Epistemic_Statements  

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Id Subject Object Predicate Lexical cue
T1 0-77 Epistemic_statement denotes Healthcare worker compliance with seasonal and pandemic influenza vaccination
T2 79-207 Epistemic_statement denotes Healthcare workers (HCWs) are at increased risk of exposure to influenza and may transmit the disease to patients in their care.
T3 208-464 Epistemic_statement denotes [1] [2] [3] Recognising the role that HCWs may play in the transmission of influenza, both the World Health Organization (WHO) and the Strategic Advisory Group of Experts on Immunization recommend seasonal and pandemic influenza vaccination (PIV) for HCWs.
T4 465-619 Epistemic_statement denotes 4, 5 In the United States, seasonal vaccination of HCWs has been recommended for more than two decades and is currently endorsed by 29 European countries.
T5 620-810 Epistemic_statement denotes 6, 7 Despite these recommendations, vaccination coverage of HCWs has remained disappointingly low and showed little improvement as pandemic influenza A (H1N1) swept across the globe in 2009.
T6 939-1188 Epistemic_statement denotes 6 Unfortunately, vaccination rates in this group have been consistently lower in most of Europe, and as will be discussed, recent provision of pandemic vaccine may have actually served to magnify the challenges with influenza vaccination among HCWs.
T7 1189-1371 Epistemic_statement denotes [8] [9] [10] [11] [12] [13] [14] [15] This article reviews and summarises the social sciences literature on factors associated with HCWs' decision to be vaccinated against influenza.
T8 2598-2723 Epistemic_statement denotes When there was doubt about the relevance of the content of the abstract, the full texts of the publications were referred to.
T9 3437-3830 Epistemic_statement denotes Recognising the impact of introducing pandemic vaccine during the 2009-2010 H1N1 pandemic and the challenges with ensuring HCW compliance in this particular context, we decided to add to our collection a systematic review on the topic published in 2011 found through a simple search using google scholar and using the terms 'healthcare workers', 'pandemic vaccination' and 'systematic review'.
T10 3967-4295 Epistemic_statement denotes There are two broad reasons why HCWs have been an important target for influenza vaccination: (i) to protect HCWs from illness and prevent absenteeism particularly during outbreaks or pandemics and (ii) to protect others, particularly those in their care, as HCWs can be an important source of nosocomial spread of this disease.
T11 4296-4485 Epistemic_statement denotes [1] [2] [3] 16, 17 When a health professional is vaccinated, this also sets an example for patients to follow and increases the likelihood that the HCW will recommend the vaccine to others.
T12 4486-4717 Epistemic_statement denotes 1, [17] [18] [19] [20] [21] [22] The latter is especially important being that members of the community and HCWs themselves often depend on the recommendation of a physician or a nurse when deciding to accept influenza vaccination.
T13 4945-5070 Epistemic_statement denotes In many studies, older age was found to be associated with higher intentions to be vaccinated and vaccine receipt among HCWs.
T14 5071-5254 Epistemic_statement denotes 9, 12, 22, [28] [29] [30] Fewer studies have associated younger age with vaccine acceptability, and others have found no significant association between age and influenza vaccination.
T15 5255-5363 Epistemic_statement denotes 19, [31] [32] [33] [34] Gender In many studies, male HCWs are found to be more likely to accept vaccination.
T16 5364-5528 Epistemic_statement denotes 11, 22, 30, 33, 35 However, following the implementation of a vaccination programme in the UK, female sex was found to be positively associated with vaccine uptake.
T17 5814-5899 Epistemic_statement denotes 32, 39, 40 In fact, being a nurse is often negatively associated with vaccine uptake.
T18 5900-5911 Epistemic_statement denotes 10, 41, 42
T19 5912-6071 Epistemic_statement denotes Achieving compliance with Influenza vaccination among HCWs is a complex process and is affected by a wide variety of factors that are difficult to disentangle.
T20 6072-6146 Epistemic_statement denotes Country-and culture-specific variables may further complicate the picture.
T21 6147-6308 Epistemic_statement denotes Although an individual decision to vaccinate or not may involve unique considerations, some general trends appear to cut across many contexts as discussed below.
