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A Network Approach of the Mandatory Influenza Vaccination Among Healthcare Workers Wright State University CORE Scholar Master of Public Health Program Student Publications Master of Public Health Program 2014 Best Practices: A Network Approach of the Mandatory Influenza Vaccination Among Healthcare Workers Greg Attenweiler Wright State University - Main Campus Angie Thomure Wright State University - Main Campus Follow this and additional works at: https://corescholar.libraries.wright.edu/mph Part of the Influenza Virus accinesV Commons Repository Citation Attenweiler, G., & Thomure, A. (2014). Best Practices: A Network Approach of the Mandatory Influenza Vaccination Among Healthcare Workers. Wright State University, Dayton, Ohio. This Master's Culminating Experience is brought to you for free and open access by the Master of Public Health Program at CORE Scholar. It has been accepted for inclusion in Master of Public Health Program Student Publications by an authorized administrator of CORE Scholar. For more information, please contact library- [email protected]. Running Head: A NETWORK APPROACH 1 Best Practices: A network approach of the mandatory influenza vaccination among healthcare workers Greg Attenweiler Angie Thomure Wright State University A NETWORK APPROACH 2 Acknowledgements We would like to thank Michele Battle-Fisher and Nikki Rogers for donating their time and resources to help us complete our Culminating Experience. We would also like to thank Michele Battle-Fisher for creating the simulation used in our Culmination Experience. Finally we would like to thank our family and friends for all of the support they provided while completing our Culminating Experience. A NETWORK APPROACH 3 Table of Contents Abstract ............................................................................................................................................4 Introduction ......................................................................................................................................5 Literature Review.............................................................................................................................6 Epidemiology .......................................................................................................................6 Complexity .........................................................................................................................14 Methods..........................................................................................................................................18 Ethics..................................................................................................................................23 Theory ............................................................................................................................................26 Social Network Theory ......................................................................................................26 Health Belief Model ...........................................................................................................27 Diffusion of Innovation ......................................................................................................27 Best Practice...................................................................................................................................28 List of Best Practices .........................................................................................................33 Discussion and Recommendations ................................................................................................35 References ......................................................................................................................................40 Appendices .....................................................................................................................................44 A NETWORK APPROACH 4 Abstract A network simulation was applied to hospital social networks improve the influenza vaccination rate of healthcare workers in a healthcare system. Social network methods can be used to develop an understanding of structures of social relations. Over 200,000 U.S. patients are hospitalized annually for influenza, which attributes to 36,000 deaths and is the sixth leading cause of death in adults. The best way to prevent influenza each year is by receiving the influenza vaccination. The typical influenza vaccination rate among healthcare workers is 40- 50%. A Healthy People 2020 objective is to increase the percentage of healthcare workers who are vaccinated annually against influenza from 45.5% in 2008 to 90%. This simulation used hypothetical questionnaire results regarding demographic, vaccination status and network focused data. Pajet Matrix Maker and NodeXL were used to analyze and create a visual representation of the hypothetical data. Our resulting sociogram illustrated that some nodes were very influential with many ties and some nodes had few ties. Complexity can be used to analyze and measure a network. The study of complexity can advise health officials to use nonlinear models, accept unpredictability, and respond to emerging patterns. The Social Network Theory, Health Belief Model, and Diffusion of Innovation were used to approach the study of influenza vaccination strategies. Previous studies focus on social network methodologies, but omit the application of social networks on real world situations. The core ideas of social network analysis have potential to enrich our understanding of fields outside the social sciences. Keywords: complexity, immunization, prevention, simulation, application A NETWORK APPROACH 5 Best Practices: A network approach of the mandatory influenza vaccination among healthcare workers Many healthcare institutions recommend that their employees receive the seasonal influenza vaccination to reduce the risk of transmission of the influenza virus from a patient to the healthcare worker (HCW) as well as to prevent the transmission of the influenza virus from a health worker to a patient. Since the 1980s, the Centers for Disease Control and Prevention (CDC) has suggested that HCWs receive the influenza vaccination (Hofmann, Ferracin, Marsh, & Dumas, 2006). Healthy People 2020 have also made increasing the number of HCWs receiving the influenza vaccination one of its goals. Healthy People 2020 objective IDD 12.9 looks to increase the percentage of HCWs who are vaccinated annually against influenza (Healthy People 2020, 2011). In 2005, the Virginia Mason Medical Center was the first to mandate an influenza vaccination program for HCWs, which led to vaccination rates of greater than 97% (Quan, Tehrani, Dickey, Spiritus, & Hizon, 2012). In 2010, the Advisory Committee on Immunization Practices (ACIP) recommended annual influenza vaccination for all people over 6 months old (Couto, Pannuti, Paz, Fink, & Machado, 2012). Overall, in the United States, HCWs influenza vaccination rates averaged to be 45% before 2008 and were 65% after the H1N1 influenza epidemic. By 2020, the U.S. Department of Health and Human Services set a goal of immunizing 90% of HCWs (Quan et al., 2012). Healthcare is often referred to as a “system.” However, do we really measure the systemic things happening in the healthcare system? A social network approach allows analysis using the strength of ties, structural holes, and many other variables within a network. Strength of ties refers to the emotion, time, intimacy, and reciprocal services that are shared generally between two people (Granovetter, 1973). Structural holes identify gaps between nodes in a A NETWORK APPROACH 6 network, which may influence communication between nodes (Hanneman & Riddle, 2005). These variables promote better visualization and understanding of a network when applied to real world applications. The social network approach is connected to broader fields of analysis such as engineering, linguistics, and other fields that are a rich source of new ideas for analysts focusing on social relations. The core ideas of social network analysis have that potential to enrich our understanding of fields outside the social sciences. Social network methods are tools that can be used to develop understanding of structures of social relations. Previous studies focus on social network methodologies but omit the application of using social networks on real world situations to see the problems and possibilities in a new way (Hanneman & Riddle, 2005). This best practice will discuss the use of social network practice and look at how it can be applied to improve the influenza vaccination rate of HCWs in a healthcare system. Literature Review Epidemiology Influenza. Influenza, more commonly known as the flu, has been recorded since the middle of the 18th century. It is caused by different strands of a contagious virus that infects the nose, throat and lungs that can cause mild to severe illness which has the potential to lead to death. Influenza symptoms include fever or chills, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches, fatigue and vomiting or diarrhea (Centers for Disease Control and Prevention [CDC], 2013). Complications from influenza include ear and sinus infections, bacterial pneumonia and dehydration. The virus can also worsen chronic disease such as diabetes, congestive heart failure or asthma. A NETWORK APPROACH 7 The influenza virus is believed to spread from an infected individual through droplets that are passed from person to person through coughing, sneezing or talking.
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