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Euro Surveill. Behaviours regarding preventive measures against pandemic H1N1 influenza among Italian healthcare workers, October 2009
Behaviours regarding preventive measures against pandemic H1N1 influenza among Italian healthcare workers, October 2009 (Euro Surveill., edited)
Eurosurveillance, Volume 14, Issue 49, 10 December 2009
Rapid communications
Behaviours regarding preventive measures against pandemic H1N1 influenza among Italian healthcare workers, October 2009
G La Torre (
)<sup>1</sup>, D Di Thiene<sup>1</sup>, C Cadeddu<sup>2</sup>, W Ricciardi<sup>2</sup>, A Boccia<sup>1</sup>
<hr> Citation style for this article: La Torre G, Di Thiene D, Cadeddu C, Ricciardi W, Boccia A. Behaviours regarding preventive measures against pandemic H1N1 influenza among Italian healthcare workers, October 2009. Euro Surveill. 2009;14(49):pii=19432. Available online: http://www.eurosurveillance.org/View...rticleId=19432
Date of submission: 04 December 2009
<hr> A survey on attitudes and behaviours towards preventive measures against pandemic H1N1 influenza 2009 was carried out during the month of October 2009 in Italy through an online questionnaire adapted to the Italian situation from a similar survey of the Harvard School of Public Health in the United States (US). Results show that the intention to get vaccinated against pandemic H1N1 influenza 2009 is generally low and that there are differences in attitudes and behaviours towards preventive measures against pandemic H1N1 influenza 2009 between physicians and nurses, especially concerning vaccination. Differences relate also to sex, region of residence and marital status.
<hr>Introduction One of the main concerns related to the present pandemic H1N1 influenza 2009 is the overwhelming burden on medical structures and resources that it poses and the consequent negative impact on mortality and morbidity. This situation puts healthcare workers (HCW) in the unusual position of being both the main actors and one of the main targets of the prevention strategies against the pandemic H1N1 influenza 2009, and considering also their usual unavoidable risk of being an important vector for transmission [1,2]. That is why it is so important to understand the behaviour and attitudes of HCW in relation to the spreading pandemic [3].The importance of this understanding is also demonstrated by studies carried out worldwide [4,5].
The aim of our survey was to gather information about attitudes and behaviours towards preventive measures against pandemic influenza among Italian HCW, taking into account the characteristics of the Italian health care setting. The survey was carried out by means of a questionnaire distributed to and collected from physicians and nurses.
Materials and methods
The questionnaire was designed by the Clinical Medicine and Public Health section of the Sapienza University of Rome, adapted to the Italian situation on the basis of a similar one used in a telephone survey in the US by the Harvard School of Public Health [6]. The adaptation consisted in changing some questions, i.e. concerning health insurance (Italy has a National Health System) or referring to pandemic H1N1 influenza 2009 instead of swine influenza as in the original version of the questionnaire.
The questionnaire was made available through the Italian Journal of Public Health website (www.ijph.it) and a remote recording system collected the anonymous answers given by physicians and nurses [8]. The survey was advertised through an email sent to addresses in databases of Public Health professionals and nurses, owned by the Italian National Society of Public Health. Access to the online questionnaire was permitted from 1 to 31 October 2009, including week-ends when the website was accessed more often.
In order to perform an inferential analysis, we considered the following dependent variables:
a) willingness to get vaccinated against pandemic H1N1 influenza 2009;
b) washing hands and using hand sanitisers more frequently than before the beginning of the pandemic.
A univariate analysis was then carried out using a chi-squared test in order to investigate the association between the dependent variables and socio-demographic characteristics, as well as occupation. Moreover, two multiple logistic regression analyses were performed, using the backward elimination procedure as described by Hosmer and Lemeshow [7]. The goodness of fit of the regression model was tested using the Hosmer-Lemeshow test. The following were considered as potential explanatory variables: age group (18-29 years as the reference group), sex (reference modality male), region of residence (reference modality Northern Italy), marital status (single/divorced/separated/widow as the reference group), occupation (physicians vs. nurses, with the latter as the reference group). The level of statistical significance was set at a p-value of ≤ 0.05.
The statistical analysis was performed using the statistical software SPSS 13.0 for Windows.
Results
One thousand nine hundred and sixty individuals participated in the survey (249 physicians, 12.7%, and 1,711 nurses, 87.3%). The socio-demographical characteristics of the sample are shown in Table 1.