T22 6309-6498 Epistemic_statement denotes A finding common to most studies is that previous receipt of the seasonal influenza vaccine is positively associated with intentions and receipt of seasonal and pandemic influenza vaccines.
T23 6573-6703 Epistemic_statement denotes 42 not having been vaccinated against seasonal influenza was also found to be associated with a lower likelihood of accepting PIV.
T24 6855-7008 Epistemic_statement denotes In some studies, perceptions of seasonal and pandemic influenza as mild diseases were associated with reduced intentions and lower uptake of the vaccine.
T25 7009-7129 Epistemic_statement denotes 10, 35 Conversely, the perception of influenza as a severe disease was associated with higher acceptance of vaccination.
T26 7130-7385 Epistemic_statement denotes 19, 20, 43 Regardless of severity, HCWs often stated that they declined influenza vaccination because they believed that their immune systems were 'strong', and they did not identify themselves as a risk group needing added protection against the disease.
T27 7688-7829 Epistemic_statement denotes The study revealed that doctors were less likely to take sick leave for minor illnesses and were more likely to 'work through' their ailment.
T28 7830-7996 Epistemic_statement denotes 45 This reflects doctor's reluctance to adopt the patient role as well as potential organisational and cultural barriers that make it difficult for them to miss work.
T29 8140-8347 Epistemic_statement denotes 46 While these findings support the argument that HCWs often find themselves at work even when sick, this is not to say that they do indeed benefit from a better health status than other professional groups.
T30 8348-8600 Epistemic_statement denotes In fact, their selfperceived 'strength' and the fact that they do not generally miss work due to illness may actually represent other organisational and defensive mechanisms that act to dissuade them from taking sick leave when this would be necessary.
T31 8601-8816 Epistemic_statement denotes Despite their training, HCWs appear to lack a proper understanding of their potential role in transmitting influenza while at work, which may be related to the unmet need for scientific information among this group.
T32 9188-9217 Epistemic_statement denotes 14, 35, 41 Fears and concerns
T33 9218-9424 Epistemic_statement denotes Concerns that the vaccine itself may cause influenza and fears about potential side effects were often cited as reasons for declining vaccination or were found to be negatively associated with immunization.
T34 9540-9657 Epistemic_statement denotes 19, 38 Higher confidence in the efficacy of the vaccine was also associated with acceptance of the influenza vaccine.
T35 9658-9917 Epistemic_statement denotes 15, 19, 22, 30, 41 A fear or dislike of needles has been cited in a few studies exploring low uptake of SIV and PIV among some HCWs 16, 30, 34, 52 , while others have shown that an opposition to vaccines in principle can be a strong barrier to receipt of SIV.
T36 9918-10180 Epistemic_statement denotes 37 Personal experience with illness Some authors have found that HCWs were more likely to receive influenza vaccination if they had a colleague who had acquired infection with Influenza A (H1N1) or if they had experienced becoming ill with influenza in the past.
T37 10181-10315 Epistemic_statement denotes 19, 41 The evidence on the effect of working with patients infected with influenza on motivating compliance with vaccination is mixed.
T38 10316-10444 Epistemic_statement denotes A study in Sao Paolo, Brazil, showed that having cared for patients with severe influenza was significantly associated with SIV.
T39 10688-10921 Epistemic_statement denotes 31, 55 It seems that despite the high case fatality ratio of this disease and the fact that many cases had been HCWs, there was little impact on the attitudes of this vulnerable group towards other related health protective measures.
T40 11335-11520 Epistemic_statement denotes 49 The US Centres for Disease Control and Prevention (CDC) has recommended the use of strategies that enhance accessibility of influenza vaccination, including mobile vaccination carts.
T41 11521-11788 Epistemic_statement denotes 56 Despite the consensus about the importance of bringing the vaccine to HCWs, a study conducted during the Influenza A (H1N1) pandemic in China showed that the lack of access to SIV in their hospital continued to be a potential barrier to vaccine receipt among HCWs.
T42 11789-11990 Epistemic_statement denotes 15 Related to accessibility, the provision of free vaccine or reimbursement of costs were cited as facilitators of vaccination in many studies and have been recommended by American advisory committees.
