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      Seasonal influenza vaccination of healthcare workers: systematic review of qualitative evidence

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          Abstract

          Background

          Most countries recommend that healthcare workers (HCWs) are vaccinated seasonally against influenza in order to protect themselves and patients. However, in many cases coverage remains low. A range of strategies have been implemented to increase uptake. Qualitative evidence can help in understanding the context of interventions, including why interventions may fail to achieve the desired effect. This study aimed to synthesise evidence on HCWs’ perceptions and experiences of vaccination for seasonal influenza.

          Methods

          Systematic review of qualitative evidence. We searched MEDLINE, EMBASE and CINAHL and included English-language studies which reported substantive qualitative data on the vaccination of HCWs for seasonal influenza. Findings were synthesised thematically.

          Results

          Twenty-five studies were included in the review. HCWs may be motivated to accept vaccination to protect themselves and their patients against infection. However, a range of beliefs may act as barriers to vaccine uptake, including concerns about side-effects, scepticism about vaccine effectiveness, and the belief that influenza is not a serious illness. HCWs value their autonomy and professional responsibility in making decisions about vaccination. The implementation of interventions to promote vaccination uptake may face barriers both from HCWs’ personal beliefs and from the relationships between management and employees within the targeted organisations.

          Conclusions

          HCWs’ vaccination behaviour needs to be understood in the context of HCWs’ relationships with each other, with management and with patients. Interventions to promote vaccination should take into account both the individual beliefs of targeted HCWs and the organisational context within which they are implemented.

          Electronic supplementary material

          The online version of this article (10.1186/s12913-017-2703-4) contains supplementary material, which is available to authorized users.

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          Most cited references47

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          Methods for the thematic synthesis of qualitative research in systematic reviews

          James Thomas, Angela Harden (2008)
          Background There is a growing recognition of the value of synthesising qualitative research in the evidence base in order to facilitate effective and appropriate health care. In response to this, methods for undertaking these syntheses are currently being developed. Thematic analysis is a method that is often used to analyse data in primary qualitative research. This paper reports on the use of this type of analysis in systematic reviews to bring together and integrate the findings of multiple qualitative studies. Methods We describe thematic synthesis, outline several steps for its conduct and illustrate the process and outcome of this approach using a completed review of health promotion research. Thematic synthesis has three stages: the coding of text 'line-by-line'; the development of 'descriptive themes'; and the generation of 'analytical themes'. While the development of descriptive themes remains 'close' to the primary studies, the analytical themes represent a stage of interpretation whereby the reviewers 'go beyond' the primary studies and generate new interpretive constructs, explanations or hypotheses. The use of computer software can facilitate this method of synthesis; detailed guidance is given on how this can be achieved. Results We used thematic synthesis to combine the studies of children's views and identified key themes to explore in the intervention studies. Most interventions were based in school and often combined learning about health benefits with 'hands-on' experience. The studies of children's views suggested that fruit and vegetables should be treated in different ways, and that messages should not focus on health warnings. Interventions that were in line with these suggestions tended to be more effective. Thematic synthesis enabled us to stay 'close' to the results of the primary studies, synthesising them in a transparent way, and facilitating the explicit production of new concepts and hypotheses. Conclusion We compare thematic synthesis to other methods for the synthesis of qualitative research, discussing issues of context and rigour. Thematic synthesis is presented as a tried and tested method that preserves an explicit and transparent link between conclusions and the text of primary studies; as such it preserves principles that have traditionally been important to systematic reviewing.
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            Appraising the evidence: reviewing disparate data systematically.

            Sheila Hawker, Sheila Payne, Christine Kerr … (2002)
            The authors describe a method of systematically reviewing research from different paradigms. They draw on the methods adapted, developed, and designed during a study concerned with the delivery of care across professional boundaries. Informed by the established method of systematic review, the authors undertook the review in distinct stages. They describe the methods developed for each stage and outline the difficulties encountered, the solutions devised, and the appraisal tools developed. Although many of the problems encountered were related to the critical assessment of qualitative research, the authors argue that the method of systematic review can be adapted for use with different data andacross disciplines.
            Article 0 comments Cited 194 times – based on 0 reviews     Review now
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              Narrative approaches to systematic review and synthesis of evidence for international development policy and practice

              Birte Snilstveit, Sandy Oliver, Martina Vojtkova (2012)
              Article 0 comments Cited 105 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Theo Lorenc:
                ORCID: http://orcid.org/0000-0001-8937-6378
                theo.lorenc@york.ac.uk
                David Marshall: d.marshall@york.ac.uk
                Kath Wright: kath.wright@york.ac.uk
                Katy Sutcliffe: katy.sutcliffe@ucl.ac.uk
                Amanda Sowden: amanda.sowden@york.ac.uk
                Journal
                Journal ID (nlm-ta): BMC Health Serv Res
                Journal ID (iso-abbrev): BMC Health Serv Res
                Title: BMC Health Services Research
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1472-6963
                Publication date (Electronic): 15 November 2017
                Publication date PMC-release: 15 November 2017
                Publication date Collection: 2017
                Volume: 17
                Electronic Location Identifier: 732
                Affiliations
                [1 ]ISNI 0000 0004 1936 9668, GRID grid.5685.e, Centre for Reviews and Dissemination, University of York, ; York, YO10 5DD UK
                [2 ]ISNI 0000000121901201, GRID grid.83440.3b, Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), Social Science Research Unit, UCL Institute of Education, University College London, ; 18 Woburn Square, London, WC1H 0NR UK
                Author information
                http://orcid.org/0000-0001-8937-6378
                Article
                Publisher ID: 2703
                DOI: 10.1186/s12913-017-2703-4
                PMC ID: 5688738
                PubMed ID: 29141619
                SO-VID: a1271298-8da1-48f4-b482-42c6c7180c8e
                Copyright © © The Author(s). 2017
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 2 February 2017
                Date accepted : 7 November 2017
                Funding
                Funded by: Department of Health (UK)
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2017

                ScienceOpen disciplines: Health & Social care
                Keywords: healthcare workers,influenza,qualitative research,systematic review,vaccination
                Data availability:
                ScienceOpen disciplines: Health & Social care
                Keywords: healthcare workers, influenza, qualitative research, systematic review, vaccination

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