Patel Amrish, Scott Sion, Griffiths Alys Wyn, Wright David
School of Economics, University of East Anglia, Norwich, UK.
School of Healthcare, University of Leicester, Leicester, UK.
Int J Nurs Stud Adv. 2025 Jul 24;9:100387. doi: 10.1016/j.ijnsa.2025.100387. eCollection 2025 Dec.
To protect care home residents the World Health Organisation recommends that 75 % of care home staff are vaccinated for influenza. In the UK this value is less than 30 %. Previously reported interventions have not been informed by theory and usually only addressed one or two known barriers to uptake. Using behavioural science, we worked with care home staff to develop an intervention which addressed all barriers at both individual and care home level.
We developed an online questionnaire, derived from the literature, asking staff about barriers and facilitators of flu vaccination. These were prioritised (based on frequency and distinctiveness), then mapped to the Theoretical Domains Framework. Relevant behaviour change techniques were identified. Care home staff selected and designed behaviour change techniques according to affordability, practicability, effectiveness, acceptability, safety and equity (APEASE) via an online questionnaire and workshop.
The prioritised barriers were: lack of time to get vaccinated; insufficient vaccine supplies; vaccination costs; a lack of peers getting vaccinated and beliefs that staff do not need vaccination and that it is ineffective. Six behaviour change techniques were selected and developed into a multi-component intervention: (behaviour change technique 1, Restructure of the physical environment) Free, in care home vaccination clinics for staff; (behaviour change techniques 2-4, Information about health consequences, Salience of consequences and information about others' approval) information campaign featuring care home staff highlighting non-vaccination risks, (behaviour change techniques 5-6, Information about health consequences and Credible source) information campaign featuring primary care doctor challenging misconceptions.
We developed the first theory and evidence-based intervention specifically to facilitate care home staff flu vaccination uptake. Feasibility and acceptability testing of the intervention followed by definitive trial to assess efficacy in care homes is necessary to inform policy decision-making.
为保护养老院居民，世界卫生组织建议75%的养老院工作人员接种流感疫苗。在英国，这一比例低于30%。先前报道的干预措施缺乏理论依据，通常只解决一两个已知的接种障碍。我们运用行为科学，与养老院工作人员合作开发了一种干预措施，以解决个人和养老院层面的所有障碍。
我们根据文献编制了一份在线问卷，询问工作人员流感疫苗接种的障碍和促进因素。对这些因素进行优先级排序（基于频率和独特性），然后映射到理论领域框架。确定了相关的行为改变技术。养老院工作人员通过在线问卷和研讨会，根据可承受性、实用性、有效性、可接受性、安全性和公平性（APEASE）选择并设计行为改变技术。
优先级障碍包括：没有时间接种疫苗；疫苗供应不足；接种成本；同事接种人数不足；以及认为工作人员不需要接种疫苗且接种无效的观念。选择了六种行为改变技术并将其发展为一种多成分干预措施：（行为改变技术1，物理环境重组）为工作人员提供免费的养老院内部疫苗接种诊所；（行为改变技术2 - 4，关于健康后果的信息、后果的显著性和关于他人认可的信息）开展宣传活动，由养老院工作人员强调不接种疫苗的风险；（行为改变技术5 - 6，关于健康后果的信息和可靠来源）开展宣传活动，由初级保健医生挑战误解。
我们开发了首个基于理论和证据的干预措施，专门用于促进养老院工作人员接种流感疫苗。在进行可行性和可接受性测试后，开展确定性试验以评估在养老院中的效果，对于为政策决策提供信息是必要的。