T43 11991-12258 Epistemic_statement denotes [56] [57] [58] [59] Other studies have shown that increased governmental and managerial support such as declarations made by ministries of health and health authorities, as well as nonpunitive approaches to promote vaccination, can improve immunization rates in HCWs.
T44 12259-12458 Epistemic_statement denotes 48, 51 Conversely, inconsistencies between actions taken by authority figures and conflicting messages provided by health authorities can negatively impact the effectiveness of vaccination campaigns.
T45 12459-12726 Epistemic_statement denotes 10,51,60 Peer influence and pressure from family members may also have a positive impact on vaccine uptake 19, 38, 61 , particularly when recommendations come from well-respected colleagues such as infectious disease specialists, physicians and other opinion leaders.
T46 12808-13140 Epistemic_statement denotes While the media may negatively affect HCWs' attitudes towards vaccination when it is used as the main source of information and is focused on the potential negative impact of vaccination 9, 38, 44, 51 , news about deaths from influenza A (H1N1) in the media positively influenced vaccination behaviour in HCWs in at least one study.
T47 13381-13834 Epistemic_statement denotes 62 HCW compliance with seasonal and pandemic influenza vaccination ª 2013 Blackwell Publishing Ltd Relationship between seasonal and pandemic influenza vaccination and the effect of a threatened pandemic Current or past receipt of SIV is a consistent predictor of pandemic vaccine acceptance among HCWs 9, 11, 12, 14, 15, 21, 29, 42 ; however, several studies provide a less clear picture of the link between seasonal and pandemic vaccination behaviour.
T48 13835-14040 Epistemic_statement denotes The relationship is further complicated by the emergence of a threat by a pandemic influenza strain, and recent experience has shown that such a threat can have a variable impact on vaccine coverage rates.
T49 14041-14263 Epistemic_statement denotes The studies conducted in some settings have shown that transmission of a pandemic strain can serve to improve coverage with the seasonal influenza vaccine, even if the same success may not be seen for pandemic vaccination.
T50 14264-14372 Epistemic_statement denotes In the US, the 2009/2010 vaccination season saw SIV coverage rates exceed 60% for the first time among HCWs.
T51 14373-14427 Epistemic_statement denotes Despite this improvement, PIV remained just below 40%.
T52 14626-14817 Epistemic_statement denotes 11 The findings for SIV in the US and Spain are encouraging; however, in other countries, SIV coverage did not improve significantly despite the emergence of the 2009 H1N1 influenza pandemic.
T53 15063-15331 Epistemic_statement denotes 12,13 A study conducted among National Health System (NHS) and non-NHS workers in the United Kingdom showed that the former were no more likely than the latter to receive the pandemic vaccine, but they did express an increased willingness to take the seasonal vaccine.
T54 15595-15821 Epistemic_statement denotes 15 In this study, however, PIV coverage reached 25%, which is comparable with or exceeds the overall coverage rates for seasonal vaccination in this group, as well as coverage with the pandemic vaccine seen in other countries.
T55 16151-16404 Epistemic_statement denotes 9 The reasons why PIV remained below the levels achieved for SIV could be related to the novelty of the influenza strain causing the pandemic and heightened concerns over the safety of a vaccine that had undergone an accelerated authorisation procedure.
T56 16405-16578 Epistemic_statement denotes 15, 44 Fear over the safety of the vaccine, as well as mention of concerns over Guillain-Barr e Syndrome surfaced as important barriers to PIV among HCWs in several studies.
T57 16632-16763 Epistemic_statement denotes 15 discussed the potential reasons for uptake rates for PIV remaining low with the introduction of influenza A (H1N1) into society.
T58 16764-17057 Epistemic_statement denotes They argued that while intentions to be vaccinated may have been high at the start of the pandemic due to fear and perceptions of personal risk, the establishment of the virus in society resulted in a certain degree of emotional tolerance that dampened the initial motivation to be vaccinated.
T59 17305-17496 Epistemic_statement denotes These authors pointed out that time elapsed because the appearance of the threat, its failure to progress, and notions of its controllability may have changed intended vaccination behaviours.
T60 17497-17500 Epistemic_statement denotes 55
T61 17501-17726 Epistemic_statement denotes Despite the interesting findings that can be extracted from the volume of literature available on influenza vaccination among HCWs, it is important to highlight some challenges that we encountered when interpreting this data.
