Unleashing the Positive Deviants at the Frontline: More than Just Sparking Change

Abstract

study was to examine factors influencing EMTs' seasonal influenza and pandemic H1N1 vaccine compliance. Methods: Avaccine compliance questionnaire in the form of online and paper surveys was administered to EMTs working in St Louis, MO in March June, 2011. McNemar tests were used to compare compliance rates across the three types of vaccine; a non-parametric test was chosen because the outcome variable is dichotomous and it is a matched sample (same EMTs over different time periods). Hierarchical logistic regressions were used to determine predictive models for 2010/2011 seasonal influenza vaccination compliance and intent to be vaccinated in the future. Good model fit, indicated by a nonsignificant chi square value, was calculated with the Hosmer and Lemeshow goodness-of-fit test. Results: In all, 265 EMTs completed the survey. EMTs' attitudes and beliefs towards influenza vaccines differed significantly when comparing vaccinated to non-vaccinated EMTs. EMTs whose employer had a mandatory vaccination policy were significantly more likely to receive the seasonal influenza vaccine (100% versus 75.6%) or the H1N1 vaccine (100% versus 66.8%) compared to those without such a policy (X 1⁄4 8.8, p < .001 and X 1⁄4 6.7, p < .01 respectively). In logistic regression controlling for demographics, the determinants of 2010/2011 seasonal influenza vaccination included belief that EMTs should be vaccinated every year (odds ratio [OR], 10.3 [95% confidence interval {CI}, 2.4 44.4]), perceived importance of vaccination [OR 8.3 (CI: 2.3 30.3)], perception that influenza vaccine has few side effects [OR 6.0 (CI: 1.8 19.7)], and past vaccine-seeking behavior [OR 4.1 (CI: 1.5 11)]. In logistic regression controlling for demographics, determinants of intent to be vaccinated included having the vaccine available on-site and free [OR 21.1 (CI: 4.7 92.7)], and belief that EMTs should be vaccinated every year [OR 6.8 (CI: 1.6 28.1)]. EMTs' attitudes and beliefs towards influenza vaccines differed significantly when comparing vaccinated to non-vaccinated EMTs. Vaccinated EMTs were significantly more likely than non-vaccinated EMTs to agree that seasonal influenza (X1⁄4 7.0, p< .01) and H1N1 (X1⁄4 8.4, p< .01) are serious diseases, that vaccination is important to them (X 1⁄4 93.2, p < .001), that non-immunized EMTs play a role in influenza transmission (X 1⁄4 21.8, p < .001), and that public health officials can be trusted regarding vaccine safe (X 1⁄4 9.2, p < .01). Conclusions: Targeted interventions should be aimed at EMTs to increase their vaccine compliance, including implementing a mandatory vaccination policy and addressing EMTs' beliefs and attitudes about vaccine in an education campaign.