Remove Barriers to Encourage Influenza Vaccination of Care Home Staff


Care home staff play a role in transmission to elderly residents by bringing flu in from their communities, especially in winter. Vaccination can combat this risk, but not all care workers get flu shots.

Influenza can be serious for the elderly. Factors that increase their risk can include immunosenescence, nutritional deficiency, general frailty, and living in congregate care settings.Flu has higher mortality in people over 75, and outbreaks in care homes increase hospitalization rates and deaths among elderly residents, especially for those with pre-existing conditions.

A recent review published in Vaccine examined the barriers and enablers of getting care home staff their flu shots to protect patients.1

“During the 2019/20 influenza season, Public Health England (PHE) reported 3,936 acute respiratory infections outbreaks with 69.9 % of them occurring in CH,” the authors wrote.

Care home staff play a role in transmission to elderly residents by bringing flu in from their communities, especially in winter. Staff may come to work sick for financial reasons, which increases risks to elderly residents. Vaccination can combat this risk, but not all care workers get flu shots.

Researchers from the United Kingdom conducted a review of literature from AMED, CINAHL, EMBASE, IBSS, MEDLINE, PsycINFO, PubMed, and SCOPUS to discover what helps and what hinders CH staff from getting flu vaccinations. They collected 42 studies to find out what makes healthcare and social workers decide to vaccinate. Researchers explored 5 domains in the review: beliefs about consequences, knowledge, environmental context and resources, emotions, and social influences.

While many care home staff get their shots, there are several reasons some do not vaccinate. In the beliefs about consequences and knowledge domains, some staff do not understand or have misconceptions about the vaccine’s effectiveness, side effects, and safety. Workers felt the vaccine wasn’t necessary, were not worried about catching influenza, and thought influenza wasn’t serious.

“Previous experience with influenza vaccination side effects and the belief that the influenza vaccine lacks value, usefulness, or benefits for oneself or others are also significant barriers that prevent CH staff from accepting the influenza vaccine,” the authors wrote.

Thoughts from these domains that enabled care home staff to vaccinate included understanding the seriousness of the flu, how the vaccine works, and not wanting to transmit it to others.

For the environmental consequences and resources domain, barriers included an inability to fund free shots at the location for workers at a convenient time, and for workers inability to pay for vaccination on their own if shots were not offered at work. Researchers said supply shortages and worker refusal due to pre-existing conditions, such as allergies, also hindered uptake. In addition, high worker turnover in care homes makes it difficult to determine who has been vaccinated and who hasn’t.

Researchers noted that when care homes hold free vaccination clinics on-site, it enables higher uptake of influenza shots. “Enablers to influenza vaccine uptake include accessibility of the influenza vaccine, availability of the influenza vaccine at a suitable and flexible time, and adequate provision of the influenza vaccine,” the authors wrote.

For the domains of emotions and social influences, researchers said worries about the shot’s effects or catching influenza from the shot prevented vaccine uptake. Fear of needles was listed as another concern. Some care home workers said they felt the employer didn’t care about them, and that acted as a barrier. Mandates were also listed as a barrier, as staff perceived them as a loss of autonomy.

Researchers found that doctor recommendations increased uptake rates, in addition to encouragement from colleagues and family members. Care home workers who felt supported were also more likely to get vaccinated. “Recognition that getting the vaccine was an obligation of staff’s social and professional role toward residents, workplace, and others is seen as an important factor,” the authors said.

The review findings highlight that it is essential to understand the complexities of vaccine choices and create strategies that address the 5 different domains, the authors concluded.

1. Alsaif F, Twigg M, Scott S, Blyth A, Wright D, Patel A. A systematic review of barriers and enablers associated with uptake of influenza vaccine among care home staff [published online ahead of print, 2023 Sep 4]. Vaccine. 2023;S0264-410X(23)01048-4. doi:10.1016/j.vaccine.2023.08.082
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