Motivators and barriers to influenza shots
Concern for own health key factor
A large Canadian study of 3,275 health care workers found that the decision to receive the vaccine for seasonal or pandemic (H1N1) influenza was most influenced by their concern for their own health.1
Some misconceptions also led health care workers to decline the vaccine, says Kim Corace, PhD, CPsych, co-author of the study and clinical health psychologist at the Ottawa Hospital in Ontario, Canada.
"Many health care workers didn’t get vaccinated because they were healthy and they felt it was unnecessary," Corace says. "They were misinformed."
Health care workers want to protect their patients, but some felt they were not at risk personally of getting influenza, so they did not feel the need to be vaccinated, she explains.
"The second part of their concerns was about vaccine safety and efficacy and the side effects of the vaccine," she adds.
The research suggests ways hospital employee health centers might improve vaccination education.
For example, one key motivator was a pro-vaccine culture in the workplace, Corace says.
It was important to HCWs to have supervisors or colleagues supporting vaccination.
"You could have the highest level — the CEO of the hospital — get a shot, but it especially helped if the direct supervisor was vaccinated," she explains. "Most people do things on a unit, and if the boss on the unit does it, you’re more likely to do it."
Peer pressure and coworker encouragement also helped improve vaccination uptake, she adds.
"If you’re in an environment where this is important on all levels then you’re more likely to get vaccinated," she says.
A hospital employee health department has no control over media and outside messages, but they can control internal communication and the public health environment, and that’s where they should put their efforts, Corace suggests.
"Have people work together to promote vaccination as much as possible, and keep the message as consistent and accurate as possible," she says.
Address the fear
The hospital’s message should address HCWs’ fears about vaccine side effects and make certain people are aware that even if they’re healthy they are at risk of becoming infected with influenza and spreading it to patients and others.
Some of these messages should come from their direct supervisors, whom they likely trust, Corace says.
"This needs to be an organizational priority to make sure health care workers are vaccinated," she adds. "Only if people in the hospital think vaccination is important will you have success."
It has to be a shared responsibility, because it is likely to fall short of vaccination goals if the campaign is left up to just one department, she says.
About 74% of HCWs were vaccinated for the seasonal flu and 87% for H1N1 among the study population, Corace says.
The study spanned the period in 2009 when the world was concerned about the H1N1 flu pandemic that struck young and healthy people. Investigators collected data about uptake of that vaccine as well as uptake of the seasonal flu vaccine and compared motivators and barriers of HCWs becoming vaccinated to prevent either flu strain.
When faced with pandemic flu, HCWs were strongly motivated by a fear of becoming infected. This virus was new and related to deaths of younger people, Corace notes.
"They thought it was more severe and different than seasonal influenzas," Corace says. "The barriers were different too: the reason people didn’t get vaccinated against H1N1 was because they felt the vaccine development was accelerated done too quickly, so how could they know if it was safe."
Similarly to the general North American population, HCWs were influenced by media messages about the pandemic flu, Corace says.
For instance, there were conflicting messages about the severity of the pandemic, and some HCWs felt H1N1 had been misrepresented by official sources, she explains.
"There was inconsistent messaging and a distrust of external sources," she adds. "When there’s not a consistent message people don’t know what to believe."
- Prematunge C, Corace K, McCarthy A, et al. A comparison of healthcare worker motivators for seasonal vs. pandemic influenza uptake: A qualitative analysis. Abstract 402. Poster presented at ID Week 2013, San Francisco, CA. Oct. 2-6, 2013.
