Knowledge, attitudes, and vaccination coverage of mandatory occupational vaccinations among Macao healthcare workers

Abstract

Active immunization is one of the most effective ways to prevent vaccine-preventable diseases (VPD). Studies have demonstrated that many of these VPDs are associated with serious morbidity and mortality among patients, disruption of health care services and lower performance of the healthcare workforce due to sick healthcare workers (HCW), and high costs and financial burden for the healthcare system as a result of patient disease management and HCW absenteeism. However, vaccination of HCWs is a major challenge for infection control in healthcare facilities worldwide. Vaccination coverage among HCWs is suboptimal across the globe, despite countless efforts and interventions aimed at increasing HCWs‟ vaccination rates. There were few studies on HCWs‟ occupational vaccinations; the majority of the research was quantitative in nature, with study settings limited to single-center, involving HCWs working in acute and tertiary care, and focused mainly on occidental countries. The objective of the present study was to explore the knowledge, attitudes, and vaccination coverage of occupational vaccinations among Chinese HCWs in Macao. This work would provide a better understanding of the perspectives of HCWs on the notion of mandatory occupational vaccinations, as well as to learn about the factors that could exert an influence on HCWs‟ vaccination uptake. A qualitative research approach was employed because little was known about the attitudes and perception of HCWs on the concept of occupational vaccinations. Moreover, an additional dimension on ethical considerations was added to the tool used in this study, since the notion of mandatory occupational vaccinations for HCWs is controversial and heavily debated. An interview guide exploring HCWs‟ knowledge, attitudes, and vaccination coverage on occupational vaccinations, as well as ethical considerations on mandatory occupational vaccinations was developed based on the constructs of the Health Belief Model. The participant inclusion criteria were HCWs currently practicing in Macao, who were 18 years of age or older, and could read and understand Chinese. The exclusion criteria were individuals, who were unable to communicate in Cantonese or Putonghua, and those unable to give informed consent for research participation. Forty-five semi-structured, in-depth, audio-recorded individual interviews conducted in Cantonese were conducted with HCWs representing different professional categories from both the primary and tertiary health care settings, as well as from the public and private health sectors. Data collection continued until theoretical saturation was achieved. Content analysis using a conventional approach was performed. To ensure the trustworthiness of the data analysis process, the verbatim transcriptions were initially independently coded by the principal investigator and a PhD in human development who was experienced in conducting exploratory qualitative research in Macao, and then the two discussed on their findings and analysis, and came to a general consensus. Several themes have emerged from this study: 1) health beliefs shape vaccination compliance; 2) action did not guarantee protection; 3) effective communication is the key to vaccination compliance; and 4) the “tug of war” between professional and individual ethical principles. The findings of this study suggested that various crucial factors could potentially exert an influence on the vaccination rates of Chinese HCW occupational vaccinations. In light of the repeated failure of voluntary, educational and other incentive programs to increase HCW vaccination rates as demonstrated in previous studies, mandatory occupational vaccination programs might be inevitably justified. Health policymakers and other occupational and public health stakeholders will need to further explore on the feasibility of implementing a mandatory vaccination policy, and to select individualized and tailor-made mandatory occupational vaccination programs or interventions to achieve optimal occupational vaccination coverage among HCWs.