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.
Background
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:
- How easily they can access vaccines
- How important their manager sees staff vaccination
- 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
Key findings
During the 2022–23 flu season, we ran a study in care homes to see how well the FluCare programme worked and whether it was good value for money. We involved 75 care homes across England where 38 were in the “usual care” group and 37 received the FluCare support. On average, 28.6% of staff in the usual care homes had the flu vaccine compared with 32.7% in the FluCare homes. Although the overall difference in staff flu vaccination rates was not statistically significant, it is important to note that most FluCare clinics were delivered from February onwards (very late in the flu season) and not all scheduled FluCare homes received vaccination clinics due to this delay. When we looked only at homes that received at least one FluCare clinic, the results were stronger: staff vaccination rates were 28.6% in the usual care group and 41.7% in the FluCare group.
Because of the late start, we redesigned the study to allow the programme to begin earlier in the flu season (September/October). Instead of recruiting individual care homes, we worked with Integrated Care Boards (ICBs) and asked them to invite local community pharmacists to deliver the service. This new, more pragmatic trial ran during the 2024–25 flu season in four ICB areas, where two received FluCare and two did not. The data is still being analysed, but early results are encouraging.
Dissemination and next steps
The team was invited by NHS East of England to present at the Flu Planning Day, where key learnings from the FluCare programme were shared. These insights were subsequently utilised by Integrated Care Boards (ICBs) and NHS staff to inform group discussions on the planning and delivery of flu vaccinations for diverse patient populations in the upcoming season. The team has established a stakeholder group of vaccine service commissioners to guide how the FluCare results are communicated. These insights are being shared with a wider range of stakeholders from the health and social care sector, including the National Care Forum, UKHSA, and NHS immunisation services, to inform decision makers responsible for commissioning the service.
Papers and resources
Who is involved?
- Professor David Wright, (PI), Professor of Pharmacy Practice, University of East Anglia
- Dr Amrish Patel, (co-PI and corresponding), Associate Professor in Economics, University of East Anglia
- 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 Measurement in Health and Social Care 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
