Using the ARCS Framework to explore motivational factors that may influence rates of offering adults vaccinations in primary care.

摘要

This research study explored motivational factors of clinical staff in 12 primary care sites at one integrated, regional healthcare organization that may help explain variation in rates of offering pneumococcal, influenza, and pertussis vaccinations to adults age 18 and older using Keller's Attention, Relevance, Confidence, and Satisfaction (ARCS) framework. Analysis of the organization's comprehensive EHR and its use of a statewide registry was used to calculate eligible encounters and rates of vaccine administration success to adult patients. The Keller Course Interest Survey originally designed to assess motivation in students was modified to a clinical care construct and administered to all primary care staff with patient contact. Separate analyses for influenza, pertussis and pneumococcal vaccines approximated state and US levels, with large variability between sites. Motivational scores differed significantly between sites and between clinicians, rooming staff and receptionists at each site. Rooming staff interviews revealed variability related to adherence to organizational policy and protocol including a lack of documentation of patient refusals to receive vaccinations and clinicians functioning autonomously and independently outside the documented guidelines. Several patient demographics, site, and the motivational domains of attention and satisfaction were all found to be statistically significant in a stepwise multiple logistic regression model of factors contributing to the success of offering influenza, pertussis, and pneumococcal vaccinations to adults. Rates of offering vaccines to adults can be improved using motivational design methods to improve and support the motivational domains of attention and satisfaction by implementing targeted educational strategies and key electronic health record design changes. The goal of these interventions would be to more easily identify eligible patients, better understand vaccination guidelines, offer clinical decision support, and provide valuable feedback in the success of offering vaccinations to adults.