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ToolsWright, David, Patel, Amrish, Blacklock, Jeanette, Bion, Veronica, Birt, Linda, Bryant, Terry, Clark, Allan, Cook, Luke, Griffiths, Alys, Guillard, Cecile, Hammond, Amber, Holland, Richard, Jones, Andy, Jones, Liz, Katangwe-Chigamba, Thando, Pitcher, Jennifer, Ruby, Po, Scott, Sion, Sims, Erika, Stirling, Susan and Wagner, Adam P. (2024) FluCare: Results from a randomised feasibility study of a complex intervention to increase care home staff influenza vaccination rates. Archives of Clinical and Biomedical Research, 8. pp. 273-290. ISSN 2572-5017
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Abstract
Background: To protect care home residents, annual staff influenza vaccination uptake is recommended to be greater than 75%. In the UK it is under 40%. With barriers and enablers to care home staff flu vaccine uptake identified, the purpose of this study was to feasibility test a theory informed intervention to improve vaccination rates. Methods: This was a five-arm (one intervention, four different control) study designed to inform the development of a definitive trial protocol. The intervention comprised of videos/posters to change vaccination attitudes, on-site clinics to increase access, a financial incentive for homes to reach target, and monthly monitoring of vaccination uptake. Control arms consisted of a mix of monthly or end of the study monitoring and provision of informational materials to identify the most suitable control arm for a definitive trial. Care homes were recruited via sector associations and purposively allocated. The feasibility outcomes were: ability to recruit enough homes; data quality (variables reported, variable completeness and consistency with a national reporting system); intervention implementation; control arm reactivity bias and signal of efficacy. Staff vaccination data was collated from homes and via a national healthcare tracking system. Process evaluation and economic data collation were undertaken to optimise intervention and research design. Results: Ten homes were recruited as per target within 11 weeks. Recruitment delays meant intervention delivery began towards end of flu season. Only 2 clinics took place in each home. All homes in intervention and chosen control arm (monthly monitoring only) reported all variables with over 90% completeness. There was a 15% difference between control homes’ reported vaccination rates and that in the national healthcare tracker, home reported data was more reliable. Signal of efficacy: intervention arm had a vaccination rate 13.6% higher than control arm. Bias: control arm did not have a higher vaccination rate than usual care control. Conclusions: Better recruitment processes, earlier start in flu season, and data collection direct from care homes are required for a definitive trial. A control arm of monthly monitoring only was identified as optimal for data collection purposes and minimising reactivity bias. The signal of efficacy was acceptable.
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