Getting Flu Shot Tied to Hospital Workers' Beliefs

By Todd Neale, Senior Staff Writer, MedPage Today
Published: March 09, 2012

Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner


Action Points
This meta-analysis found that healthcare workers were twice as likely to get vaccinated against seasonal influenza if they believed that flu prevention is important, that the vaccine is effective, and that influenza is highly contagious.

Other predictors included having a family that is usually vaccinated and being willing to prevent flu transmission.


Among healthcare workers employed in hospitals, the strongest predictor of receiving the seasonal influenza vaccine was a belief in the importance of flu prevention, a meta-analysis showed.

That was one of several factors associated with more than double the likelihood of being vaccinated, Josien Riphagen-Dalhuisen, PhD, of the University of Groningen in the Netherlands, and colleagues reported online in Occupational and Environmental Medicine.

Other factors included a willingness to prevent transmission and believing the vaccine works.

"Future studies could use this information for their interventions and target the predictors that seem to have the most influence on vaccine uptake, and also focus on educating healthcare workers in order to prevent misinformation," the authors wrote.

The CDC, which recommends seasonal flu vaccination for all individuals older than 6 months, has identified healthcare workers as a priority because of the potential to spread infection to vulnerable patients.

And other organizations -- including Association for Professionals in Infection Control and Epidemiology (APIC), the American Academy of Pediatrics (AAP), and the Infectious Diseases Society of America (IDSA) -- have called for requirements for vaccination among healthcare workers.

Influenza vaccine coverage remains low in this group, however, ranging from 2.1% to 62% in the studies included in the current meta-analysis, all conducted before the 2009 H1N1 pandemic. Even after the pandemic, the rate reached only 63.5% in the U.S., according to a CDC survey.

To examine predictors of getting the vaccine, Riphagen-Dalhuisen and colleagues performed a meta-analysis of 13 non-interventional, cross-sectional studies that included a total of 84,880 hospital workers. Ten of the studies assessed vaccine uptake with a questionnaire and the other three used clinical records.

Six studies were conducted in the U.S., three in Europe, two in Canada, one in Australia, and one in several countries. In most of the study, the vaccine was provided for free by the hospitals and immunization was voluntary.

The strongest predictors of receiving the seasonal vaccine were the following:

Believing that flu prevention is important (RR 3.63, 95% CI 2.87 to 4.59)
Having a family that is usually vaccinated (RR 2.32, 95% CI 1.64 to 3.28)
Being willing to prevent influenza transmission (RR 2.31, 95% CI 1.97 to 2.70)
Believing that influenza is highly contagious (RR 2.25, 95% CI 1.66 to 3.05)
Knowing that the vaccine is effective (RR 2.22, 95% CI 1.93 to 2.54)

"We therefore recommend targeting these predictors when developing new influenza vaccination implementation strategies for hospital healthcare workers," the researchers wrote.

Demographic factors associated with vaccination were male gender, an age of 40 years or older, and being a physician (RRs 1.16 to 1.23). Being a nurse was negatively associated with receiving the vaccine (RR 0.90, 95% CI 0.88 to 0.91).

Other negative predictors included a belief that the vaccine transmits influenza (RR 0.67), a belief that vaccination is unpleasant (RR 0.68), and a preference for natural or complementary medicine (RR 0.26).

"Our findings are consistent with the results of previous reviews, which also suggested that raising awareness about vaccine effectiveness and the risks of influenza makes vaccination more likely to be accepted," the authors wrote.

They acknowledged that their study was limited by the inability to address how the predictors interacted with one another using multivariate analysis, and also by the lack of data on vaccine uptake during a pandemic.

"Some reports on pandemic influenza vaccination have shown predictors similar to those described here, although other predictors also might play a role in vaccine uptake," they wrote.