title: Accounting for personal and professional choices for pandemic influenza vaccination amongst English healthcare workers.
abstract: BACKGROUND
  Healthcare workers (HCWs) are encouraged to get vaccinated during influenza pandemics to reduce their own, and patients', risk of infection, and to encourage their patients to get immunised. Despite extensive research on HCWs' receipt of vaccination, little is known about how HCWs articulate pandemic influenza vaccination advice to patients.
  
  
  OBJECTIVE
  To explore HCWs' uptake of the A/H1N1 vaccine during the pandemic of 2009-2010, their recommendations to patients at the time, and their anticipated choices around influenza vaccination under different pandemic scenarios.
  
  
  METHODS
  We conducted semi-structured interviews and focus groups with eight vaccinated and seventeen non-vaccinated HCWs from primary care practices in England. The data was analysed using thematic analysis.
  
  
  RESULTS
  The HCWs constructed their receipt of vaccination as a personal choice informed by personal health history and perceptions of vaccine safety, while they viewed patients' vaccination as choices made following informed consent and medical guidelines. Some HCWs received the A/H1N1 vaccine under the influence of their local practice organizational norms and values. While non-vaccinated HCWs regarded patients' vaccination as patients' choice, some vaccinated HCWs saw it also as a public health issue. The non-vaccinated HCWs emphasised that they would not allow their personal choices to influence the advice they gave to patients, whereas some vaccinated HCWs believed that by getting vaccinated themselves they could provide a reassuring example to patients, particularly those who have concerns about influenza vaccination. All HCWs indicated they would accept vaccination under the severe pandemic scenario. However, most non-vaccinated HCWs expressed reticence to vaccinate under the mild pandemic scenario.
  
  
  CONCLUSIONS
  Providing evidence-based arguments about the safety of new vaccines and the priority of public health over personal choice, and creating strong social norms for influenza vaccination as part of the organizational culture, should increase uptake of influenza vaccination among primary care HCWs and their patients.
authors.affiliation: School of Psychology, University of Southampton, Southampton SO17 1BJ, United Kingdom. Electronic address: a.m.marcu@soton.ac.uk.
authors.forename: Afrodita
authors.initials: A
authors.lastname: Marcu
authors.affiliation: Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, United Kingdom.
authors.forename: Helena
authors.initials: H
authors.lastname: Rubinstein
authors.affiliation: Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, United Kingdom.
authors.forename: Susan
authors.initials: S
authors.lastname: Michie
authors.affiliation: School of Psychology, University of Southampton, Southampton SO17 1BJ, United Kingdom.
authors.forename: Lucy
authors.initials: L
authors.lastname: Yardley
mesh_terms: D000328:Adult; D001521:Behavior Therapy; D003428:Cross Infection / Q000517:prevention & control; D004739:England; D005260:Female; D006282:Health Personnel; D006801:Humans; D007251:Influenza, Human / Q000517:prevention & control*; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000517:prevention & control; D010342:Patient Acceptance of Health Care; D014611:Vaccination / Q000706:statistics & numerical data*
keywords: A/H1N1; Healthcare workers; Influenza; Pandemic; Primary care; Vaccination