted advantages including saved administration time and improved planning, but also disadvantages including wasted clinical time from non-attenders. InterpretationThe findings indicate that issuing appointment dates and times should be considered as part of a range of measures to improve LAIV uptake in two-year-olds amongst low performing practices. However, the pragmatic, unblinded nature of the study design and the within practice annual comparisons are limitations, and mean results should be interpreted with caution. Further controlled evaluation, including assessment of lost time due to DNAs and feasibility of scaling, is needed. FundingThere was no additional funding provided to undertake this study. Staff time was contributed by Cwm Taf Morgannwg University Health Board and Public Health Wales.