T62 17727-18003 Epistemic_statement denotes The focus is on two main issues; the lack of longitudinal studies that help identify the factors that govern the translation of stated intentions into actual vaccination behaviours and the challenges of drawing conclusions from studies that use various definitions of the HCW.
T63 18004-18204 Epistemic_statement denotes Much of the social sciences literature exploring the factors associated with vaccine compliance in HCWs are crosssectional studies that assess intention or receipt of seasonal or pandemic vaccination.
T64 18273-18377 Epistemic_statement denotes included a total of 37 articles examining factors associated with Influenza A (H1N1) vaccine compliance.
T65 18490-18813 Epistemic_statement denotes 64 Studies that looked at the intentions or willingness of HCWs to receive pandemic vaccine were an important contribution to the research on vaccination compliance during the initial stages of the 2009 pandemic and identified groups of HCWs that could have been targeted to ensure the effectiveness of vaccination efforts.
T66 18814-19006 Epistemic_statement denotes 9, 19, 21, 29, 54 However, there was little effort to follow whether these stated intentions were translated into vaccination behaviours through longitudinal or serial cross-sectional methods.
T67 19189-19401 Epistemic_statement denotes used an extended version of the theory of planned behaviour (TPB) to find determinants of SIV intentions and vaccine receipt in HCWs and also explored potential moderators of the intention-behaviour relationship.
T68 19402-19549 Epistemic_statement denotes These authors found that moral norm, or one's feelings of obligation to adopt a certain behaviour, is a significant moderator of this relationship.
T69 19550-19694 Epistemic_statement denotes Interestingly, however, they also found that HCWs who had low levels of moral norm were the ones who acted according to their stated intentions.
T70 19695-19814 Epistemic_statement denotes This means that those who felt less of an obligation to do good for others often did not receive influenza vaccination.
T71 19815-19985 Epistemic_statement denotes One of the main conclusions drawn from this study was that interventions need to focus on emphasising to HCWs the benefits of vaccination for patients and family members.
T72 20226-20245 Epistemic_statement denotes 11, 22, 34, 38, 59
T73 20246-20486 Epistemic_statement denotes Understanding attitudes among HCWs towards influenza vaccination may have been further complicated by the changing definition of the HCW used by most authors and the issues associated with the generalisability of many of the study findings.
T74 20487-20679 Epistemic_statement denotes 16, 19, 62 In many publications, the term 'healthcare worker' insinuates a group of workers employed in a healthcare institution that may or may not be responsible for patient care activities.
T75 21214-21451 Epistemic_statement denotes [9] [10] [11] 31, 67 While the main conclusions are consistent, an emphasis on the barriers specific to a particular group of HCWs allows for a better understanding of their concerns and the formulation of targeted vaccination campaigns.
T76 21452-21658 Epistemic_statement denotes The use of findings on attitudes and perceptions towards vaccination in the formulation of tailored outreach programmes directed at a specific study population has only been undertaken by a few researchers.
T77 21772-21987 Epistemic_statement denotes 16, 69, 70 Education is a necessary component of such strategies because health professionals often harbour misconceptions about the influenza vaccine that can be addressed with provision of appropriate information.
T78 21988-22099 Epistemic_statement denotes Furthermore, improved knowledge about influenza and influenza vaccination can positively impact vaccine uptake.
T79 22355-22552 Epistemic_statement denotes 12, 52, 61, 70, 71 Although education is important, the literature has now shown that relying on a single component strategy may not be sufficient to enhance compliance with vaccination among HCWs.
T80 22684-22958 Epistemic_statement denotes 67, 75 A focus group study revealed that the creation of a 'safety culture' at work that emphasised the importance of influenza vaccination as part of a broader set of measures to ensure HCW and patient protection could be a better approach to ensure vaccine uptake by HCWs.
T81 22959-23230 Epistemic_statement denotes 48 Others have argued for the use of an 'ecological model' when addressing HCW compliance to vaccination; a holistic approach that incorporates the community, organisations and policy-makers in making changes that can help influence vaccine uptake among the target group.
T82 23231-23407 Epistemic_statement denotes 16 Such models are an important step forward in the formulation of multi-pronged strategies that will be better suited to address the target behaviours that need to be changed.
