Australian hospital paediatricians and nurses' perspectives and practices for influenza vaccine delivery in children with medical comorbidities

Daniel A Norman; Margie Danchin; Christopher C Blyth; Pamela Palasanthiran; David Tran; Kristine K Macartney; Ushma Wadia; Hannah C Moore; Holly Seale

doi:10.1371/journal.pone.0277874

Australian hospital paediatricians and nurses' perspectives and practices for influenza vaccine delivery in children with medical comorbidities

PLoS One. 2022 Dec 12;17(12):e0277874. doi: 10.1371/journal.pone.0277874. eCollection 2022.

Authors

Daniel A Norman^{1

2}, Margie Danchin^{3

4

5}, Christopher C Blyth^{1

2

6

7}, Pamela Palasanthiran^{8

9}, David Tran¹⁰, Kristine K Macartney^{11

12

13}, Ushma Wadia^{1

14}, Hannah C Moore¹, Holly Seale¹⁵

Affiliations

¹ Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Crawley, Western, Australia.
² School of Medicine, University of Western Australia, Crawley, Western, Australia.
³ Department of General Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia.
⁴ Vaccine Uptake Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
⁵ Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
⁶ Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western, Australia.
⁷ Department of Microbiology, PathWest Laboratory Medicine, Nedlands, Western, Australia.
⁸ School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
⁹ Infectious Diseases Service, Sydney Children's Hospitals Network, Randwick, New South Wales, Australia.
¹⁰ Department of Paediatrics, Northern Health, Epping, Victoria, Australia.
¹¹ National Centre for Immunisation Research and Surveillance, University of Sydney, Sydney, New South Wales, Australia.
¹² Department of Infectious Diseases and Microbiology, Children's Hospital Westmead, Westmead, New South Wales, Australia.
¹³ School of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia.
¹⁴ Department of Paediatrics, Fiona Stanley Hospital, Murdoch, Western, Australia.
¹⁵ School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.

Abstract

Introduction: Influenza vaccination of children with medical comorbidities is critical due their increased risks for severe influenza disease. In Australia, hospitals are an avenue for influenza vaccine delivery to children with comorbidities but are not always effectively utilised. Qualitative enquiry sought to ascertainment the barriers and enablers for influenza vaccination recommendation, delivery, and recording of these children at Australian hospitals.

Methods: Semi-structured interviews and discussion group sessions were conducted with paediatricians and nurses at four tertiary paediatric specialist hospitals and two general community hospitals in three Australian states. Transcripts from interviews and group sessions were inductively analysed for themes. The Capability, Opportunity, Motivation, and Behaviour (COM-B) model was used to explore the elements of each theme and identify potential interventions to increase influenza vaccination recommendation and delivery behaviours by providers.

Results: Fifteen discussion sessions with 28 paediatricians and 26 nurses, and nine in-depth interviews (five paediatricians and four nurses) were conducted. Two central thematic domains were identified: 1. The interaction between hospital staff and parents/patients for influenza vaccine recommendation, and 2. Vaccination delivery and recording in the hospital environment. Six themes across these domains emerged detailing the importance of dedicated immunisation services, hospital leadership, paediatricians' vaccine recommendation role, the impact of comorbidities, vaccination recording, and cocooning vaccinations. Supportive hospital leadership, engaged providers, and dedicated immunisation services were identified as essential for influenza vaccination of children with comorbidities in Australian hospital.

Conclusion: Recommendation of influenza vaccination for Australian children with comorbidities is impacted by the beliefs of paediatricians and the perceived impact of influenza disease on children's comorbidities. Dedicated immunisation services and supportive hospital leadership were drivers for influenza vaccine delivery at hospitals. Future interventions targeting hospital-based influenza vaccine delivery for children with comorbidities should take a rounded approach targeting providers' attitudes, the hospital environment and leadership support.

Copyright: © 2022 Norman et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Australia / epidemiology
Child
Health Knowledge, Attitudes, Practice
Hospitals
Humans
Influenza Vaccines*
Influenza, Human* / epidemiology
Influenza, Human* / prevention & control
Vaccination

Substances

Influenza Vaccines

Grants and funding

PP provided funding for DN's airline travel and accommodation during discussion groups and interviews conducted at Children’s Hospital at Westmead and Sydney Children’s Hospital, Randwick through PP's Funding from the Department of Immunology and Infectious Diseases, Sydney Children's Hospitals Network, Randwick. DN's airline travel and accommodation during discussions and interviews conducted at The Royal Children’s Hospital, Melbourne and Northern Hospital, Epping was provided through his University of Western Australia’s HDR Funding: 20761103. No other funding for this project was sought or provided. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.