title: Implementing a declination form programme to improve influenza vaccine uptake by staff in Department of Veterans Affairs spinal cord injury centres: a pilot study.
abstract: BACKGROUND
  Individuals with spinal cord injuries and disorders are at high risk for respiratory and influenza-related complications after developing influenza. These individuals often have frequent contact with the healthcare system. Vaccination rates in healthcare workers at Department of Veterans Affairs (VA) spinal cord injury (SCI) centres have been approximately 50% for several years. Efforts are needed to increase vaccination uptake among SCI HCWs. Declination form programmes (DFPs) in combination with other strategies have resulted in significant increases in influenza vaccination uptake in HCWs.
  
  
  OBJECTIVE
  Use of external and internal facilitation including local teams and consensus processes to pilot a DFP in two VA SCI centres and evaluate factors influencing implementation.
  
  
  METHODS
  Implementation meetings and a consensus-building process with leadership and implementation team members were conducted, along with semi-structured post-implementation interviews with members of each implementation team (N = 7).
  
  
  RESULTS
  The DFP was well accepted and easy to use. Leadership was a key facilitator for DFP implementation. Barriers included difficulty communicating with HCWs working during early/late shifts. Participation was 100% at Site 1 and 48% at Site 2.
  
  
  CONCLUSIONS
  Use of local teams and consensus to identify strategies to implement a DFP is feasible and effective for achieving moderate-to-high levels of participation in the programme.
authors.affiliation: Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr VA Hospital, Hines, IL, USA; Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, IL, USA. Electronic address: jennifer.hill3@va.gov.
authors.forename: J N
authors.initials: JN
authors.lastname: Hill
authors.affiliation: Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, IL, USA; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: B M
authors.initials: BM
authors.lastname: Smith
authors.affiliation: Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr VA Hospital, Hines, IL, USA; Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, IL, USA; Department of Preventive Medicine, Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: C T
authors.initials: CT
authors.lastname: Evans
authors.affiliation: Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr VA Hospital, Hines, IL, USA; Human Immunodeficiency Virus/Hepatitis Quality Enhancement Research Initiative, Los Angeles, CA, USA; University of California - Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA.
authors.forename: H
authors.initials: H
authors.lastname: Anaya
authors.affiliation: National Spinal Cord Injury/Disorders Services, Clinical Operations, Veterans Affairs Central Office, Seattle, WA, USA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
authors.forename: B
authors.initials: B
authors.lastname: Goldstein
authors.affiliation: Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr VA Hospital, Hines, IL, USA; Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, IL, USA; Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: S L
authors.initials: SL
authors.lastname: LaVela
mesh_terms: D001521:Behavior Therapy; D003428:Cross Infection / Q000517:prevention & control*; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D006282:Health Personnel; D006787:Hospitals, Veterans; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control*; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010865:Pilot Projects; D013119:Spinal Cord Injuries / Q000628:therapy; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D007252:Influenza Vaccines
keywords: Healthcare workers; Implementation strategies; Influenza vaccination; Local consensus process; Spinal cord injury; Veterans