title: Using behavior change frameworks to improve healthcare worker influenza vaccination rates: A systematic review.
abstract: Influenza vaccination of healthcare workers (HCW) is important for protecting staff and patients, yet vaccine coverage among HCW remains below recommended targets. Psychological theories of behavior change may help guide interventions to improve vaccine uptake. Our objectives were to: (1) review the effectiveness of interventions based on psychological theories of behavior change to improve HCW influenza vaccination rates, and (2) determine which psychological theories have been used to predict HCW influenza vaccination uptake.
  
  
  
  MEDLINE, EMBASE, CINAHL, PsycINFO, The Joanna Briggs Institute, SocINDEX, and Cochrane Database of Systematic Reviews were searched for studies that applied psychological theories of behavior change to improve and/or predict influenza vaccination uptake among HCW.
  
  
  
  The literature search yielded a total of 1810 publications; 10 articles met eligibility criteria. All studies used behavior change theories to predict HCW vaccination behavior; none evaluated interventions based on these theories. The Health Belief Model was the most frequently employed theory to predict influenza vaccination uptake among HCW. The remaining predictive studies employed the Theory of Planned Behavior, the Risk Perception Attitude, and the Triandis Model of Interpersonal Behavior. The behavior change framework constructs were successful in differentiating between vaccinated and non-vaccinated HCW. Key constructs identified included: attitudes regarding the efficacy and safety of influenza vaccination, perceptions of risk and benefit to self and others, self-efficacy, cues to action, and social-professional norms. The behavior change frameworks, along with sociodemographic variables, successfully predicted 85-95% of HCW influenza vaccination uptake.
  
  
  
  Vaccination is a complex behavior. Our results suggest that psychological theories of behavior change are promising tools to increase HCW influenza vaccination uptake. Future studies are needed to develop and evaluate novel interventions based on behavior change theories, which may help achieve recommended HCW vaccination targets.
authors.affiliation: University of Ottawa, Ottawa K1N 6N5, Canada; University of Ottawa Institute of Mental Health Research, Ottawa K1Z 7K4, Canada; Ottawa Hospital Research Institute, Ottawa K1Y 4E9, Canada. Electronic address: kim.corace@theroyal.ca.
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Corace
authors.affiliation: Public Health Ontario, Toronto M5G 1V2, Canada; University of British Columbia, Vancouver V6T 1Z4, Canada. Electronic address: jocelyn.srigley@cw.bc.ca.
authors.forename: Jocelyn A
authors.initials: JA
authors.lastname: Srigley
authors.affiliation: Public Health Ontario, Toronto M5G 1V2, Canada. Electronic address: d@override.org.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Hargadon
authors.affiliation: Public Health Ontario, Toronto M5G 1V2, Canada. Electronic address: dorothy.yu1314@gmail.com.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Yu
authors.affiliation: Queen's University, Kingston K7L 3N6, Canada. Electronic address: tmacdon@queensu.ca.
authors.forename: Tara K
authors.initials: TK
authors.lastname: MacDonald
authors.affiliation: Queen's University, Kingston K7L 3N6, Canada. Electronic address: fabrigar@queensu.ca.
authors.forename: Leandre R
authors.initials: LR
authors.lastname: Fabrigar
authors.affiliation: University of Ottawa, Ottawa K1N 6N5, Canada; Ottawa Hospital Research Institute, Ottawa K1Y 4E9, Canada; Public Health Ontario, Toronto M5G 1V2, Canada; University of Toronto, Toronto M5S 2J7, Canada. Electronic address: gary.garber@oahpp.ca.
authors.forename: Gary E
authors.initials: GE
authors.lastname: Garber
mesh_terms: D001291:Attitude of Health Personnel; D003428:Cross Infection / Q000517:prevention & control; D015438:Health Behavior; D006282:Health Personnel; D006801:Humans; D007252:Influenza Vaccines / Q000627:therapeutic use*; D007251:Influenza, Human / Q000517:prevention & control*; D011582:Psychological Theory; D014611:Vaccination / Q000523:psychology* / Q000706:statistics & numerical data*
chemical_list: D007252:Influenza Vaccines
keywords: Behavior change theory; Healthcare worker; Influenza vaccination; Systematic review