Knowledge and Attitudes towards Seasonal Influenza Vaccination among Healthcare Workers in Residential Care Homes for Elderly (RCHEs) in Hong Kong

Background: Seasonal influenza can cause significant morbidity and mortality among elderly in RCHEs. Annual vaccination is the most effective measure to prevent influenza and associated complications, and is recommended for both the elderly and healthcare workers (HCWs). In 2008/09, vaccination rates for elderly and staff in Hong Kong RCHEs were 92.8% and 70.5% respectively.

Objective: To explore the knowledge and attitudes towards seasonal influenza vaccination so as to develop an effective vaccine promotion program for staff in RCHEs.

Methods: A mixed method study was conducted using focus group interviews and a cross-sectional survey to explore knowledge and attitudes about influenza vaccine. Five focus groups were conducted among 7 nurses from Visiting Health Team (VHTs) of the Elderly Health Service (EHS) and 29 staff from 16 RCHEs, which were analyzed using content analysis. 1715 staff from 41 RCHEs (with staff vaccination rates <=50%) returned the questionnaire (response rate 82.7%). Chi-sqaure tests were used to identify possible reasons for vaccine acceptance. Likelihood ratio (LR) statistics were used to detect significant factors affecting vaccine acceptance. An intervention program aiming at improving staff knowledge and attitudes was developed and conducted in 21 randomly selected (out of the 41) RCHEs. Pre- and Post- intervention effects were analyzed with paired t-test.

Results: Focus group interviews identified four major factors: 1) misconceptions and lack of knowledge, 2) lack of accessibility for night-shift staff, 3) attitudes towards vaccine efficacy and safety, and 4) emphasizing self-protection was a better strategy for promoting vaccine acceptance than protection for residents. The survey showed that vaccine acceptance was significantly associated with years of service in RCHEs (p=0.002), staff groups (eg. in-charge, nurses, care assistance) (p<0.001), need for providing direct residents’ care (p<0.001) and attitudes towards vaccine effectiveness (p<0.001).  Staff’s attitude towards vaccine effectiveness was the most important predictor for acceptance according to LR test (p<0.001). The common demotivators were fear of side effects (53.4%), lack of self-protection (29.1%), lack physical fitness (17.8%) and fear of injections (17.1%). The intervention program was found to be effective, in that knowledge scores significantly improved from 5.8 to 7.9 (p=0.001). The expected vaccine acceptance had increased from 40.3% in 2008/09 to 74.1% in 2009/10 among staff of the 21 RCHEs (p<0.001).

Conclusions: This study emphasizes the importance of a comprehensive approach to promote influenza vaccination for HCWs in RCHEs. Integrating components to address knowledge of and attitudes towards influenza vaccination, as well as self-protection strategies, may contribute to more acceptance and thus higher uptake of vaccination.