Table 1. Socio-demographical characteristics of the survey participants, Italy, October 2009 (n=1,960)
We found that 70.4% of the 1,360 females of our sample would not get vaccinated against pandemic H1N1 influenza 2009, while 49.2% of the 600 males would get vaccinated (p<0.001) (Table 2). The main difference for the same question was related to occupation: 67% of physicians and 31% of nurses would get vaccinated against pandemic H1N1 influenza 2009 (p<0.001). In contrast, nurses were more prone (79.5%) than physicians (64.7%) to wash their hands or use hand sanitisers more frequently in response to reports of pandemic influenza (p<0.001).
Table 2. Univariate analysis to investigate the association between the dependent variables and socio-demographic characteristics, as well as occupation, Italy, October 2009 (n=1960)
Results from the multivariate analysis (Table 3) show that respondents aged 30-49 years are less likely to get vaccinated in comparison to young adults (18-29 years old) (adjusted odds ratio (AOR)=0.66; 95% confidence interval (CI): 0.52-0.83). Females also are less likely to get vaccinated (AOR=0.64; 95%CI: 0.51-0.8), confirming the results from the univariate analysis. Health professionals who are more likely to get vaccinated live in Southern Italy or on the islands (AOR=1.81; 95%CI: 1.36-2.41) and are physicians (AOR=2.87; 95%CI: 2.14-3.85).
As far as concerns the variable ?Yes, I washed my hands or used hand sanitisers more frequently?, there is a statistically significant association with: age (≥50 years: AOR=1.56; 95%CI: 1.17-2.08), sex (female: AOR=1.59; 95% CI: 1.24-2.03), region of residence (Central Italy: AOR=1.36; 95%CI: 1.06-1.76; Southern Italy and islands: AOR=1.76; 95%CI: 1.23-2.53), marital status (married/cohabitant: AOR=1.54; 95%CI: 1.21-1.96) and occupation (physicians: AOR=0.42; 95%CI: 0.3-0.57).
Table 3. Multivariate analysis, Italy, October 2009 (n=1,908)
Conclusions
HCW are a strategic target for pandemic H1N1 influenza 2009 prevention such as vaccination and frequent hand-washing, since they are at higher risk themselves of contracting influenza, can place their patients at risk and are critical for a functioning health care system. Our online survey demonstrated that pandemic H1N1 influenza 2009 modified the behaviour of HCW, but a high percentage may still not realise that vaccination is a fundamental means of prevention and how important it is that they get vaccinated. This finding is surprising, as many studies worldwide present different attitudes among HCW [1,2].
The present study has some limitations, and the results must be interpreted with caution. First of all, a possible selection bias could have occurred, since healthcare professionals with internet skills would have been more likely to participate in the online survey. Moreover, it is likely that participants are mainly representative of younger HCW and this is supported by the age of responders (almost half of the participants should have been over 50 years old, according to the information included in the databases). Concerning possible information bias, we are convinced of the validity of the self-report answers, since it is unlikely that participants spent time giving unreliable and biased views of their attitudes and behaviours.
Despite some limitations, our survey could be a useful tool for Italian decision makers to promote and launch programmes and campaigns aimed at informing and educating HCW. The results could also be used to motivate HCW to adopt attitudes and decisions which correspond to public health policies, since at the end of November 2009, only 14% of healthcare professionals had been vaccinated against pandemic H1N1 influenza 2009 at the national level [8]. Finally, this study could also help tailor vaccination campaigns by concentrating on groups (nurses, females, adults ≥30 years) or regions (Northern Italy) where the intended vaccine uptake is lower.
<hr>References
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Eurosurveillance, Volume 14, Issue 49, 10 December 2009
Rapid communications
Behaviours regarding preventive measures against pandemic H1N1 influenza among Italian healthcare workers, October 2009
G La Torre (
- Clinical Medicine and Public Health Unit, Sapienza University of Rome, Italy
- Institute of Hygiene, Catholic University of the Sacred Heart Rome, Italy
<hr> Citation style for this article: La Torre G, Di Thiene D, Cadeddu C, Ricciardi W, Boccia A. Behaviours regarding preventive measures against pandemic H1N1 influenza among Italian healthcare workers, October 2009. Euro Surveill. 2009;14(49):pii=19432. Available online: http://www.eurosurveillance.org/View...rticleId=19432
Date of submission: 04 December 2009
<hr> A survey on attitudes and behaviours towards preventive measures against pandemic H1N1 influenza 2009 was carried out during the month of October 2009 in Italy through an online questionnaire adapted to the Italian situation from a similar survey of the Harvard School of Public Health in the United States (US). Results show that the intention to get vaccinated against pandemic H1N1 influenza 2009 is generally low and that there are differences in attitudes and behaviours towards preventive measures against pandemic H1N1 influenza 2009 between physicians and nurses, especially concerning vaccination. Differences relate also to sex, region of residence and marital status.
