Promoting flu immunisation in Health Care staff Flu immunisation campaign meeting – 25th May 2011 Promoting flu immunisation in Health Care staff Public Health Wales VPDP, Aneurin Bevan HB and Cardiff and Vale UHB Occupational Health Departments Simon Cottrell Simon.Cottrell@Wales.NHS.UK Insert name of presentation on Master Slide All photos used in this presentation (c) Leah Millinship

All Wales Occupational Health group 2010 Background All Wales Occupational Health group 2010 Closer working relationship with NHS Wales Occupational Health Departments Central help in promoting influenza vaccination Further to the information from Anne in her presentation, here is some background to this presentation. Public Health Wales VPDP have working with Occupational Health Departments in Wales for four years now to assess and monitor influenza immunisation uptake in NHS Wales staff. In 2010 we were invited to the All Wales Occupational Health Forum meeting in Llandrindod Wells to present the 2009/10 seasonal and pandemic influenza immunisation uptake data. During the discussion session after it was raised that support at a national level in improving uptake in health care workers was not as obvious as it was on other issues. Partly as a result of this and partly through efforts from the VPDP and the Occupational Health Departments in improving immunisation uptake data quality the VPDP fostered a closer working relationship and we decided to offer assistance in promotion of influenza immunisation among Health Care worker.

“Protect yourself and others“ Background Local Ownership and recognisable faces Benefits to patients Benefits to staff “Protect yourself and others“ Working with Nicky in Cardiff and Vale University Health Board and Elaine in Aneurin Bevan Health Board, we started to develop some promotional materials that could be used around hospitals and Health Care facilities. One of the key themes from our literature review was that interventions where there was local ownership and where recognisable staff took key roles in promoting tended to be more effective. The VPDP had recently commissioned a bank of photographs that could be used to promote immunisation, including a series featuring NHS staff. These photographs were taken in the University Hospital in Cardiff, so we decided to use some of these photographs in the promotional campaign. Another of the key themes was to emphasize that influenza immunisation in Health Care staff benefits both patients and the staff receiving immunisation. We decided to use the ‘Protect yourself and others’ message that had previously been used to promote immunisation in Wales by the Welsh Government. Because we placed an emphasis on involving local staff, because we wanted to be able to evaluate whether there was value to the promotional materials we developed before releasing anything at a national level, we limited this intervention to two Health Board areas only – with an aim to share it more widely if the materials proved useful.

Posters The team cam up with four posters. All posters featured real staff from the University hospital, from a variety of professional backgrounds: The posters featured the ‘Protect yourself and others’ message and asked ‘Have you had your flu jab?’. The posters also featured contact details so that anyone reading the poster would be able to get in touch with their Occupational Health nurses and arrange to be immunised. These posters feature a physiotherapist and a pediatric nurse.

Posters There were two more posters, featuring a radiographer and a doctor. We had decided to contact the staff that featured in the posters personally to forewarn them that we’d like to post their photos around wards. Unfortunately we weren’t able to track down the doctor that posed for the photo, so we decided not to use this one.

Leaflet Leaflet aimed at Healthcare staff To the point, evidence based Featuring local staff in the background picture (Nurse, Physiotherapist, Radiographer) A5 size – for small notice boards, pigeon holes, mail shots, etc Also set up as a webpage We also produced a range of leaflets that could be used for notice boards, pigeon holes or mail drops. The leaflets featured the same staff that were used in the poster, and emphasized ten to the point, evidence based messages to highlight the importance of flu immunisation in Health Care staff. We also set up an online version of the webpage and distributed the link to the two Occupational Health Departments involved.

Stickers Increase visibility of influenza immunisation Encourage staff to talk about their flu jab to other staff Indirectly advertise immunisation sessions The final arm to our promotional campaign was the use of simple stickers, reinforcing the ‘Protect yourself and others’ message that could be given to staff turning up at the immunisation sessions, proclaiming ‘I’ve had my flu jab’ have you? The intention was that the stickers would increase visibility of the flu immunisation campaign, encourage staff to tell other staff that they’d just had their flu jab and to indirectly advertise that the sessions were taking place in the building.

