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ToolsKatangwe-Chigamba, Thando, Alsaif, Faisal, Anyiam-Osigwe, Adaku, Bion, Veronica, Clark, Allan, Garrett, Hilary, Wyn Griffiths, Alys, Guillard, Cecile, Hammond, Amber, Holland, Richard, Jones, Liz, Patel, Amrish, Pitcher, Jennifer, Risebro, Helen, Scott, Sion, Seeley, Carys, Sims, Erika, Stirling, Susan, Wagner, Adam, Wright, David and Birt, Linda (2025) Process evaluation of the flucare cluster randomised controlled trial: Assessing the implementation of a behaviour change intervention to increase influenza vaccination uptake among care home staff in England. BMC Health Services Research, 25. ISSN 1472-6963
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Abstract
Background: Influenza (flu) vaccination rates of Care home staff (CHS) in England are consistently lower (≈ 15% in 2023) than World Health Organisation recommendations (≥ 75%). The FluCare trial examined the effectiveness of a multi-component intervention (including on-site flu vaccination clinics, information materials including video, £850 incentive and monthly monitoring with feedback) designed to address known barriers to flu vaccine uptake amongst CHS. This paper reports an embedded process evaluation designed to understand implementation of the FluCare intervention and provide explanations for observed effects in the trial. Methods: The FluCare cluster randomised controlled trial was conducted between November 2022 and March 2023. A mixed methods process evaluation was conducted employing questionnaires, semi-structured interviews, video analytics (no. clicks and duration of view) and clinic logs (no. clinics delivered, days/time clinics were delivered, and no. staff vaccinated). CHS (including managers) and vaccination providers (pharmacists, nurses and general practitioners) were purposively and conveniently selected, respectively, for the interviews. Descriptive statistics were obtained for quantitative data, and qualitative data were analysed thematically. Results: FluCare intervention implementation varied across Care homes (CHs), with clinics and videos not being implemented in 35% and 43% of the intervention CHs respectively. In addition, clinic days and times varied depending on provider (pharmacy or general practice) and CH. Partial intervention implementation was partly influenced by managers’ engagement and sub-organisational cultures marked by negative narratives around vaccines. Contextual barriers included delivery of clinics late in the flu season. A greater indication of implementation fidelity was positively associated with change in staff attitudes and behaviours, with some getting vaccinated for the first time. Conclusions: Variation in implementation of the FluCare intervention provides an explanation for detecting a difference where the intervention was fully implemented in the main trial. Manager and leader engagement is vital for both successful implementation and staff engagement. Avoidable contextual barriers, such as late timing of clinics, must be addressed to enhance flu vaccination uptake by CHS. More work is needed to understand the role of CH leaders in influencing intervention implementation, sub-organisational cultures and vaccination attitudes. Trial registration: ISRCTN22729870. Registered on 24 August 2022.
| Item Type: | Article |
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| Additional Information: | Data availability: FluCare data and materials are available for secondary research purposes. In the first instance, requests should be directed to Dr Amrish Patel (amrish.patel@uea.ac.uk). Release of data may be subject to completion of a data sharing agreement. Funding: The study was funded through a National Institute for Health and Care Research (NIHR), Public Health Research funding body. Grant ref: NIHR133455. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. APW & HR also received support from the NIHR Applied Research Collaboration East of England (NIHR ARC EoE) at Cambridgeshire and Peterborough NHS Foundation Trust. |
| Faculty \ School: | Faculty of Science > School of Chemistry, Pharmacy and Pharmacology Faculty of Medicine and Health Sciences > Norwich Medical School Faculty of Social Sciences > School of Economics |
| UEA Research Groups: | Faculty of Medicine and Health Sciences > Research Groups > Norwich Clinical Trials Unit Faculty of Science > Research Groups > Statistics Faculty of Medicine and Health Sciences > Research Groups > Health Services and Primary Care Faculty of Medicine and Health Sciences > Research Groups > Epidemiology and Public Health Faculty of Medicine and Health Sciences > Research Centres > Public Health Faculty of Social Sciences > Research Groups > Economic Theory Faculty of Social Sciences > Research Groups > Behavioural Economics Faculty of Social Sciences > Research Centres > Centre for Behavioural and Experimental Social Sciences Faculty of Medicine and Health Sciences > Research Groups > Health Economics |
| Depositing User: | LivePure Connector |
| Date Deposited: | 09 Sep 2025 16:30 |
| Last Modified: | 09 Sep 2025 19:30 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/100354 |
| DOI: | 10.1186/s12913-025-13298-0 |
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