title: Innovative approaches for understanding seasonal influenza vaccine declination in healthcare personnel support development of new campaign strategies.
abstract: OBJECTIVE
  The main objectives of our study were to explore reasons for seasonal influenza vaccine acceptance and declination in employees of a large integrated healthcare system and to identify underlying constructs that influence acceptance versus declination. Secondary objectives were to determine whether vaccine acceptance varied by hospital location and to identify facility-level measures that explained variability.
  
  
  METHODS
  A national health promotion survey of employees was conducted that included items on vaccination in the 2009-2010 influenza season. The survey was administered with two other institutional surveys in a stratified fashion: approximately 40% of participating employees were randomly assigned to complete the health promotion survey.
  
  
  METHODS
  National single-payer healthcare system with 152 hospitals.
  
  
  METHODS
  Employees of the healthcare system in 2010 who responded to the survey.
  
  
  METHODS
  Factor analysis was used to identify underlying constructs that influenced vaccine acceptance versus declination. Mean factor scores were examined in relation to demographic characteristics and occupation. Multilevel logistic regression models were used to determine whether vaccine acceptance varied by location and to identify facility-level measures that explained variability.
  
  
  RESULTS
  Four factors were identified related to vaccine declination and were labeled as (1) "don't care," (2) "don't want," (3) "don't believe," and (4) "don't know." Significant differences in mean factor scores existed by demographic characteristics and occupation. Vaccine acceptance varied by location, and vaccination rates in the previous year were an important facility-level predictor.
  
  
  CONCLUSIONS
  Results should guide interventions that tailor messages on the basis of particular reasons for declination. Occupation-specific and culturally appropriate messaging should be considered. Continued efforts will be taken to better understand how workplace context influences vaccine acceptance.
authors.affiliation: Office of Public Health, Veterans Health Administration, Washington, DC, USA. tamara.schult@va.gov
authors.forename: Tamara M
authors.initials: TM
authors.lastname: Schult
authors.forename: Ebi R
authors.initials: ER
authors.lastname: Awosika
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Hodgson
authors.forename: Pamela R
authors.initials: PR
authors.lastname: Hirsch
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Nichol
authors.forename: Sue R
authors.initials: SR
authors.lastname: Dyrenforth
authors.forename: Scott C
authors.initials: SC
authors.lastname: Moore
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D005163:Factor Analysis, Statistical; D005260:Female; D019538:Health Care Surveys; D006282:Health Personnel / Q000523:psychology*; D006293:Health Promotion; D006801:Humans; D007251:Influenza, Human / Q000517:prevention & control*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D016312:Treatment Refusal / Q000523:psychology; D014481:United States; D014611:Vaccination / Q000523:psychology*