Neisha Sundaram1, Kathryn Duckett2, Chee Fu Yung3, Koh Cheng Thoon4, Sucitro Sidharta5, Indumathi Venkatachalam6, Angela Chow7, Joanne Yoong8. 1. Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore 117549, Singapore; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom. Electronic address: neisha_sundaram@nuhs.edu.sg. 2. Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore 117549, Singapore. Electronic address: kathrynduckett@yahoo.co.uk. 3. Infectious Disease Service, Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore. Electronic address: yung.chee.fu@singhealth.com.sg. 4. Infectious Disease Service, Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore; Duke-NUS Graduate School of Medicine, National University of Singapore, 8 College Road, Singapore 169857, Singapore. Electronic address: thoon.koh.cheng@singhealth.com.sg. 5. Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore 117549, Singapore. Electronic address: ephsds@nus.edu.sg. 6. Division of Infectious Disease, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore. Electronic address: indumathi.venkatachalam@singhealth.com.sg. 7. Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore 117549, Singapore; Department of Clinical Epidemiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore. Electronic address: Angela_CHOW@ttsh.com.sg. 8. Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore 117549, Singapore; Center for Economic and Social Research, University of Southern California, 1909 K Street, Washington, DC 20006, United States. Electronic address: joanne_yoong@nuhs.edu.sg.
Abstract
BACKGROUND: Influenza vaccine acceptance among healthcare workers (HCWs) is a worldwide problem, but relatively little research has focussed on Asia, including Singapore. Despite widespread access and recommendations from public health authorities, influenza vaccine uptake remains suboptimal among HCWs. METHODS: Our qualitative study used focus group discussions to identify and explain factors limiting influenza vaccine acceptance among HCWs in Singapore. A total of 73 doctors, nurses, allied health and ancillary staff across three public hospitals were included. RESULTS: Challenges identified include a fear of contracting influenza from vaccination exacerbated by negative anecdotes regarding vaccine safety and efficacy, distrust of published efficacy data, uncertainty regarding relevance of existing data for Singapore, reluctance to introduce chemicals or overmedicate, pain from injection, low risk attributed to influenza and limited awareness of influenza transmission with a preference for alternatives in patient protection. Differences in attitudes were observed across vocational groups. Lack of overt promotion by hospital leadership in some institutions, perceived vaccine hesitancy among doctors, access, and work culture that implicitly encourages working through illness were further barriers. CONCLUSION: Our findings highlight a combination of misperceptions about influenza vaccination and cognitive biases at the individual level, and challenges at the institutional level limiting uptake. Findings indicate an urgent need to provide targeted education and communication. Rather than providing more data, we recommend a widely-disseminated, locally-compiled synthesis addressing specific concerns of hesitant HCWs. Tailoring interventions to specific vocational groups should be considered. Institutional norms and culture may have a powerful influence in setting default behaviours: more effort is needed in improving influenza vaccine promotion and priority at some institutions, integrating vaccine-related communication with other infection control communication and addressing influenza vaccine hesitancy among doctors as a priority. Finally, further study of strategies to address cognitive biases affecting influenza vaccine acceptance in Singapore is desirable.
BACKGROUND: Influenza vaccine acceptance among healthcare workers (HCWs) is a worldwide problem, but relatively little research has focussed on Asia, including Singapore. Despite widespread access and recommendations from public health authorities, influenza vaccine uptake remains suboptimal among HCWs. METHODS: Our qualitative study used focus group discussions to identify and explain factors limiting influenza vaccine acceptance among HCWs in Singapore. A total of 73 doctors, nurses, allied health and ancillary staff across three public hospitals were included. RESULTS: Challenges identified include a fear of contracting influenza from vaccination exacerbated by negative anecdotes regarding vaccine safety and efficacy, distrust of published efficacy data, uncertainty regarding relevance of existing data for Singapore, reluctance to introduce chemicals or overmedicate, pain from injection, low risk attributed to influenza and limited awareness of influenza transmission with a preference for alternatives in patient protection. Differences in attitudes were observed across vocational groups. Lack of overt promotion by hospital leadership in some institutions, perceived vaccine hesitancy among doctors, access, and work culture that implicitly encourages working through illness were further barriers. CONCLUSION: Our findings highlight a combination of misperceptions about influenza vaccination and cognitive biases at the individual level, and challenges at the institutional level limiting uptake. Findings indicate an urgent need to provide targeted education and communication. Rather than providing more data, we recommend a widely-disseminated, locally-compiled synthesis addressing specific concerns of hesitant HCWs. Tailoring interventions to specific vocational groups should be considered. Institutional norms and culture may have a powerful influence in setting default behaviours: more effort is needed in improving influenza vaccine promotion and priority at some institutions, integrating vaccine-related communication with other infection control communication and addressing influenza vaccine hesitancy among doctors as a priority. Finally, further study of strategies to address cognitive biases affecting influenza vaccine acceptance in Singapore is desirable.
Authors: Thoa Thi Minh Nguyen; Kathryn E Lafond; Tung Xuan Nguyen; Phu Dac Tran; Hang Minh Nguyen; Van Thi Cam Ha; Thu Thi Do; Nga Thu Ha; Jane F Seward; Jeffrey W McFarland Journal: Vaccine Date: 2020-01-27 Impact factor: 3.641
Authors: Emilien Jeannot; Manuella Viviano; Charlotte de Pree; Mona Amadane; Emmanuel Kabengele; Pierre Vassilakos; Patrick Petignat Journal: Int J Environ Res Public Health Date: 2018-07-09 Impact factor: 3.390