BACKGROUND: Influenza vaccination among healthcare personnel (HCP) has been recommended by national organizations to reduce influenza-related morbidity and mortality; however, Hawaii’s HCP vaccination percentage (74%) remains below the national goal (90%). Mandatory influenza vaccination has demonstrated success in improving vaccination uptake elsewhere; however, HCP attitudes towards mandatory vaccination in Hawaii have not been evaluated. We examined attitudes related to mandatory influenza vaccination in HCP in two Hawaii healthcare facilities.
METHODS: We distributed an online survey to HCP in two mid-size community healthcare facilities in Hawaii in April 2015. HCP were questioned about their demographics; influenza vaccination status during the past two seasons; and knowledge, attitudes, and beliefs towards influenza vaccination. Frequencies, chi-square tests, and multivariate logistic regression analyses were conducted to determine factors related to vaccination uptake and support of mandatory influenza vaccination for HCP.
RESULTS: Our survey was completed by 886 HCP (24% response rate). Respondents had a median age of 42 years and were predominantly female (83%) and in direct-care occupations (60%). Vaccination uptake among respondents was 72%. Fifty-six percent of respondents supported mandatory influenza vaccination while 23% objected; the remainder were undecided or did not respond. Sixty percent (n=124) of those who objected provided a rationale; 72% of these related to freedom of choice, followed by concerns about side effects (16%) and vaccine efficacy (12%). Vaccination uptake was significantly lower among objectors than supporters (46% versus 89%, p<0.05), and having direct patient contact was significantly associated with objection (OR=2 [95% CI 1–4]). Agreeing that influenza is a serious health threat (OR=2 [95% CI 1–4]) and the influenza vaccine is safe (OR=4 [95% CI 2–10]) were significantly associated with support of mandatory vaccination; having received educational information about influenza and vaccination was not.
CONCLUSIONS: Our findings suggest many Hawaii HCP may be amenable to mandatory influenza vaccination. However, a noteworthy minority object, largely related to issues around freedom of choice. Initiatives to increase support among this group should be considered with the understanding that education about influenza and vaccination may not be the most effective solution. Further studies are needed to identify successful strategies to increase support. One initiative that might be explored, especially towards HCP with direct patient care, is to reinforce influenza vaccination as a patient safety obligation.