title: Factors associated with healthcare worker acceptance of vaccination: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Healthcare workers experience occupational risk of infection and may transmit infections to patients. Vaccination provides an efficient means of protecting workers and patients, but uptake may be low. We sought to identify factors influencing vaccine acceptance by healthcare workers in order to obtain insights leading to more effective vaccination programs in this population.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  We searched Medline, Embase, and CINAHL databases to identify studies published up to May 2012. Factors influencing vaccination acceptance were devised a priori. Random-effects meta-analysis was performed to generate summary estimates of effect. Heterogeneity and publication bias were explored using statistical tools.
  
  
  RESULTS
  Thirty-seven studies evaluating a variety of vaccines (against influenza, pertussis, smallpox, anthrax, and hepatitis B) were included. Homogeneous effects on vaccine acceptance were identified with desire for self-protection (odds ratio [OR], 3.42 [95% confidence interval (CI), 2.42-4.82]) and desire to protect family and friends (OR, 3.28 [95% CI, 1.10-9.75]). Concern that vaccine transmits the illness it was meant to prevent decreased acceptance (OR, 0.42 [95% CI, 0.30-0.58]). Differences in physician and nurse acceptance of immunization were seen between Asian and non-Asian studies.
  
  
  CONCLUSIONS
  Consideration of self-protection (rather than absolute disease risk or protection of patients) appears the strongest and most consistent driver of healthcare workers' decisions to accept vaccination, though other factors may also be impactful, and reasons for between-study divergence in effects is an important area for future research. This finding has important implications for the design of programs to enhance healthcare worker vaccine uptake.
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Marija
authors.initials: M
authors.lastname: Vasilevska
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ku
authors.forename: David N
authors.initials: DN
authors.lastname: Fisman
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D009726:Nurses; D016017:Odds Ratio; D061214:Patient Safety; D010820:Physicians; D014611:Vaccination / Q000706:statistics & numerical data*