title: Attitudes toward influenza vaccination improvement strategies in Veterans Affairs health care workers providing care for patients with spinal cord injuries and disorders: Acceptability of a declination form program.
abstract: BACKGROUND
  Influenza is associated with high rates of morbidity and mortality. The most effective way to prevent influenza or severe consequences from the illness is vaccination, and key organizations recommend that all health care workers (HCWs) be vaccinated annually for influenza. Recent literature suggests declination form programs (DFPs) are a useful approach to improve HCW influenza vaccination rates.
  
  
  OBJECTIVE
  To understand support for and beliefs about use of an influenza vaccination DFP, and how this is associated with HCW beliefs about other influenza vaccination improvement strategies.
  
  
  METHODS
  Data were collected via a cross-sectional mailed national survey. Participants included HCWs providing care to Veterans with spinal cord injuries and disorders (SCI/D) from 23 nationwide Veterans Affairs facilities. Analyses included bivariate analyses of outcomes among DFP supporters vs. non-supporters.
  
  
  RESULTS
  Of the HCW respondents, 67% reported that they would support a DFP at their facility. A greater proportion of HCWs who support (vs. do not support) DFPs reported receiving an annual influenza vaccination (86.35% vs. 65.81%, p<0.0001). Similarly, a significantly greater proportion of HCWs who support DFPs (vs. do not support) reported willingness to receive an influenza vaccination (83.79% vs. 61.48%, p<0.0001) and nasal spray influenza vaccination (45.75% vs. 32.50%, p=0.0156). HCWs who support DFPs were more likely to report a great deal of influence in almost all typical vaccination improvement campaign strategies on their decision to be vaccinated, and less likely to endorse commonly provided reasons for refusing vaccination as valid.
  
  
  CONCLUSIONS
  More HCWs who support DFPs engage in important influenza-related health behaviors (e.g., vaccination), and support other influenza vaccination improvement strategies. Facilities may benefit from implementing DFPs as part of their vaccination improvement campaign. Support for DFPs among HCWs is high, suggesting implementing this as a policy would be well-received by staff, and potentially effective in increasing HCW influenza vaccination.
authors.affiliation: Department of Veterans Affairs (VA), Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Edward Hines, Jr. VA Hospital, Hines, IL, USA; Department of Veterans Affairs (VA), Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines, Jr. VA Hospital, Hines, IL, USA; Center for Healthcare Studies, Institute for Public Health and Medicine, General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Sherri L
authors.initials: SL
authors.lastname: LaVela
authors.affiliation: Department of Veterans Affairs (VA), Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Edward Hines, Jr. VA Hospital, Hines, IL, USA; Department of Veterans Affairs (VA), Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines, Jr. VA Hospital, Hines, IL, USA. Electronic address: bella.etingen@va.gov.
authors.forename: Bella
authors.initials: B
authors.lastname: Etingen
authors.affiliation: Department of Veterans Affairs (VA), Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Edward Hines, Jr. VA Hospital, Hines, IL, USA; Department of Veterans Affairs (VA), Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines, Jr. VA Hospital, Hines, IL, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Miskevics
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D006282:Health Personnel; D006787:Hospitals, Veterans; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D013119:Spinal Cord Injuries / Q000628:therapy; D014611:Vaccination / Q000523:psychology*
chemical_list: D007252:Influenza Vaccines
keywords: Declination form program; Health care workers; Influenza vaccination