Di Castri Antonia M, Halperin Donna M, McPherson Charmaine M, Nunn Alexandra, Farrar-Muir Haley, Kwong Jeffrey C, Henry Bonnie
Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and The Nova Scotia Health Authority , Halifax, NS, Canada.
Department of Community Health and Epidemiology, Dalhousie University , Halifax, NS, Canada.
Hum Vaccin Immunother. 2020 Jun 2;16(6):1354-1363. doi: 10.1080/21645515.2019.1692561. Epub 2020 Jan 10.
Influenza can be potentially fatal to vulnerable populations, particularly those in the hospital. Canada's National Advisory Committee on Immunization recommends that health-care workers (HCW) be immunized against influenza partly to avoid infecting high-risk populations. However, influenza immunization rates among HCW remain suboptimal. In 2012, health authorities across British Columbia (B.C.) implemented a province-wide influenza prevention policy requiring HCW to either be immunized or wear a mask when in patient-care areas during the influenza season. This paper describes the second of two studies focused on what was learned from years 2 and 3 of the policy. A case study approach was used to examine this policy implementation event. Qualitative data were collected through key documents and key informant interviews with members of leadership teams responsible for policy implementation. Framework analysis and Prior's approach were used to analyze data from interviews and documents, respectively. Policy implementation varied by geographic region and gaps persist in immunization tracking and discipline for noncompliance. Debate regarding the scientific evidence used to support the policy fuels resistance from particular groups. Despite these challenges, findings suggest that the policy has been habituated, largely due to consistent policy objectives. This study emphasizes the importance of ongoing inter-professional and cross-sectoral program evaluation. While adherence may be routine for many, implementation processes must continue to respond to contextual issues to narrow the gap in policy implementation and to continue to engage stakeholders to ensure compliance.
流感对弱势群体，尤其是住院患者，可能具有致命性。加拿大国家免疫咨询委员会建议医护人员接种流感疫苗，部分原因是为了避免感染高危人群。然而，医护人员的流感疫苗接种率仍未达到最佳水平。2012年，不列颠哥伦比亚省（简称BC省）各地的卫生当局实施了一项全省范围的流感预防政策，要求医护人员在流感季节期间在患者护理区域要么接种疫苗，要么佩戴口罩。本文描述了两项研究中的第二项，重点是从该政策实施的第二年和第三年所学到的内容。采用案例研究方法来审视这一政策实施事件。通过关键文件以及与负责政策实施的领导团队成员进行关键信息访谈收集定性数据。分别运用框架分析和普赖尔方法来分析访谈和文件中的数据。政策实施因地理区域而异，在免疫接种跟踪和对违规行为的惩处方面仍存在差距。关于支持该政策的科学证据的争论引发了特定群体的抵制。尽管存在这些挑战，但研究结果表明，该政策已被习惯化，这主要归功于一致的政策目标。本研究强调了持续进行跨专业和跨部门项目评估的重要性。虽然对许多人来说遵守规定可能已成惯例，但实施过程必须继续应对实际问题，以缩小政策实施差距，并继续促使利益相关者参与以确保合规。
