title: Planning and process evaluation of a multi-faceted influenza vaccination implementation strategy for health care workers in acute health care settings.
abstract: BACKGROUND
  Influenza transmitted by health care workers (HCWs) is a potential threat to frail patients in acute health care settings. Therefore, immunizing HCWs against influenza should receive high priority. Despite recommendations of the World Health Organization, vaccine coverage of HCWs remains low in all European countries. This study explores the use of intervention strategies and methods to improve influenza vaccination rates among HCWs in an acute care setting.
  
  
  METHODS
  The Intervention Mapping (IM) method was used to systematically develop and implement an intervention strategy aimed at changing influenza vaccination behaviour among HCWs in Dutch University Medical Centres (UMCs). Carried out during the influenza seasons 2009/2010 and 2010/2011, the interventions were then qualitatively and quantitatively evaluated by way of feedback from participating UMCs and the completion of a web-based staff questionnaire in the following spring of each season.
  
  
  RESULTS
  The IM method resulted in the development of a transparent influenza vaccination intervention implementation strategy. The intervention strategy was offered to six Dutch UMCs in a randomized in a clustered Randomized Controlled Trial (RCT), where three UMCs were chosen for intervention, and three UMCs acted as controls. A further two UMCs elected to have the intervention. The qualitative process evaluation showed that HCWs at four of the five intervention UMCs were responsive to the majority of the 11 relevant behavioural determinants resulting from the needs assessment in their intervention strategy compared with only one of three control UMCs. The quantitative evaluation among a sample of HCWs revealed that of all the developed communication materials, HCWs reported the posters as the most noticeable.
  
  
  CONCLUSIONS
  Our study demonstrates that it is possible to develop a structured implementation strategy for increasing the rate of influenza vaccination by HCWs in acute health care settings. The evaluation also showed that it is impossible to expose all HCWs to all intervention methods (which would have been the best case scenario). Further study is needed to (1) improve HCW exposure to intervention methods; (2) determine the effect of such interventions on vaccine uptake among HCWs; and (3) assess the impact on clinical outcomes among patients when such interventions are enacted.
authors.affiliation: Department of PharmacoEpidemiology & PharmacoEconomics, University Centre of Pharmacy, University of Groningen, A. Deusinglaan 1, P.O. Box XB45, Groningen 9713 AV, the Netherlands. j.riphagen@umcg.nl
authors.forename: Josien
authors.initials: J
authors.lastname: Riphagen-Dalhuisen
authors.forename: Gerard
authors.initials: G
authors.lastname: Frijstein
authors.forename: Nannet
authors.initials: N
authors.lastname: van der Geest-Blankert
authors.forename: Marita
authors.initials: M
authors.lastname: Danhof-Pont
authors.forename: Herbert
authors.initials: H
authors.lastname: de Jager
authors.forename: Nita
authors.initials: N
authors.lastname: Bos
authors.forename: Ed
authors.initials: E
authors.lastname: Smeets
authors.forename: Marjan
authors.initials: M
authors.lastname: de Vries
authors.forename: Pieter
authors.initials: P
authors.lastname: Gallee
authors.forename: Eelko
authors.initials: E
authors.lastname: Hak
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D006282:Health Personnel; D006801:Humans; D017589:Immunization Programs / Q000379:methods*; D007252:Influenza Vaccines / Q000008:administration & dosage*; D033181:Information Dissemination; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D009426:Netherlands; D011795:Surveys and Questionnaires
chemical_list: D007252:Influenza Vaccines