Evaluation So here are some results from the evaluation we carried out. This slide shows the 2010/11 immunisation uptake compared to the 2009/10 immunisation uptake in the Health Board areas in Wales. There was an increase in immunisation uptake in both of the Health Boards concerned, however because our intervention wasn’t the only one taking place and also because there was a general increase in immunisation uptake in all Health Board areas, these results do not tell that much about our intervention.

437 visits to Top 10 reasons web page This chart shows monthly visits to the ‘Ten top reasons’ web page we set up. There were 437 visits to the web site between September and January, peaking in December.

Out of 4,181 staff immunised in 2010/11: 60% had a flu jab last year 34% did not have a flu jab last year 6% did not answer In order to give some more robust information on how the promotional materials went down with Health Care staff, we were able to add some evaluation questions to consent forms that were filled in by all staff presenting for immunisation. We’ve processed 4,181 of the forms at present and there are a few more to go, but these are the results so far. Out of the 4,181 staff we asked, 60% received the seasonal flu jab in both 2009/10 and 2010/11 and 34% presented for immunisation in 2010/11 but hadn’t previously presented in 2009/10

Questionnaires from 4,181 people presenting vaccinated 56% had seen a poster 15% had seen a sticker 3% had seen a leaflet Out of the 4,181 staff immunised in 2010/11, 56% had seen the posters, 15% had seen the stickers and 3% had seen the leaflets.

Out of all 4,181 staff immunised: 57% saw one or more of the materials 48% had only seen posters 8% had only seen stickers 2% had only seen leaflets 43% had not seen any or did not answer We looked at this in a little more detail: 57% of all the staff we questionaired had seen one or more of the materials 48% had only seen the posters 8% had only seen the stickers 2% had only seen the leaflets And 43% had not seen the posters or did not answer

Out of the 2,400 who had seen a poster/ sticker/ leaflet: 73% said the materials were a positive influence 16% said the materials were not a positive influence 11% did not answer Out of the 2,400 staff that had seen either the poster, leaflet or sticker, 73% said that the materials had a positive influence in their decision to have a flu immunisation.

If you saw... Were they a positive influence on choosing to be vaccinated We assessed next the effect of each material in isolation. Out of the 2,029 staff who said they had only seen a poster, 73% said it had a positive effect on their decision to have a flu jab. Out of the 339 staff who said they had only seen the stickers, 72% said they had a positive effect on their decision to have a flu jab. Out of the 63 staff who said they had only seen the leaflets, 75% said they had a positive effect on their decision to have a flu jab – however this was the promotional material that reached to lowest number of people. n=2,400 n=2,029 n=339 n=63

77% said the materials were a positive influence Out of the 1,425 who were vaccinated this year but not last, and had seen the materials: 77% said the materials were a positive influence 14% said the materials were not a positive influence 9 % did not answer We were particularly interested in those who chose to have a flu immunisation in 2010/11 but hadn’t previously gone for their seasonal flu jab in 2009/10. So out of these 1,425 staff 77% said that the materials had a positive effect on their decision to have a flu jab.

Conclusions It is not possible conclude whether these promotional materials directly increased uptake, however: The posters, leaflets and stickers reached a large number of staff The posters reached the largest number of staff The promotional materials positively affected three quarters of all those who saw them to get immunised against influenza Informal feedback – staff liked seeing colleagues on the posters, and liked stickers All promotional materials used were low cost and easily prepared and distributed Although it is hard to say whether the promotional materials increased uptake, we can definitely draw some conclusions on their acceptance among staff. Based on this analysis, it would appear that the promotional materials were a useful contributing factor toward improving uptake in the 2010/11 immunisation campaign, and that these materials should be made available to Health Board Occupational Health Departments to tailor for local use in their 2011/12 campaigns.

Questions? Acknowledgments Richard Lewis, Nicola Joyce, Leony Davies and Anne McGowan, Richard Roberts Nicola Bevan, Gayle Farrell – Cardiff and Vale University Health Board Elaine Lewis, Kim Watkins – Aneurin Bevan Health Board Leah Millinship Questions?