Implementing a Sustainable Peer-to-Peer Education Approach for Flu Prevention In Long-Term Care Settings

Background: In response to the 2009 H1N1 outbreak, FHI 360 developed and implemented under a Susan G. Harwood grant from OSHA a training program to prepare for and prevent the safety and health hazards associated with both pandemic and seasonal influenza in long-term care. The training program—which used a peer-to-peer-education model—was developed in response to identified gaps, including a lack of awareness and knowledge among healthcare workers about the importance of flu vaccination and a lack of pandemic planning in home care and long-term care sectors.

Program background: In 2010-2011, FHI 360 developed and implemented the training program “Prevention, Protection and Preparedness: What Healthcare Workers Need to Know to Address Seasonal and Pandemic Influenza in the Health Care Setting.” A train-the-trainer curriculum was developed in both English and Spanish to train long-term care staff that would in turn train their peers, particularly those who are front line workers. The training materials were designed to include graphic-heavy, low-literacy and plain language content and to address potential barriers to training. They were developed in a way that would not require special equipment or technology and that could be used year to year across flu seasons. Outreach was conducted to identify long-term care programs to implement the training program. Facilities were recruited through various channels including existing partnerships with organizations. The training program was implemented in sites across three locations in the US. Throughout the program’s duration, over 100 long-term care and home care staff were trained to serve as trainers. In turn, they trained over 800 of their front line peers. The training curriculum continues to be used and implemented in long-term care settings, and by the trainers who received the training as part of the program.

Evaluation Methods and Results: To examine the effectiveness of the training program, the project evaluation used multiple measures to identify participants’ baseline knowledge and attitudes on influenza, and measure the degree to which participants attained the intended learning objectives. The data were collected via pre- and post-surveys of training participants administered immediately after training and 6 weeks post training. Two of the sites that implemented the training program served as case studies for the program evaluation.  A series of quantitative analyses, including paired-sample t-tests, were conducted on the data collected from participants from each of these two sites (N=276). Additionally, brief focus groups were conducted with participants after train-the-trainer sessions to gather qualitative feedback.  The results indicated that the trainings contributed to increased knowledge about flu protection and beliefs about flu prevention among participants. 

Conclusions: Train-the-trainer programs with a peer-to-peer education focus may offer a cost effective and sustainable option for implementing flu prevention and other infection control efforts in long-term care.

Implications for research and/or practice: Providers could be encouraged to use a peer-to-peer model and train their own trainers to build capacity and continue improving their flu prevention and other infection control practices.