Determinants of seasonal influenza vaccination hesitancy among healthcare personnel: An integrative review.

AIMS AND OBJECTIVES: To explore the determinants of and behaviour change models for seasonal influenza vaccination compliance among healthcare personnel. BACKGROUND: COVID-19 vaccine hesitancy among healthcare personnel may be better understood by exploring determinants of seasonal influenza vaccine hesitancy. DESIGN: Integrative literature review. METHODS: A systematic search was conducted in accordance with PRISMA guidelines. Six thousand and forty-eight articles were screened. Seventy-eight met inclusion criteria. Due to the heterogeneity of included articles, a narrative synthesis was conducted utilising a conceptual matrix to identify thematic categories. RESULTS: Six thematic categories were identified as influencing HCP SIV compliance: 'perceived vulnerability', 'trust', 'past behaviour', 'professional duty', 'access and convenience' and 'knowledge and experience'. The Health Belief Model (HBM) was the most commonly utilised health behaviour change model within the seasonal influenza vaccination context. Few studies have examined seasonal influenza vaccine acceptance and uptake within the Australian HCP context, particularly involving community care and aged care. CONCLUSIONS: Factors that appear to relate to influenza vaccination compliance among HCP can be grouped according to several thematic categories, and they also appear influential in COVID-19 vaccine uptake. In particular, an emerging focus on 'trust' or the more emotive considerations of decision-making around health-protective behaviours requires further exploration in the context of a pandemic. Efforts to influence these domains to increase compliance, however, are likely to be impeded by a lack of a well-developed and tested behaviour change model. RELEVANCE TO CLINICAL PRACTICE: Healthcare personnel (HCP) face high levels of occupational exposure to seasonal influenza every year. An emerging focus on 'trust' and the more emotive considerations of decision-making around health-protective behaviours requires further exploration in the context of a pandemic.

Experiences of outcome monitoring in service users with psychosis: Findings from an Improving Access to Psychological Therapies for people with Severe Mental Illness (IAPT-SMI) demonstration site.

OBJECTIVES: Psychological therapy services are increasingly required to instate routine outcome monitoring (ROM), to demonstrate the clinical and economic impact of interventions. Professionals' views of ROM are an acknowledged barrier to implementation. Service user perspectives have rarely been examined, but acceptability and perceptions of ROM are critical to successful implementation. We investigated service users' experiences of ROM in an Improving Access to Psychological Therapies for people with Severe Mental Illness psychosis demonstration site. DESIGN: ROM comprised a periodic assessment battery completed at baseline, mid-therapy, and end-of-therapy and a single measure completed session-by-session. Qualitative and quantitative feedback were sought at each periodic ROM administration, and, for sessional ROM, at mid-therapy and end-of-therapy. Demographic and clinical correlates of satisfaction were examined cross-sectionally at baseline. Consistency of satisfaction over time and associations of satisfaction with engagement were examined longitudinally. METHODS: Service users rated baseline (n = 281/289), mid-therapy (n = 114/121), end-of-therapy (n = 124/154), and session-by-session (mid-therapy n = 63/87 and end-of-therapy n = 90/123) ROM from 0 ('extremely unhelpful') to 10 ('extremely helpful') and gave qualitative feedback. RESULTS: Service users predominantly found ROM helpful (score 6-10; 64-72%) or neutral (score 5; 19-29%). Finding ROM less helpful was associated with younger age and poorer general outcomes, but not with psychotic symptoms or therapy dropout. Emerging qualitative themes included feeling understood, valuing opportunities to reflect, expressing feelings, and tracking progress towards goals. Shorter batteries would be preferable, particularly for younger respondents, and those with poorer outcomes. CONCLUSIONS: ROM is acceptable for people with psychosis. Tailoring assessments to specific subgroups should be considered. PRACTITIONER POINTS: Routine outcome monitoring for psychological therapy is acceptable to people with psychosis. Most respondents experienced outcome monitoring as an opportunity to feel understood. Younger people and those with poorer functioning and well-being might be at higher risk of dissatisfaction. Short assessment batteries and less frequent outcome monitoring might be preferable for some service users. Limitations of the study Feedback about session-by-session outcome monitoring was not contemporaneous with completion and may be subject to memory or other biases. Only two-thirds of service users provided feedback about session-by-session ROM (compared to >94% for periodic ROM) so findings may not be fully representative. Feedback about measures was not provided anonymously, and it is possible that service users were reluctant to express criticism about ROM to the assessor.

Declining incidence of osteoporotic hip fracture in Australia.

UNLABELLED: Between 1997-1998 and 2006-2007 in Australia, the age-standardised incidence rates of hip fractures declined by 20 and 13 %, in females and males, respectively. Although this may be related to the rollout of public health campaigns and strategies addressing osteoporosis, absolute numbers of hip fractures continued to increase. BACKGROUND: Previous reports described an increasing trend in osteoporotic hip fracture incidence in Australia in the 1980s with a stabilisation over the 1990s. AIM: The aim of this study was to describe national trends in the incidence of osteoporotic hip fracture in Australia between 1997-1998 and 2006-2007. METHODS: Data on low-trauma hip fractures in persons aged 50 years and over were obtained from the National Hospital Morbidity Database. Cases where the patient was transferred in from another hospital were excluded. Age-standardised incidence rates were calculated and a linear test for trend applied. RESULTS: Although the absolute number of hip fracture cases has continued to increase, from 14,769 in 1997-1998 to 16,412 in 2006-2007, these numbers are lower than previous predictions based on population ageing. Over the 10-year period, the age-standardised incidence rates in females declined by 20 %, from 370 to 295 per 100,000, while the age-standardised incidence rates in males declined by 13 %, from 200 to 174 per 100,000. Both declines were statistically significant. The sex difference in incidence rates narrowed between 1997-1998 (females 85 % higher) and 2006-2007 (females 70 % higher). CONCLUSIONS: The age-standardised incidence of osteoporotic hip fracture in Australia is falling. This may be related to the uptake of bisphosphonates as well as the rollout of public health campaigns and strategies addressing osteoporosis.