Healthcare Provider Attitudes Toward Seasonal Influenza Vaccine Policies

To assess factors associated with the likelihood that healthcare providers (HCP) will accept seasonal influenza vaccine policy changes, Nova Scotia researchers examined the roles that their knowledge and attitude play in the matter.

Between September and October 2010, researchers circulated a self-report survey to a sample of HCPs in a pediatric care facility that provides primary and consultative services. The survey was designed to collect information pertaining to the knowledge, attitudes, and beliefs HCPs have regarding seasonal influenza vaccinations. The researchers wanted to know what factors were associated with their willingness to accept policy change. The outcome was measured by evaluating the impact that knowledge had on individual attitudes.

In the United States, more than 300 facilities require immunizations in order to maintain employment. In response to this change, vaccine compliance rates have exceeded 99%. Policies that require annual influenza vaccinations as a condition for employment are endorsed by The Society for Healthcare Epidemiology of America (SHEA). Still, overall HCP vaccination rates remain well below the recommended target of 90%.

Failures to increase vaccination uptake among HCP have pushed jurisdictions in Canada to increase seasonal influenza vaccine uptake through policy changes, which include: mandatory masking programs, declarations, and the consideration of legislative changes.

In 2012, British Columbia became the first jurisdiction in Canada to put into place a province-wide policy that required designated HCPs to either receive a seasonal influenza vaccine or wear a mask. Following the implementation of this policy, immunizations increased from 40% to 74%.

Results from the study were mixed when evaluating the impact that knowledge had on actual willingness to accept vaccine policy changes, suggesting that knowledge was only a significant predictor at the organizational and legislative levels.

According to the study’s authors, “Even with a 'mandatory' vaccine program, there are pitfalls associated with attitudinal barriers to vaccine acceptance amongst HCPs.” The study results suggest that although knowledge is a critical factor in willingness to accept policy change at local and legislative levels, it is an insufficient predictor.

The researchers concluded, “attitudes toward behavior reflect the judgement and perceptions of that knowledge (ie, information) and thus play a key role in the willingness to accept policy change. Knowledge is a proximal predictor of attitudes, implying that it must be an important consideration when attempting to impact attitudes.”

In order to impact HCPs' willingness to accept policy change pertaining to seasonal influenza vaccination, new, comprehensive, and novel approaches should be taken. According to research, peer vaccine champions, opinion leaders, and participation from labor management, have all been proven to be effective in other contexts. Early involvement and communication by union officials proved to be an effective approach to helping HCPs accept “vaccinate or mask” policy changes.

Human resistance may be the greatest challenge when introducing any policy changes. To successfully implement changes, early engagement and collaboration with labor unions and safety bodies is an avenue worth exploring. For healthcare organizations attempting large-scale change in their seasonal influenza programs, the researchers advise removing as many barriers as possible and considering options that will protect patient populations most effectively.