Evidence map›Paper›PMID 40835927›Full record

Trial reportBMC health services research2025

Process evaluation of the flucare cluster randomised controlled trial: assessing the implementation of a behaviour change intervention to increase influenza vaccination uptake among care home staff in England.

Thando Katangwe-Chigamba, Faisal Alsaif, Adaku Anyiam-Osigwe, Veronica Bion, Allan Clark, Hilary Garrett, Alys Wyn Griffiths, Cecile Guillard, Amber Hammond, Richard Holland and 11 more

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC health services research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Trial
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

21 authors.

Thando Katangwe-ChigambaNorwich Clinical Trials Unit, University of East Anglia, Norwich, UK. T.Katangwe@uea.ac.uk.
Faisal AlsaifSchool of Pharmacy, University of East Anglia, Norwich, UK.
Adaku Anyiam-OsigweNorwich Clinical Trials Unit, University of East Anglia, Norwich, UK.
Veronica BionNorwich Clinical Trials Unit, University of East Anglia, Norwich, UK.
Allan ClarkNorwich Medical School, University of East Anglia, Norwich, UK.
Hilary GarrettSchool of Medicine and Population Health, University of Sheffield, Sheffield, UK.
Alys Wyn GriffithsSchool of Medicine and Population Health, University of Sheffield, Sheffield, UK.
Cecile GuillardNorwich Clinical Trials Unit, University of East Anglia, Norwich, UK.
Amber HammondNorwich Clinical Trials Unit, University of East Anglia, Norwich, UK.
Richard HollandUniversity of Exeter, Exeter Medical School, Exeter, UK.
Liz JonesSchool of Medicine and Population Health, University of Sheffield, Sheffield, UK.
Amrish PatelSchool of Economics, University of East Anglia, Norwich, UK.
Jennifer PitcherNorwich Clinical Trials Unit, University of East Anglia, Norwich, UK.
Helen RisebroNorwich Clinical Trials Unit, University of East Anglia, Norwich, UK.
Sion ScottSchool of Healthcare, University of Leicester, Leicester, UK.
Carys SeeleyNorwich Clinical Trials Unit, University of East Anglia, Norwich, UK.
Erika SimsNorwich Clinical Trials Unit, University of East Anglia, Norwich, UK.
Susan StirlingNorwich Clinical Trials Unit, University of East Anglia, Norwich, UK.
Adam WagnerNorwich Clinical Trials Unit, University of East Anglia, Norwich, UK.
David WrightSchool of Healthcare, University of Leicester, Leicester, UK.
Linda BirtSchool of Healthcare, University of Leicester, Leicester, UK.

Funding

National Institute for Health and Care Research, Public Health Research funding body NIHR133455
6 · The paper itself

Abstract

backgroundInfluenza (flu) vaccination rates of Care home staff (CHS) in England are consistently lower (≈ 15% in 2023) than World Health Organisation recommendations (≥ 75%). The FluCare trial examined the effectiveness of a multi-component intervention (including on-site flu vaccination clinics, information materials including video, £850 incentive and monthly monitoring with feedback) designed to address known barriers to flu vaccine uptake amongst CHS. This paper reports an embedded process evaluation designed to understand implementation of the FluCare intervention and provide explanations for observed effects in the trial.

methodsThe FluCare cluster randomised controlled trial was conducted between November 2022 and March 2023. A mixed methods process evaluation was conducted employing questionnaires, semi-structured interviews, video analytics (no. clicks and duration of view) and clinic logs (no. clinics delivered, days/time clinics were delivered, and no. staff vaccinated). CHS (including managers) and vaccination providers (pharmacists, nurses and general practitioners) were purposively and conveniently selected, respectively, for the interviews. Descriptive statistics were obtained for quantitative data, and qualitative data were analysed thematically.

resultsFluCare intervention implementation varied across Care homes (CHs), with clinics and videos not being implemented in 35% and 43% of the intervention CHs respectively. In addition, clinic days and times varied depending on provider (pharmacy or general practice) and CH. Partial intervention implementation was partly influenced by managers' engagement and sub-organisational cultures marked by negative narratives around vaccines. Contextual barriers included delivery of clinics late in the flu season. A greater indication of implementation fidelity was positively associated with change in staff attitudes and behaviours, with some getting vaccinated for the first time.

conclusionsVariation in implementation of the FluCare intervention provides an explanation for detecting a difference where the intervention was fully implemented in the main trial. Manager and leader engagement is vital for both successful implementation and staff engagement. Avoidable contextual barriers, such as late timing of clinics, must be addressed to enhance flu vaccination uptake by CHS. More work is needed to understand the role of CH leaders in influencing intervention implementation, sub-organisational cultures and vaccination attitudes.

trial registrationISRCTN22729870. Registered on 24 August 2022.

Indexed as

Health PersonnelInfluenza, HumanInfluenza VaccinesVaccinationAttitude of Health PersonnelEnglandFemaleHumansMaleProcess Assessment, Health CareSurveys and QuestionnairesInfluenza VaccinesCommunity pharmacyEmployeesLong-term care facilitiesNursing homesProcess evaluationResidential homesStaff

Identifiers

PMID40835927
PMCPMC12369172

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.