Motivating Factors for High Rates of Influenza Vaccination among Healthcare Workers

Background: More than 90% of healthcare workers (HCW) are vaccinated each year without a mandatory influenza vaccination policy at SJCRH. Factors associated with HCW uptake of influenza vaccines have not previously been evaluated in a high compliance rate setting.

Objective: To assess the factors associated with HCW acceptance and refusal of influenza vaccination in a pediatric oncology hospital with high employee influenza vaccination rate.

Methods: A structured, anonymous, electronic questionnaire was distributed in August 2010 to all employees (HCW and non-HCW) at SJCRH. Demographics, prior receipt of influenza vaccines, reasons for acceptance or refusal of seasonal and 2009 H1N1 vaccine, and attitudes on mandatory vaccination were assessed. Survey responses regarding reasons for receiving influenza vaccines were categorized into 4 groups: 1) personal benefit, 2) altruism, 3) authority effect, and 4) peer effect.

Results: 63% of the 3227 SJCRH employees responded to the survey; response rate among the 925 HCW was 95%. 45% of HCW were 36-50 years of age, 79% were females, 19% had a chronic medical condition, and 42% had been working at SJCRH for ≤ 5 years. 94% and 75% of HCW reported receiving seasonal and 2009 H1N1 influenza vaccines, respectively, in 2009-2010 season. Benefits to self and/or patients were cited as the most frequent reasons for vaccination (Table). Reasons for refusal of seasonal influenza vaccine included “the vaccine makes me feel sick” (31%), “the vaccine causes rare but serious side effects” (25%), and “the vaccine doesn’t work” (25%). Reasons for H1N1 vaccine refusal included “it is not mandatory” (30%) and “a new vaccine with not enough information about its side effects” (22%). 37% of HCW, 33% and 29% of HCW who reported receiving the seasonal and 2009 H1N1 influenza vaccines, respectively, opposed mandating vaccination citing it was a violation of freedom of choice and personal autonomy.

I got vaccinated against influenza because (multiple responses permitted)	Seasonal Vaccine(N=817)	H1N1 Vaccine(N=651)
Vaccine reduces my risk of getting sick.	682 (83)	559 (86)
Vaccine reduces the risk of transmitting influenza virus to patients.	640 (78)	528 (81)
Vaccine reduces the risk of transmitting influenza virus to my family and friends.	596 (73)	502 (77)
I do not want to miss work due to illness.	522 (64)	425 (65)
My supervisor / my employer asked me to get the vaccine.	284 (35)	227 (35)
My doctor / family / friends recommended that I get the vaccine.	209 (26)	194 (30)
I feel like I have to get vaccinated.	163 (20)	122 (19)
Everyone else at SJCRH received the vaccine.	60 (7)	53 (8)

Conclusions: In this cohort of HCWs with a high influenza vaccination rate, mandating influenza vaccine was viewed unfavorably by many. Personal benefit and altruism were the most common responses driving the choice to get vaccinated. Efforts to explore non-mandatory approaches to increase influenza vaccination rate amongst HCWs should continue.