Factors influencing staff attitudes to COVID-19 vaccination in care homes in England: a qualitative study

Bettina Friedrich; Gillian Forbes; Arnoupe Jhass; Fabiana Lorencatto; Laura Shallcross; Vivi Antonopoulou

doi:10.1186/s12913-023-10031-7

Factors influencing staff attitudes to COVID-19 vaccination in care homes in England: a qualitative study

BMC Health Serv Res. 2023 Oct 6;23(1):1066. doi: 10.1186/s12913-023-10031-7.

Authors

Bettina Friedrich¹, Gillian Forbes², Arnoupe Jhass¹, Fabiana Lorencatto^{2

3}, Laura Shallcross¹, Vivi Antonopoulou^{4

5}

Affiliations

¹ Institute of Health Informatics, Faculty of Population Sciences, University College London, 222 Euston Road, London, NW1 2DA, UK.
² Centre for Behaviour Change, Department of Clinical, Education and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
³ NIHR Policy Research Unit in Behavioural Science, Population Health Sciences Institute, Newcastle University, Newcastle, NE2 4AX, UK.
⁴ Centre for Behaviour Change, Department of Clinical, Education and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK. v.antonopoulou@ucl.ac.uk.
⁵ NIHR Policy Research Unit in Behavioural Science, Population Health Sciences Institute, Newcastle University, Newcastle, NE2 4AX, UK. v.antonopoulou@ucl.ac.uk.

Abstract

Background: The COVID-19 pandemic disproportionately affected people living and working in UK care homes causing high mortality rates. Vaccinating staff members and residents is considered the most effective intervention to reduce infection and its transmission rates. However, uptake of the first dose of the COVID-19 vaccine in care homes was variable. We sought to investigate factors influencing uptake of COVID-19 vaccination in care home staff to inform strategies to increase vaccination uptake and inform future preparedness.

Methods: Twenty care home staff including managerial and administrative staff, nurses, healthcare practitioners and support staff from nine care homes across England participated in semi-structured telephone interviews (March-June 2021) exploring attitudes towards the COVID-19 vaccine and factors influencing uptake. We used thematic analysis to generate themes which were subsequently deductively mapped to the Capability, Opportunity, Motivation-Behaviour (COM-B) model. The Behavioural Change Wheel (BCW) was used to identify potential intervention strategies to address identified influences.

Results: Enablers to vaccine uptake included the willingness to protect care home residents, staff and family/friends from infection and the belief that vaccination provided a way back to normality (reflective motivation); convenience of vaccination and access to accurate information (physical opportunity); and a supporting social environment around them favouring vaccination (social opportunity). Barriers included fears about side-effects (automatic motivation); a lack of trust due to the quick release of the vaccine (reflective motivation); and feeling pressurised to accept vaccination if mandatory (automatic motivation).

Conclusions: We identified influences on COVID-19 vaccine uptake by care home staff that can inform the implementation of future vaccination programmes. Strategies likely to support uptake include information campaigns and facilitating communication between staff and managers to openly discuss concerns regarding possible vaccination side effects. Freedom of choice played an important role in the decision to be vaccinated suggesting that the decision to mandate vaccination may have unintended behavioural consequences.

Keywords: Behavioural influences; COVID-19 pandemic; COVID-19 vaccine; Care home employees; Care homes; Mandatory vaccination.

MeSH terms

Attitude of Health Personnel
COVID-19 Vaccines
COVID-19* / epidemiology
COVID-19* / prevention & control
Drug-Related Side Effects and Adverse Reactions*
England / epidemiology
Humans
Pandemics
Vaccination

Substances

COVID-19 Vaccines