Understanding motivators and barriers of hospital-based obstetric and pediatric health care worker influenza vaccination programs in Australia

Figures & data

Table 1. Awareness of free HCW vaccines and accessing them.

Oh, a vague awareness …I wouldn't know what and when and when it's appropriate to have it. (Nurse 1 (OT))

No not that I'm aware and I wouldn't know where to go to get it. (Nurse 5)

I know that we're eligible for a whole range of them but, to be honest, I haven't looked into them beyond the obvious. (Nurse 11)

I forget how many years ago … they had a bit of a drive. The Occupational Health and Safety nurses had come to the ward and told us the different vaccines we could get…(Nurse 2)

I do unfortunately keep getting this letter sent to me saying I'm due for something and I haven't done anything about it. But yeah, I do realize that we are entitled. (Nurse 12)

I guess that's through occ health and safety … But we really don't get information. I haven't received much information. (Nurse 13)

… I remember when I first started here…I had a vaccine then… and I remember them explaining to me then that you can always come and get your vaccines here and ring us up at any time and organize a time… they make it quite obvious that you can get things. (Nurse 14)

I wouldn't have a clue. All I know is the flu is something that they do annually. (Midwife 3)

…as an adult and I'm responsible for myself, you kind of have to rely on your knowledge, and if you don't have it. Then who knows? There's no reason for me to worry about it. (Nurse 9)

Note: All non-midwives were pediatric nurses unless otherwise stated. OT=Operating theater nurse caring for both obstetric and pediatric patients.

Table 2. Should vaccinations be mandatory for HCWs?

I've got no problem having the flu vac. But I'm a bit of a stubborn person. I don't like being told that I have to do something. …Because it's my body and it's my choice. … it's like assault. Like forcing me to do something I don't want to do. Then I would dig my heels in and go no, I'm not having it just to spite them. (Nurse 12)

…why my body needs that something injected into my body if maybe I don't need to have it. …if it's for a big epidemic, most definitely I would have the vaccination. (Admin 1)

… I don't think you can make it mandatory but I don't know… There could be exclusions or that kind of thing, but I don't think you can actually force people to have it. (Nurse 1)

I think the flu one should be because it is seasonal. It is each year. It's not something that you have to have and then you've got it for a 10-year span. (Nurse 6)

I do - personally I think everyone should get vaccinated … at the moment we've got children with things – having to deal with things that they shouldn't have to because they're not old enough to be vaccinated yet. And so they're sick from diseases that could have been prevented if everyone got vaccinated. (Nurse 7)

I guess that's tricky because it still takes away someone's decision to be able to say they're against it and not necessarily all health care workers will be pro vaccinations, so probably - I don't think it should be mandatory. (Dr 1)

It would be good if you could make something like the flu vaccine mandatory for sure. (Midwife 5)

… it's a personal choice. You are injecting yourself with a foreign body. So whether people agree with that or not, that should be their choice. (Nurse 10)

… I feel like people should still be able to have a choice, but I suppose if there was …an outbreak … staff really would have a responsibility to themselves and to their patients to have a vaccine… I'm a bit undecided there… I wouldn't be fussed, but I can imagine that some people would be very upset. (Nurse 2)

Personally I do. (Midwife 1)

Yeah, absolutely. (Nurse 4 (OT))

No. How can you be made to have a medical intervention? It's illegal. Mandatory is not an option. (Midwife 4)

Note: All non-midwives were pediatric nurses unless otherwise stated. OT=Operating theater nurse caring for both obstetric and pediatric patients.

Table 3. Awareness of the seasonal influenza vaccination program.

… I didn't notice it advertised anywhere … the girl with the trolley came … so just from word of mouth. (Nurse 10)

… I think everyone just knew that they came round with the trolley …(Nurse 13)

I don't know. I just knew… just always had them here for years. (Midwife 3)

…usually notices go up and on the intranet and just word of mouth when it's starting to get close to that season…the trolleys come round…(Nurse 1 (OT))

It's difficult not to hear about it. … it comes on email. We have overhead announcements of the influenza trolley. It comes by internal email and, basically, they come around to the department, so you can't miss them. (Dr 2)

… we have a memo come out, sent from someone in that department saying they're now available. We also have a nurse come around with the immunisation trolley and she offers it to all staff. (Midwife 5)

… our communication book. Also just through ward meetings and stuff like that, posters around the place, the usual. (Nurse 11)

… there's posters around, things like that, or when you go onto the internet, it'll come up about the flu season and flu shots are coming up. …over the PA and that, everyone, no matter what job you're doing, can hear it. I think most roles in the hospital will log onto the computer at some stage. Or your payslip, I remember it comes on your payslip, flu vacc now available, so everyone opens up and reads their payslip. (Nurse 14)

… over the PA. Then our educator gave us a flyer with some information … (Nurse 5)

…around the region, the newsletter that the hospital put out, in the past through my line manager when I didn't have email access, and when I first started at the hospital the Occupational Health and Safety nurses told us. (Nurse 2)

Note: All non-midwives were pediatric nurses unless otherwise stated. OT=Operating theater nurse caring for both obstetric and pediatric patients.

