Planning and process evaluation of a multi-faceted influenza vaccination implementation strategy for health care workers in acute health care settings

Josien Riphagen-Dalhuisen,Nita Bos,Pieter Gallee,Marita Danhof-Pont,Gerard Frijstein,Herbert De Jager,Nannet Van Der Geest-Blankert,Marjan De Vries,Ed Smeets,Eelko Hak

doi:10.1186/1471-2334-13-235

Abstract

BackgroundInfluenza transmitted by health care workers (HCWs) is a potential threat to frail patients in acute health care settings. Therefore, immunizing HCWs against influenza should receive high priority. Despite recommendations of the World Health Organization, vaccine coverage of HCWs remains low in all European countries. This study explores the use of intervention strategies and methods to improve influenza vaccination rates among HCWs in an acute care setting.MethodsThe Intervention Mapping (IM) method was used to systematically develop and implement an intervention strategy aimed at changing influenza vaccination behaviour among HCWs in Dutch University Medical Centres (UMCs). Carried out during the influenza seasons 2009/2010 and 2010/2011, the interventions were then qualitatively and quantitatively evaluated by way of feedback from participating UMCs and the completion of a web-based staff questionnaire in the following spring of each season.ResultsThe IM method resulted in the development of a transparent influenza vaccination intervention implementation strategy. The intervention strategy was offered to six Dutch UMCs in a randomized in a clustered Randomized Controlled Trial (RCT), where three UMCs were chosen for intervention, and three UMCs acted as controls. A further two UMCs elected to have the intervention. The qualitative process evaluation showed that HCWs at four of the five intervention UMCs were responsive to the majority of the 11 relevant behavioural determinants resulting from the needs assessment in their intervention strategy compared with only one of three control UMCs. The quantitative evaluation among a sample of HCWs revealed that of all the developed communication materials, HCWs reported the posters as the most noticeable.ConclusionsOur study demonstrates that it is possible to develop a structured implementation strategy for increasing the rate of influenza vaccination by HCWs in acute health care settings. The evaluation also showed that it is impossible to expose all HCWs to all intervention methods (which would have been the best case scenario). Further study is needed to (1) improve HCW exposure to intervention methods; (2) determine the effect of such interventions on vaccine uptake among HCWs; and (3) assess the impact on clinical outcomes among patients when such interventions are enacted.

Highlights

Influenza transmitted by health care workers (HCWs) is a potential threat to frail patients in acute health care settings
These clinical trial studies demonstrating the effects of immunizing HCWs against influenza on patient outcomes were all conducted in long-term care facilities [10], and it should be noted that acute care hospital settings are very different compared to long-term care as they have a higher patient turnover, which hampers the applicability of findings from long-term care settings to acute care settings [9]
From the communication reports derived from the intervention University Medical Centres (UMCs), it became evident that (1) longer opening hours for administration of the vaccine, (2) more vaccination locations, and (3) the use of mobile carts appeared to be associated with an increased vaccine uptake among HCWs

Summary

Introduction

Influenza transmitted by health care workers (HCWs) is a potential threat to frail patients in acute health care settings. Using a micro-simulation hospital department model, Van den Dool et al demonstrated that, no herd immunity can be achieved, there is an inverse linear relationship between the number of vaccinated HCWs and the number of infected hospital patients, meaning that each additional HCW who is immunized against influenza adds to the preventive effect [9] These clinical trial studies demonstrating the effects of immunizing HCWs against influenza on patient outcomes were all conducted in long-term care facilities [10], and it should be noted that acute care hospital settings are very different compared to long-term care as they have a higher patient turnover, which hampers the applicability of findings from long-term care settings to acute care settings [9]

Methods

Results

Discussion

Conclusion