Project AMM34

FluCare: Estimating the effectiveness and cost-effectiveness of a complex intervention to increase care home staff influenza vaccination rates

We have been awarded funding from the National Institute for Health Research (NIHR) Public Health Research for Applied Research stream to test a behaviour change intervention (the new service) which uses promotional videos, leaflets and vaccination clinics in care homes designed to encourage more care home staff to uptake the flu vaccine.


Every year flu, caught from staff and visitors, causes serious illness and death in care home residents. The best defence against flu is vaccination, which prepares the body to be able to fight it. To best protect care home residents, the World Health Organisation recommends that over three quarters of care home staff should be vaccinated. In the UK, less than half of care home staff are vaccinated which means that residents are put at higher risk.

The FluCare study will help find out if offering flu vaccination clinics and tailored information about the risk of flu to care home residents has an influence on whether more care home staff have a flu vaccination.  Using the findings, this research will develop a toolkit which will tell people about the new service and encourage them to use it. This study will be working closely with residents and their relatives to ensure that the study is appropriate for care homes.

Project Aims

After reviewing the evidence and speaking to care home staff and managers, this study found three main reasons for why staff do or do not get vaccinated. These are:

  1. How easily they can access vaccines
  2. How important their manager sees staff vaccination
  3. Attitudes and beliefs around vaccination

*It is important to note that this research started before the COVID-19 vaccinations became compulsory for care home staff and they will be monitoring the effect of this on flu vaccinations.

The research will test if the following approaches can increase how many staff get the flu vaccination:

  • Health Care professionals vaccinating staff in the care home
  • Providing vaccine information leaflets and videos for staff and managers
  • Providing free vaccinations for everyone
  • Offering incentives to managers who increase the number of vaccinated staff
  • Monitoring how many staff get vaccinated and giving feedback to the home

Project Activity

The research has four stages that will take place over 3 years in East Anglia, London and the East Midlands. The four stages are: 

Stage 1: Preparing the FluCare service

  • Develop the vaccine information for staff, in consultation with our Patient and Public Involvement group (PPI)
  • Make contact with care homes and GPs or community pharmacists to see if they can run flu vaccination clinics in care homes for the staff

Stage 2: The feasibility study

  • Recruit ten care homes. There are five arms to the study (2 care homes in each)
  • Two care homes receive the full service; six care homes receive different amounts of the service; two care homes just carry on with ‘service as usual’
  • Test the different approaches

Stage 3: Learning from feasibility study

  • Refine the service and decide which mixture of approaches to study on a larger scale

Stage 4: The Randomised Controlled Trial

  • Recruit seventy care homes with low vaccination levels. Randomise them to see which care home will either get the new service or carry on with 'service as usual'
  • At end of the flu season (2022/2023), compare how many staff are vaccinated in the 'new service' and 'service as usual' groups
  • See if the service improves resident health and saves money for the NHS
  • Find out whether people used the new service as intended
  • Listen to people who were involved to find out what did and did not work to learn how to improve the service

Next steps

So far, this study has developed the promotional material and they have interest from several care homes. As soon as they have ethical approval to do the research, then the study will commence. 

Who is involved?

Principal Investigators: Professor David Wright, Professor of Pharmacy Practice, University of East Anglia (

Dr Amrish Patel, Associate Professor in Economics, University of East Anglia (

Researchers linked in the ARC: Dr Linda Birt, Research Fellow, ARC East of England Inclusive Involvement in Research for Practice Led Health and Social Care (IIRP) theme / University of East Anglia (

Dr Adam P Wagner, Theme Lead, ARC East of England Health Economics and Prioritisation (HEP) theme / University of East Anglia (

Dr Sion Scott, Senior Research Associate, ARC East of England Ageing and Multi-Morbidity (AMM) theme / University of East Anglia (