<hr>Introduction One of the main concerns related to the present pandemic H1N1 influenza 2009 is the overwhelming burden on medical structures and resources that it poses and the consequent negative impact on mortality and morbidity. This situation puts healthcare workers (HCW) in the unusual position of being both the main actors and one of the main targets of the prevention strategies against the pandemic H1N1 influenza 2009, and considering also their usual unavoidable risk of being an important vector for transmission [1,2]. That is why it is so important to understand the behaviour and attitudes of HCW in relation to the spreading pandemic [3].The importance of this understanding is also demonstrated by studies carried out worldwide [4,5].
The aim of our survey was to gather information about attitudes and behaviours towards preventive measures against pandemic influenza among Italian HCW, taking into account the characteristics of the Italian health care setting. The survey was carried out by means of a questionnaire distributed to and collected from physicians and nurses.
Materials and methods
The questionnaire was designed by the Clinical Medicine and Public Health section of the Sapienza University of Rome, adapted to the Italian situation on the basis of a similar one used in a telephone survey in the US by the Harvard School of Public Health [6]. The adaptation consisted in changing some questions, i.e. concerning health insurance (Italy has a National Health System) or referring to pandemic H1N1 influenza 2009 instead of swine influenza as in the original version of the questionnaire.
The questionnaire was made available through the Italian Journal of Public Health website (www.ijph.it) and a remote recording system collected the anonymous answers given by physicians and nurses [8]. The survey was advertised through an email sent to addresses in databases of Public Health professionals and nurses, owned by the Italian National Society of Public Health. Access to the online questionnaire was permitted from 1 to 31 October 2009, including week-ends when the website was accessed more often.
In order to perform an inferential analysis, we considered the following dependent variables:
a) willingness to get vaccinated against pandemic H1N1 influenza 2009;
b) washing hands and using hand sanitisers more frequently than before the beginning of the pandemic.
A univariate analysis was then carried out using a chi-squared test in order to investigate the association between the dependent variables and socio-demographic characteristics, as well as occupation. Moreover, two multiple logistic regression analyses were performed, using the backward elimination procedure as described by Hosmer and Lemeshow [7]. The goodness of fit of the regression model was tested using the Hosmer-Lemeshow test. The following were considered as potential explanatory variables: age group (18-29 years as the reference group), sex (reference modality male), region of residence (reference modality Northern Italy), marital status (single/divorced/separated/widow as the reference group), occupation (physicians vs. nurses, with the latter as the reference group). The level of statistical significance was set at a p-value of ≤ 0.05.
The statistical analysis was performed using the statistical software SPSS 13.0 for Windows.
Results
One thousand nine hundred and sixty individuals participated in the survey (249 physicians, 12.7%, and 1,711 nurses, 87.3%). The socio-demographical characteristics of the sample are shown in Table 1.
Table 1. Socio-demographical characteristics of the survey participants, Italy, October 2009 (n=1,960)
We found that 70.4% of the 1,360 females of our sample would not get vaccinated against pandemic H1N1 influenza 2009, while 49.2% of the 600 males would get vaccinated (p<0.001) (Table 2). The main difference for the same question was related to occupation: 67% of physicians and 31% of nurses would get vaccinated against pandemic H1N1 influenza 2009 (p<0.001). In contrast, nurses were more prone (79.5%) than physicians (64.7%) to wash their hands or use hand sanitisers more frequently in response to reports of pandemic influenza (p<0.001).
Table 2. Univariate analysis to investigate the association between the dependent variables and socio-demographic characteristics, as well as occupation, Italy, October 2009 (n=1960)
Results from the multivariate analysis (Table 3) show that respondents aged 30-49 years are less likely to get vaccinated in comparison to young adults (18-29 years old) (adjusted odds ratio (AOR)=0.66; 95% confidence interval (CI): 0.52-0.83). Females also are less likely to get vaccinated (AOR=0.64; 95%CI: 0.51-0.8), confirming the results from the univariate analysis. Health professionals who are more likely to get vaccinated live in Southern Italy or on the islands (AOR=1.81; 95%CI: 1.36-2.41) and are physicians (AOR=2.87; 95%CI: 2.14-3.85).
