Developing an Evidence-Based Intervention to Improve Influenza Vaccination Rate Among Care Homes Staff

Abstract

Background Influenza poses a significant health risk to older people in care homes, who are particularly vulnerable to severe complications. Vaccination is an effective way to prevent influenza outbreaks in care homes. However, influenza vaccination rates among care home staff remain low. To address this public health issue, this thesis, as part of the FluCare study, explores the development and evaluation of an intervention designed to improve influenza vaccination uptake among care home staff. Methods This thesis includes three studies, all conducted within the context of the FluCare study. The first study was a systematic review conducted to identify barriers and enablers affecting influenza vaccine uptake among care home staff. The second study was a survey of local authorities (LAs) to identify current practices and interventions used to improve influenza vaccination rates among care home staff. The third study involved interviews with vaccine providers to identify the barriers and enablers related to implementing in-care home influenza vaccination clinics for care home staff. Results The systematic review identified key barriers and enablers to influenza vaccine uptake, such as doubts about the effectiveness of the vaccine, concerns about side effects, and lack of accessibility to the influenza vaccine. Enablers included free onsite vaccination, management encouragement, and reminder systems. These findings informed the FluCare intervention by highlighting the need to address both individual and organizational barriers. The cross-sectional survey of local authorities showed that most interventions aimed at enhancing influenza vaccination among care home staff focused on education (91.4%) and improving access to the influenza vaccine (63.8%), with fewer local authorities offering incentives to care homes or staff. Regression analysis suggested that certain interventions may be associated with higher vaccination rates, including informing staff about vaccination goals and policies (p = 0.063), sending email or text reminders (p = 0.080), and the availability of interventions to enhance access to the vaccine (p = 0.065). The interviews with vaccine providers identified barriers and enablers to delivering in-care home vaccination clinics. Key barriers included late timing of the clinics, lack of staff awareness about the clinics, and poor communication and coordination with care home managers. Key enablers included financial incentives for vaccine providers and effective communication and coordination with care home managers. Conclusion This thesis identifies the barriers and enablers to influenza vaccine uptake and the implementation of vaccination clinics in care homes, establishing a baseline for Behaviour Change Techniques (BCTs) to effectively enhance influenza vaccine uptake and improve the implementation of vaccination clinics within care homes. The findings emphasize the need for continuous evaluation to refine interventions. The thesis also highlights areas warranting further investigation, such as identifying and selecting the most appropriate BCTs with key stakeholders to improve the implementation and adoption of vaccination clinics.