In Lombardy, influenza vaccination coverage among National Health Service (SSN) staff stands at 28.6 percent, a level that is rising (it was 23.4 percent two years ago), but still decidedly low.
For health care workers, the recommendation to get vaccinated is strong and widely shared, and we cannot be satisfied with fewer than one vaccinated worker in three.
Lombardy health care organizations invest in information campaigns, increase the number of vaccination sites, simplify access, and test various organizational initiatives. A survey conducted by Rosanna Tarricone, Vittoria Ardito, and Francesco Petracca for CSL Seqirus mapped what organizations are doing to promote influenza vaccination among health care workers.
A journey inside organizations
The research is part of a well-established field that studies why, even among health professionals, vaccination uptake remains lower than expected. Numerous international studies have already shown that resistance among health care workers is not limited to Italy, but is widespread across many advanced health systems.
The study (of which the survey is only the first step) aims to observe what happens “inside” health care organizations:
- which initiatives are promoted,
- which are perceived as effective,
- where the barriers lie.
Culture beyond logistics
The research is based on a survey conducted with the institutional support of the Lombardy Region, in which 72 Lombardy health care organizations, both public and private, took part.
Organizations deploy a wide range of measures, mainly falling into two broad categories:
- organizational initiatives, aimed at facilitating access from a logistical standpoint, such as increasing the number of vaccination sites, offering the possibility of getting vaccinated directly in the ward or among colleagues (a practice adopted by more than half of the organizations), and simplifying procedures;
- communication initiatives, aimed at raising awareness, such as targeted emails, informational letters, dedicated web pages, and internal campaigns.
All the initiatives are perceived by survey participants as effective on average (none receives a score below 7 out of 10), but an important difference emerges: personalized and direct actions (individual invitations, targeted communications, facilitated access) are perceived as more effective, while general initiatives, such as posters and signage, are less impactful, even though they are among the most widely used.
This points to a first misalignment: what is easiest to implement on a large scale is not necessarily what is perceived as most effective.
Moreover, organizational barriers (access, schedules, logistics) are considered, all in all, secondary, showing that the organizational measures implemented by health care organizations work; the main barriers are cultural and behavioral: low risk perception, hesitancy, limited trust.
Behavioral interventions
To persuade health care staff to get vaccinated, strategies will therefore need to be rethought, integrating behavioral tools.
More targeted interventions are needed, capable of speaking to specific groups of workers with messages that are relevant to their context.
The next phase of the research will therefore focus on interventions inspired by behavioral science, still little used but promising, such as preassigned vaccination appointments (defaults); making peer comparison explicit (social norms); new message-framing techniques; and elements of competition among facilities (gamification).
Since not all initiatives work in the same way for everyone, it will be important to test, measure, and adapt interventions before extending them on a large scale. The path to be followed in the next steps is to gain a deeper understanding of the determinants of vaccine hesitancy among health care workers and to identify combinations of interventions that are effective for different targets.
Rosanna Tarricone, Vittoria Ardito, Francesco Petracca. Iniziative adottate per promuovere la vaccinazione antinfluenzale degli operatori sanitari. Evidenze di una survey condotta in Regione Lombardia (in Italian).
