Root causes of low influenza vaccination coverage rates among nurses working in a tertiary care university hospital in Turkey: result of a study using nominal group technique

Despite scientific evidence and recommendations for healthcare workers (HCWs), influenza vaccination coverage rates (VCRs) are quite low. An interdisciplinary team-led quality improvement project was planned to identify the root causes of low influenza VCR among nurses. To reveal the current situation, the influenza vaccination process flow chart for HCWs in the hospital and influenza VCRs of nurses in 4 influenza seasons between 2018 and 2023 were determined. A survey, including the Health Belief Model Scale for Influenza Prevention, was applied to determine nurses' attitudes towards vaccination and the barriers and facilitators of vaccination. Possible reasons for low VCRs were listed using brainstorming and placed in a fishbone diagram. The nominal group technique was used to score these potential causes, leading to identifying the root causes. VCR among nurses ranged from 7.1% to 17.7%, one in 3 nurses vaccinated by mobile teams. Major root causes of low VCRs were identified as inappropriate prioritization policy of the Ministry of Health in the distribution of seasonal influenza vaccines, lack of continuity of supply afterward, lack of vaccination culture, and effective communication strategies to motivate vaccination. Influenza VCRs among nurses are well below the recommended level. The most important reasons for low VCRs are the lack of effective influenza vaccination policies at the institutional and national level, lack of awareness of the demand for mobile vaccination, and uncertainty in vaccine supply. Securing the availability and accessibility of vaccines on-site might be the most important strategy for improving VCRs.