As far as concerns the variable ?Yes, I washed my hands or used hand sanitisers more frequently?, there is a statistically significant association with: age (≥50 years: AOR=1.56; 95%CI: 1.17-2.08), sex (female: AOR=1.59; 95% CI: 1.24-2.03), region of residence (Central Italy: AOR=1.36; 95%CI: 1.06-1.76; Southern Italy and islands: AOR=1.76; 95%CI: 1.23-2.53), marital status (married/cohabitant: AOR=1.54; 95%CI: 1.21-1.96) and occupation (physicians: AOR=0.42; 95%CI: 0.3-0.57).
Table 3. Multivariate analysis, Italy, October 2009 (n=1,908)
Conclusions
HCW are a strategic target for pandemic H1N1 influenza 2009 prevention such as vaccination and frequent hand-washing, since they are at higher risk themselves of contracting influenza, can place their patients at risk and are critical for a functioning health care system. Our online survey demonstrated that pandemic H1N1 influenza 2009 modified the behaviour of HCW, but a high percentage may still not realise that vaccination is a fundamental means of prevention and how important it is that they get vaccinated. This finding is surprising, as many studies worldwide present different attitudes among HCW [1,2].
The present study has some limitations, and the results must be interpreted with caution. First of all, a possible selection bias could have occurred, since healthcare professionals with internet skills would have been more likely to participate in the online survey. Moreover, it is likely that participants are mainly representative of younger HCW and this is supported by the age of responders (almost half of the participants should have been over 50 years old, according to the information included in the databases). Concerning possible information bias, we are convinced of the validity of the self-report answers, since it is unlikely that participants spent time giving unreliable and biased views of their attitudes and behaviours.
Despite some limitations, our survey could be a useful tool for Italian decision makers to promote and launch programmes and campaigns aimed at informing and educating HCW. The results could also be used to motivate HCW to adopt attitudes and decisions which correspond to public health policies, since at the end of November 2009, only 14% of healthcare professionals had been vaccinated against pandemic H1N1 influenza 2009 at the national level [8]. Finally, this study could also help tailor vaccination campaigns by concentrating on groups (nurses, females, adults ≥30 years) or regions (Northern Italy) where the intended vaccine uptake is lower.
<hr>References
- Hampton T. H1N1 vaccine urged for health workers, but some resist getting on board. JAMA. 2009;302(17):1848-9
- ECDC - Why healthcare workers are a priority group for pandemic influenza A(H1N1) vaccination? 6 October 2009. Available from: http://ecdc.europa.eu/en/activities/...3083f30&ID=664
- Paget J. The influenza pandemic and Europe: the social impact and public health response. Ital J Public Health 2009;6(3):257-9. Available from: http://www.ijph.it/pdf/24/257.pdf
- Imai T, Takahashi K, Todoroki M, Kunishima H, Hoshuyama T, Ide R et al. Perception in relation to a potential influenza pandemic among healthcare workers in Japan: implications for preparedness. J Occup Health. 2008;50(1):13-23
- Chor JS, Ngai KL, Goggins WB, Wong MC, Wong SY, Lee N et al. Willingness of Hong Kong healthcare workers to accept pre-pandemic influenza vaccination at different WHO alert levels: two questionnaire surveys. BMJ. 2009;339:b3391. Available from: http://www.bmj.com/cgi/content/full/339/aug25_2/b3391
- Harvard Opinion Research Program. Harvard School of Public Health SWINE FLU (H1N1 VIRUS) SURVEY April 29, 2009. Available from: http://www.hsph.harvard.edu/news/pre...lu.TOPLINE.pdf
- Hosmer DW, Lemeshow S. Applied logistic regression. New York: Wiley 1989
- CNEPS-ISS. La campagna di vaccinazione per l?influenza pandemica [Vaccination campaign for pandemic flu] [Italian]. FluNews 2009;(5):5-Available from: http://www.epicentro.iss.it/focus/h1.../FluNews_5.pdf
- Prex publisher. Available from: http://www.prex.it/english/index.htm
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