T83 23408-23535 Epistemic_statement denotes Interventions must take into consideration the differences of those within the HCW group as well as context-specific variables.
T84 23779-24012 Epistemic_statement denotes [76] [77] [78] The focus on specific subgroups of HCWs, especially those in closest contact with high-risk populations, has been noted in the literature as an important step to a better understanding of the concerns among HCW groups.
T85 24013-24230 Epistemic_statement denotes The combination of strategies that encompass all HCWs with those that target HCWs showing the least susceptibility to vaccination campaigns can be instrumental in ensuring broad vaccine coverage in different settings.
T86 24489-24732 Epistemic_statement denotes However, these efforts have not improved coverage rates among HCWs, and the challenges of ensuring adherence to vaccine policies for novel influenza viruses have recently been highlighted with the emergence of the H1N1 pandemic strain in 2009.
T87 24733-24963 Epistemic_statement denotes In the future, researchers should engage hospital and public authorities when planning and conducting studies to ensure that findings are translated to evidence-based policies that are in-line with the general thinking among HCWs.
T88 24964-25151 Epistemic_statement denotes Perceptions of vulnerability and severity, as well as concerns over one's health or the health of others, have been consistently proven to be associated with compliance with this measure.
T89 25152-25390 Epistemic_statement denotes However, research has also shown that determinants of compliance extend to situational and organisational factors that need to be considered in the formulation and implementation of strategies to encourage uptake of influenza vaccination.
T90 25391-25583 Epistemic_statement denotes One of the important situational criteria that need to be considered is the potential influence of an outbreak/pandemic with an emerging influenza virus in swaying vaccination-related choices.
T91 25584-25842 Epistemic_statement denotes Studies have shown that the influenza A (H1N1) pandemic has had variable impact in shifting acceptance towards SIV among HCWs, and despite improvements seen in some settings, uptake of pandemic vaccine has generally failed to match seasonal vaccine coverage.
T92 25843-26001 Epistemic_statement denotes There may be a number of reasons for this, including the perception of novel influenza as a mild disease, and fears over rapidly authorised pandemic vaccines.
T93 26002-26182 Epistemic_statement denotes Further research such as longer-term follow-up of study populations is needed to better understand the translation of HCWs' willingness and intentions to be vaccinated into action.
T94 26183-26380 Epistemic_statement denotes Such assessments could be a step towards a better understanding of the real-world barriers to vaccination compliance among HCWs and highlight the modulators of the intention-behaviour relationship.
T95 26381-26577 Epistemic_statement denotes There appears to be a need to tailor informational and educational campaigns so as to appeal to the main concerns and perceptions among HCWs, and allay fears these may have related to vaccination.
T96 26578-26796 Epistemic_statement denotes Furthermore, an exploration of the barriers to this measure among some of the most resistant HCW groups and a targeted campaign to address their concerns could be an important step in ensuring broader vaccine coverage.
T97 26797-27121 Epistemic_statement denotes Communication efforts need to be sensitive to the fact that HCWs respond to the implementation of influenza vaccination policies differently to the rest of the general population, and that even within this group, some healthcare professionals appear less susceptible to strategies to enhance compliance compared with others.
T98 27122-27357 Epistemic_statement denotes Studies that specifically analyse the role of risk communication in changing vaccination behaviours among HCWs, and the role of social or peer influence should be an integral component of future initiatives to improve compliance rates.
T99 27358-27580 Epistemic_statement denotes Despite the need for the provision of information to HCWs as a means to enhance compliance, there is increasing recognition of the limited capacity for information alone to stimulate great improvements in vaccine coverage.
T100 27847-28063 Epistemic_statement denotes The promotion of influenza vaccination among HCWs could be 'sold' to this audience more effectively if it is packaged as part of broader initiatives to ensure safe and conducive environments to influenza vaccination.
T101 28064-28270 Epistemic_statement denotes This would require integrating vaccination campaigns within wider initiatives promoting health and safety at the workplace and a non-punitive and non-coercive approach to vaccination enforcement among HCWs.
T102 28271-28427 Epistemic_statement denotes Evaluations of the comparative effectiveness of such initiatives should be conducted and tailored recommendations made to overcome any remaining challenges.