System-level interventions to support staff physical and mental wellbeing during times of particular pressure or crisis in health services

Background: The UK National Health Service has the largest workforce in Europe, and the fifth largest in the world, with an estimated 1.3 million employees. Attention to staff health and well-being is a critical aspect of effective care delivery, and is of even more importance for maintaining services during periods of high demand. In most countries guidance for healthcare workers recommends annual influenza vaccination to prevent ill health during times of seasonal and pandemic influenza. However, research has frequently highlighted that uptake of influenza vaccination amongst healthcare workers is low. Objectives: This rapid review forms part of a wider review of organisational-level interventions to enhance the health and wellbeing of healthcare workers during times of increased demand for services. This synthesis focuses on the literature relating to the vaccination of staff during times of seasonal and pandemic influenza. Methods: We searched Medline, EMBASE, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, CINAHL, HMIC (Health Management Information Consortium) and Web of Science in October and November 2020. The search was supplemented by reference list checking of included reviews, and using the “similar to” function within online journal repositories. Brief inclusion and exclusion criteria were as follows: Population: Staff employed in healthcare organisations. Intervention/comparison: Studies evaluating interventions with the aim of increasing the uptake of influenza vaccination during periods of seasonal or pandemic influenza. Also, studies which reported factors influencing the outcomes of interventions. Outcomes: Effectiveness in terms of uptake, vaccination rates, health and wellbeing of staff, or data regarding views and perceptions. Setting: Healthcare services in any high or middle income country, including both hospital-based and community-based services. Study design: Any study published since 2010 reporting empirical data. We prioritised examination of other reviews, and supplemented this with scrutiny of abstracts of primary studies, in particular studies published more recently than the review sources. The search results were screened against the inclusion criteria by two reviewers independently. As this was a rapid review, quality (risk of bias) assessment was not undertaken but any weaknesses of the literature as a whole were reported. We performed a narrative and framework synthesis of the included studies. Results: From a database of 1065 studies we included 13 reviews and 85 primary studies. The reviews synthesised between three and 37 primary studies, with the majority having few primary studies in common. The primary studies reported results from countries around the world with differing healthcare systems. Cross-sectional and survey designs dominated the literature. Evidence from the studies indicates that interventions to increase the uptake of influenza vaccination amongst healthcare staff result in small to moderate increases in uptake for non-mandatory actions. Interventions which include mandatory requirements (such as completing formal opt-out declarations or compulsory vaccination) are more effective, but have issues of acceptability in many countries. Interventions which include multiple elements are more effective than single actions. These elements should include evidence-based information regarding level of personal risk, methods of virus transmission, and efficacy and safety of the vaccine. Information should be specific to healthcare workers (rather than aimed at the general population), and address the individual barriers reported. Vaccinations should be freely available to staff via on-site or mobile clinics, with peer-to-peer vaccination having potential. Managerial support and the involvement of staff in planning programmes may be helpful, in particular those groups who are known to have low uptake (females and nursing staff). The review indicates that interventions during times of pandemic require the same elements as those at other times, although additional attention to communications regarding vaccine safety and personal risk may be beneficial, as well as extra measures to extend convenient access to vaccination. Limitations: We carried out a rapid review to distil key messages for stakeholders, and therefore our searching methods were limited, and some relevant literature may not have been identified and included. As typical for rapid reviews we did not carry out critical appraisal of individual studies, but commented on the quality of the literature overall. Conclusions: Non-mandatory interventions to increase uptake of influenza vaccination amongst healthcare staff have small to moderate effectiveness, with rates often remaining low. Mandatory measures are more effective, but require ethical debate. Interventions with multiple strands have greater effectiveness than single components, with ease of access and evidence-based information particularly important during pandemics. Exploration of barriers amongst those least likely to be vaccinated (females, nursing staff) may be beneficial. Funding and registration: NIHR Health Services & Delivery Research Programme (project number NIHR 130588). PROSPERO registration number CRD42020217851.