Abstract
Australian healthcare professionals (HCPs) form a crucial yet vulnerable workforce that is prioritised for seasonal influenza vaccination (SIV), due to high levels of occupational exposure. Despite extensive vaccination programs of varying effectiveness and other protective health measures, nearly 23% of HCPs are infected with the influenza virus each season, posing a risk to the health of susceptible patients and close contacts. Understanding the factors that influence HCP vaccination behaviour is essential for enhancing vaccination policy, including learning from the COVID-19 pandemic for future emerging pathogens.This doctoral thesis presents my five-year research journey that commenced before the COVID-19 pandemic. The purpose of this study was to acquire an understanding of Australian HCPs’ vaccination decision-making related to seasonal influenza. This study sought to identify and understand factors influencing the uptake of SIV among Australian nurses, midwives, medical practitioners and pharmacists, seen as experts and advocates of vaccination. The aim of the study was to inform interventions directed at increasing SIV rates among Australian HCPs. The research questions that guided the study are:
1.What factors (beliefs, attitudes, barriers, enablers and experiences) affect Australian HCP acceptance and uptake of SIV?
2.What interventions can be recommended to improve influenza vaccination uptake among HCPs?
3.Can these findings be generalised to other vaccination programs, including under epidemic and pandemic conditions?
The research employs a pragmatic philosophical approach and follows an exploratory sequential mixed-methods design, spanning four distinct phases. Phase 1a involves an analysis of global literature through an integrative review, facilitating an understanding of global HCP vaccination challenges related to SIV. The review identified research gaps within the Australian HCP vaccination context and provided an applicable theoretical framework, Triandis’ theory of interpersonal behaviour (TIB), to guide exploration of HCP health decision-making processes. Phase 1b comprised the exploration and justification of the use of the TIB as a theoretical framework for the analysis of this research.
A qualitative study design was subsequently employed to gain a nuanced understanding of Australian HCPs’ attitudes, lived experiences and behaviours around SIV (Phase 2). Considered the most trusted providers and advocates of vaccines and vaccination information, the HCP cohort recruited included nurses, midwives, medical practitioners and pharmacists. Semi-structured interviews, conducted during the COVID-19 pandemic, also disclosed a range of unsolicited perceptions and experiences related to COVID-19 vaccinations. In undertaking data analysis, I identified the potential presence of a set of HCP characteristics (or an archetype) and circumstances that tended to be associated with positive vaccination intention and behaviour.
Insights gained from the qualitative phase, informed by both the TIB framework and the findings, guided the development of a survey tool for the quantitative study in Phase 3. This study (Study 3) sought to both validate the qualitative results in relation to the archetype and factors associated with SIV uptake and test the applicability of the TIB framework. The generalisability of the proposed vaccination archetype was further assessed by examining HCPs’ attitudes and intentions regarding COVID-19 vaccinations, particularly with regard to their likely acceptance of new vaccine technologies. Phase 4 synthesises and analyses the research components from all stages of the mixed-methods study, delivering comprehensive conclusions, recommendations and suggestions for future research.
This thesis culminates in four publications, with one further manuscript pending publication, which have disseminated key findings and highlighted opportunities for future research. This exploration of HCP vaccine acceptance in the Australian context emphasises the pivotal role of trust and professional values as key enablers of HCP SIV uptake, supported by highly accessible vaccination services.
Key recommendations emerging from the findings include the importance of ensuring HCP characteristics generally align with the archetype shown to be associated with vaccine uptake, thereby addressing HCPs’ vaccine complacency, not necessarily vaccine hesitancy, to ensure positive vaccination intention. It is also recommended that SIV is easily accessible within work environments and free of cost to facilitate the intention to behaviour impetus. These findings also appear to hold broader significance beyond SIV with potential generalisability to other vaccine scenarios, such as COVID-19. This new knowledge also potentially offers greater insights into the enablers of vaccine acceptance of novel vaccines utilising new technologies, particularly those developed in response to current or future public health emergencies.
A potential next step following from this research would be to conduct ‘real world’ testing of initiatives that apply strategies to encourage alignment with and reinforce HCP archetype characteristics associated with vaccine uptake.
| Date of Award | 2025 |
|---|---|
| Original language | English |
| Supervisor | Holly NORTHAM (Supervisor), Mary BUSHELL (Supervisor), Karen STRICKLAND (Supervisor) & Adrian Webster (Supervisor) |