Recommendations to Improve the Influenza Immunization Campaign in Nunavut, Canada

Transcription

1 Recommendations to Improve the Influenza Immunization Campaign in Nunavut, Canada Sally (Yue) Lin, BA, MPH Department of Health, Government of Nunavut, Iqaluit, NU Canadian Public Health Service, Public Health Agency of Canada May 27, 2015

2 Influenza in Nunavut Universal influenza vaccination program Vulnerable populations» Infants, people with chronic diseases, pregnant women High price of Medevacs» Up to $40,000 per trip Iqaluit Vaccine types» FluViral (age 6 months) and FluMist (ages 2-17) Low vaccine coverage rate» Estimated ~10-20%» National average: ~30% 2

3 Needs Assessment With clinical and non-clinical health staff in Community Health Centres (CHC) Objectives:» To assess staff opinions on the usefulness of various health promotion strategies in motivating the community to be immunized against influenza.» To understand the existing practices and challenges in program delivery Goal: To propose recommendations for future influenza immunization programs and campaigns. Repulse Bay CHC Cape Dorset CHC Pond Inlet CHC 3

4 Methods Environmental scan of existing flu campaigns in Canada to inform survey design Two-page survey with qualitative and quantitative sections Sampling objective: At least one response from a clinical and nonclinical health staff member from all 25 CHCs in Nunavut during a 4-week period in June & July CHCs in Nunavut 4

5 Methods Surveys ed to: Regional communicable disease coordinators (RCDC) Supervisors of community health programs (SCHP) Community health nurses (CHN) Supervisors of community public health nurses (SCHPN) Community health representatives (CHR) RCDCs Office of the CMOH Non Clinical Non Clinical SCHPs Clinical Territorial CHR Non Clinical SCHPNs Non Clinical Respond through , fax, telephone, or inperson focus group in Iqaluit CHNs Clinical CHRs Non clinical 5

6 Results 45 completed surveys were collected in total Received responses from all but one CHCs in the territory (n=24/25, 96%) Almost met sampling objective Approximately equal number of responses from clinical (n=23) and non-clinical staff (n=22) Pangnirtung CHC Igloolik CHC 6

7 Results "How useful do you think the strategies listed below would be in motivating your community members to get the influenza vaccination?" Strategies Prizes and incentives Multimedia PSAs Posters reminders Mobile Flu Clinics Social Media HCW Personal Invites Engaging local leaders/politicians Info Pamphlets Nurse Presentations GN Flu Website Engaging faith-based groups Completely Useless Somewhat Useless Unsure Somewhat Useful Extremely Useful Likert Scale 7

8 Results Qualitative analysis explored staff's views on: Vaccine hesitancy Subthemes: Skepticism, Fear, Apathy Accessibility Subthemes: Vaccine Delivery, Health System Capacity, Paperwork, Vaccine Type, Maximum Vaccine Access Kimmirut CHC Campaign strategies Subthemes: Multimedia Public Service Announcements, Poster Reminders & Educational Materials, Prices & Incentives Grise Fiord CHC 8

9 Vaccine Hesitancy Skepticism Anti-vaccination activists are affecting Nunavut attitudes. People read about things on the Internet that makes them suspicious of the vaccine and it spreads by word of mouth or over social media (SCHP) Fear The main thing [community members say] is, I got sick from the flu shot, and I m not getting it anymore, never in my life. (SCHP) Apathy Some people are just not interested and don t want the flu shot. (CHR) 9

10 Accessibility Vaccine Delivery Actually getting the influenza vaccines to our community was a huge struggle this past year. Getting the influenza vaccines to the communities should be a top priority, despite additional shipping costs. (SCPHN) Health System Capacity Extra nursing staff is a must to deliver a more positive outcome for this needed program. (CHN) Maximizing Vaccine Access Whenever someone seeks a health service (e.g. dentist visit) they will get asked if they want the flu shot. We are very opportunistic about this kind of thing. (SCHP) 10

11 Campaign Strategies Multimedia PSAs The health promotion message truly has to have an Inuit face. It could be very powerful to get the elders together to speak about when these [vaccine-preventable] diseases were prevalent. (SCHP) YouTube videos, especially funny ones; they really catch on. Video and radio messaging should be the focus of the campaign; I think that is an area where we are really lacking. (SCHPN) Prices and Incentives Maybe provide snacks or whatever, that would be nice. But prizes I don t agree with it. (CHR) 11

12 Discussion Program Recommendations 1. Prioritize vaccine transportation. 2. Consider extending FluMist eligibility to ages Consider accepting verbal consent from parents. 4. Build health system capacity for flu immunizations. 5. Continue to increase vaccine accessibility. 6. Provide some guidelines for the use of prizes and incentives. Campaign Recommendations 1. Directly address anti-vaccine skepticism and dispel flu myths. 2. Emphasize herd immunity. 3. Develop short flu vaccine promotion videos. 4. Utilize established social media channels for vaccine promotion. 5. Develop an Influenza Vaccine Promotion Kit. 12

13 Limitations 1. Limited accurate data on immunization coverage and reporting in Nunavut due to limited staff capacity. 2. Hard to obtain an accurate assessment of survey response rate due to high staff turnover. 1. Beyond scope of project to speak with community members and other allied health professionals. 13

14 Strengths 1. The first needs assessment of the influenza vaccination campaign in Nunavut. 1. High number of respondents over the summer vacation period. 1. Actively solicited feedback from both clinical and non-clinical health staff. Clyde River CHC 1. Inform Nunavut s health policymakers and health staff in planning future flu immunization programs and campaigns Arctic Bay CHC 14

15 Next Steps Building a business case for more public health nurses to increase staff capacity in CHCs Incentives are a regional responsibility because of limited territorial resources» Some regions provided tea, coffee, and cookies» Raffle draw for recipes developed by the Dept. of Health, cooking pot, and ingredients Multimedia campaign proposal for influenza season» Videos, posters, and fact sheets» Social media to address flu myths 15

16 Thank you! QUESTIONS? For more information, please contact: Sally (Yue) Lin Maureen Baikie Carolina Palacios All photos of CHCs from: 16