PHRC Phase 2 (2011-2019) projects – Projects related to living and working conditions

Improving flu vaccination uptake by healthcare workers: a study of implementation and attitudes

Lead investigators

Martine Stead , Institute for Social Marketing, University of Stirling
and Fay Sullivan, NatCen Social Research (NatCen)


There are two main dimensions to uptake, demand (attitudes of HCWs towards the vaccination) and supply (how the vaccination programme is implemented). Both dimensions are likely to help explain variations in uptake and to identify potential barriers to uptake. This study will examine the relationship between both dimensions, and its findings will inform the development of strategies and interventions which have the potential to increase uptake. These could then be tested experimentally in future research.

Aims and objectives

The aims of the study are:

  1. to explore qualitatively the interaction of staff attitudes and vaccine uptake, in a range of high and low uptake Trusts
  2. to explore and describe the key dimensions of good practice in flu programme implementation, in terms of engagement with staff attitudes and beliefs, models of delivery and organisational context
  3. to assess quantitatively and retrospectively whether good practice in implementation is associated with higher uptake of the vaccination, and what other contextual factors might explain variation in uptake.

Two research exercises are proposed:

  • A. Qualitative study exploring the interaction of staff attitudes, good practice in implementation and vaccine uptake. This will address Aims 1 and 2.
  • B. Quantitative study of the relationship between implementation and uptake. This will address Aim 3.


Qualitative case studies exploring the interaction between good practice in flu vaccination implementation and uptake, in four NHS Trusts (February- April 2017).

The sample will comprise four Trusts (n=4): two with higher levels of vaccination uptake and two with lower levels. Within each Trust, we will interview up to 15 members of staff (total n=60). These will comprise two groups:

  1. Flu campaign leads, other flu campaign implementers and senior managers (3-5 interviews per Trust), Healthcare staff (10-12 interviews per Trust, comprising 3 different healthcare staff groups and including those who did and did not have the vaccination).
  2. Interviews will be conducted either face to face in workplace locations convenient to participants or by telephone.

Online questionnaire survey of flu leads in all Trusts in England to assess what factors might explain variations in uptake between Trusts (June-July 2017).

Based on insights from the qualitative phase of the study and a rapid literature review, a questionnaire will be developed to examine factors which might be related to variability in uptake of the vaccination across trusts. The questionnaire will be cognitively tested to ensure that it is comprehensible and acceptable to participants.

The finalised questionnaire will be administered in an online format to the main flu campaign leads in each Trust in England (n=237).


    • Douglas Eadie, University of Stirling
    • Nathan Critchlow, University of Stirling
    • Fiona Dobbie, University of Stirling
    • Anne Marie MacKintosh, University of Stirling
    • Katja Gravenhorst, NatCen
    • Hayley Lepps, NatCen
    • Aude Bicquelet, NatCen
    • Rupal Patel, NatCen

Duration: 01/10/2016 - 31/12/2017 (15 months)