Table 4. Barriers.

Fear of adverse reactions	…my daughter, when she had vaccinations she had a bad experience with her vaccinations, her regular vaccinations, and I fear having vaccination myself…(Admin 1)
	… I mean for most people there is no issue, but every now and then someone comes up with a bad reaction…It does affect people's confidence I suppose in the vaccine… you only need one bad reaction to make everybody think about it a little bit. (Midwife 1)
Fear of needles	We can go around sticking needles in people all day and doing interventions to other people but when it comes to us. It's like, oh, no…I think there are certainly people definitely that avoid it. The whole needle phobia thing just amazes me. (Nurse 9)
	…because I have an anxiety disorder around needles, hearing it announced on the speaker overhead and everyone talks about it and they start wearing the stickers around the hospital, you get a little bit more anxious than you would usually.(Nurse4 (OT))
Privacy concerns	…we had to take our shirts off to get as high as they need to. (Nurse 8)
	…just one little flimsy thing that anyone could look over… (Nurse 9)
	…they expect you to have the vaccine in the middle of the corridor. (Nurse2)
Personal decision not to get vaccinations	…some people you talk to on the ward say, no, I never get it, I don't agree with vaccines. (Nurse 14).
	…they don't want to add anything that's not natural into their system (Nurse 1(OT))
Misconception about vaccination and ingredients	‘the vaccine is actually the disease, whatever it is, even if it is in a small dose’ (Admin 1)
	I didn't want to have the Fluvax with the preservative in it so I went to my GP and got the preservative-free one there. (Midwife 4)
Lack of knowledge	…severity plays an important role of making decisions to have vaccinations or not, but I think when I was a child I was given all these against all those diseases and it seemed like they were quite bad diseases, so it is maybe flu vaccination I don't take as seriously.(Admin 1)
	… I think it's that belief that - you know, I'm going to get sick. If I get the flu vax I'm going to get sick. People just don't understand that it's not a live virus so you don't actually get sick. You do have an immune response sometimes and you can get cold symptoms, but it's not the flu. (Nurse 8)

Note: All non-midwives were pediatric nurses unless otherwise stated. OT=Operating theater nurse caring for both obstetric and pediatric patients.

Table 5. Motivators.

Sense of responsibility	guess the pros for me are for the children here. I want to make sure that I'm not going to make them sick. (Nurse 12)
	you don't want to pass it on to your family or anyone that you're working with or any of your patients, especially with our patients here because most of them are quite vulnerable. (Nurse 14)
	… if I got sick I wouldn't want to give it to the patients that I'm looking after. (Midwife 2)
	It's just something you have to do, especially working with vulnerable people. (Nurse 4 (OT))
	I mean yeah, I don't want to spread on to any mothers and babies that's the only reason why I would do it. I don't necessarily do it for myself. (Midwife 4)
Convenience and ease of access	The convenience, obviously. It's one of the - it would be the top thing. They're just easy. They come around. We don't have to have to try and fit in appointments after hours or fit it in with work. It's all on-site. (Nurse 8)
Free cost	It doesn't cost you anything here. If you go to the GP it's going to cost you for the vaccine plus the visit to the GP. (Midwife 3)
Culture of support for the program	Peer discussions. Everyone talks about it and advocates for it … They were wearing the stickers and everyone asked have you had your flu vaccine? … You don't want to be the one that's not immune. You feel like you're bringing the team down and you're going to infect everyone…(Nurse 7)
	… we do discuss it at ward meetings that the flu vaccine is available, just to remind staff to take it up if they can. I mean there's no real pushing to make people go and have it but just to remind them… (Midwife 1)
	As coordinator, I usually do a lap of the ward, just to say to the girls they're here and do they want to have it done. I mean, I don't push it and I don't think anyone does a - you know, but it's - we just make sure that people are aware that they're on the ward or can get it done. (Nurse 10)
	… this ward it goes beyond advocacy, to the point where you are forced to do it and if you don't do it you'll probably get a very stern talking to about why you haven't done it…I've seen an instance with a student nurse where she had decided that she wasn't getting vaccinated and in front of a large group of people was very aggressively interrogated as to why she hadn't done it. (Nurse 12)
	I haven't really heard much in terms of advocating toward staff members. A lot of the consultants that I work with are advocating it very strongly to most parents…. (Doctor 1)
Personal values and family culture	I come from a family … all very pro-vaccination. So that's the way I've been brought up. (Nurse 7)
	…mum's always you know had us vaccinated and it's - no-one in my family is against it. So that's how I've been brought up. (Nurse 8)

Note: All non-midwives were pediatric nurses unless otherwise stated. OT=Operating theater nurse caring for both obstetric and pediatric patients.