Identifying strategies to increase influenza vaccination in GP practices: a positive deviance approach

Fam Pract. 2016 Jun;33(3):318-23. doi: 10.1093/fampra/cmw016. Epub 2016 Mar 28.


Background: Influenza (flu) is an acute viral infection of the respiratory tract, which can lead to serious complications for individuals within at-risk groups. Evidence indicates that aspects of organization and delivery within GP practices can have an influence on the rates of flu vaccination uptake. Positive deviance is a methodological approach that facilitates identification of factors associated with high performance.

Objective: To use positive deviance to isolate factors associated with high performance by comparing GP practices achieving high and low flu vaccination uptake.

Methods: This was a qualitative study. A total of 18 practice managers and 2 GPs from 20 GP practices participated, 10 with high and low vaccination rates, respectively. Telephone interviews were conducted, audio recorded and fully transcribed. Framework Analysis was used to analyse the data.

Results: High uptake practices were more likely than low uptake practices to have a lead member of staff who demonstrated tenacity, have aspirational uptake targets, have developed and used additional prompts within their IT systems to identify eligible patients, have GPs who were opportunistically vaccinating and use phone calls as a first-line strategy to invite patients for vaccination.

Conclusions: This is the first known qualitative study to identify strategies used by UK GP practices to deliver seasonal flu vaccination programmes. It is one of few studies using the robust and novel approach of positive deviance to inform health care recommendations. This approach has offered new and more nuanced insights into GP practice factors associated high flu vaccination uptake beyond those captured through large-scale survey research.

Keywords: General practice; influenza; primary health care; vaccination..

Publication types

  • Multicenter Study

MeSH terms

  • General Practice
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Influenza Vaccines / administration & dosage*
  • Influenza, Human / prevention & control*
  • Interviews as Topic
  • Qualitative Research
  • Reminder Systems / statistics & numerical data*
  • United Kingdom
  • Vaccination / statistics & numerical data*


  • Influenza Vaccines