Tailoring Immunization Programmes for Seasonal Influenza (TIP FLU)

"[A]s HCWs are trusted sources of information on preventive health for patients, encouraging HCWs to act as champions advocating for SIV could be a powerful intervention to increase uptake of SIV among other priority groups."

Seasonal influenza vaccination (SIV) of health care workers (HCWs) is recommended to protect them and their patients from infection and to reduce the risk of hospital- or health-care-acquired influenza. Although the World Health Organization (WHO) recommends annual SIV for HCWs, uptake remains low in most countries in the WHO European Region. To address this problem, the WHO Regional Office for Europe proposes an approach called tailoring immunisation programmes for seasonal influenza (TIP FLU), to design evidence-informed solutions to increase uptake of SIV among HCWs. TIP FLU is grounded in theories of behaviour change and planning models for health programmes, and provides tools for designing SIV programmes seeking to reach HCWs, tailored to specific contexts and the needs of health care institutions and networks.

WHO describes a pathway to vaccination decision-making, which proposes that an individual's acceptance of and participation in vaccination is mediated by a number of determinants, which are categorised into different types of factors:

• Personal factors are tied to internal knowledge, perceptions, beliefs, and assessments that influence an individual's motivation to accept and/or participate (or not) in vaccination.
• Social and community factors reflect the networks to which an individual is connected, the degree of community support for vaccination, and the norms that guide vaccination behaviours. They are related to how factual, practical, and experiential knowledge is shared within communities, as well as the influence of professional and personal relationships and social networks such as media (traditional and social) and professional associations.
• Environmental factors are outside of the control of the individual, yet an individual reacts to them. Policy shapes desired norms, while factors related to vaccination service availability and cost facilitate opportunities for vaccination.
• The encounter with a HCW is a critical moment, which can maintain, encourage, or discourage an individual's vaccination acceptance and participation.
• The overall context can determine behaviour, particularly in relation to the current burden of vaccine-preventable diseases at global, national, and local levels.

The model recognises that a HCW's behaviour is mediated by the same categories of determinants.

The step-by-step TIP FLU approach involves a sequence of activities, which are designed to: identify and prioritise intended populations of HCWs; diagnose the demand- and supply-side motivators and barriers to SIV; and design and assess programmatic interventions. The 9 steps are:

The formative phase: listen, learn, and diagnose

• Step 1: examine available information on SIVs and HCWs
• Step 2: conduct a SWOT (Strengths, Weaknesses Opportunities, Threats) analysis and create a preliminary TIP FLU map
• Step 3: determine main issue(s) to address
• Step 4: conduct new research if needed
• Step 5: identify, prioritise, and describe HCW "target groups"
• Step 6: write TIP FLU situation summary

The planning phase: design, implement, assess, and adjust

• Step 7: set TIP FLU objective and subobjectives
• Step 8: design TIP FLU programme
• Step 9: monitor, evaluate, and adjust (as needed) the TIP FLU programme interventions

There are two interrelated TIP FLU documents:

1. A guide for increasing health care workers' uptake of seasonal influenza vaccination [PDF] - This publication offers a step-by-step guide to enable policymakers and programme managers to understand and apply the approach by conducting formative research, designing programmatic interventions. and evaluating SIV programmes that aim to reach HCWs who work directly with patients. In addition to the above-outlined steps, the guide includes annexes focusing on: (i) methodology to create the TIP FLU conceptual map of behavioural determinants to SIV uptake among HCWs; (ii) qualitatative component - semi-structured interviews (SSIs); (iii) qualitatative component - survey questionnaire; (iv) sample terms of reference template for research agency commissioned to assist in carrying out the formative research; and (v) review of successful interventions to increase SIV rates among HCWs.
2. Understanding health care workers' uptake of seasonal influenza vaccination in Montenegro: a case study for policy-makers and programme managers [PDF] - This case study documents the application of TIP FLU at the Primary Health Care Centre (PHCC) Podgorica in Montenegro, focusing on the formative phase. When accompanied by the TIP FLU guide, it can be used to apply the approach to conduct formative research and to design and evaluate SIV programmes seeking to reach HCWs in a given context. The case study is intended for those responsible for designing and implementing SIV programmes/campaigns seeking to reach frontline HCWs including: national decision-makers and policy and programme managers, as well as public health, immunisation, and behaviour change programme managers.

TIP FLU is an adaptation of the Guide to Tailoring Immunization Programmes (TIP), or TIP guide, published in April 2013 (see Related Summaries, below).